Supreme Court Upholds ACA

The Supreme Court released its ruling in Texas vs. United States in a 7-2 majority upholding the constitutionality of the Affordable Care Act.

The Court found that the plaintiff has not suffered harm by enforcing the individual mandate under the ACA. This ruling did not address whether the individual mandate is a true mandate and not a tax and if the ACA could continue without the enforcement of the individual mandate.

What does the mean for individual coverage?

The Affordable Care Act is not going away and will continue to be the law of the land.   For Indiana, we do predict a return of health insurance carriers offering individual coverage within the state.  Companies like Anthem will return to provide coverage in all of Indiana counties.  We could see regional carriers like IU Health or even an Ascension (St. Vincent’s) in specific counties.  National carriers like Humana, Aetna, Cigna & UnitedHealthcare could also enter the Indiana individual health market.   

Carriers entering the Indiana market may be determined by Hoosier participation in the exchange.  2015 we had a peak of 219K members who purchased coverage through the marketplace.  Currently, Indiana has 136K enrolled in an exchange plan. 

If Indiana has projected marketplace growth back to the 200K, that could 

Carrier competition would not bring back the PPO network for the individual plans.  Companies have determined the only way to control costs and be profitable is to utilize narrow networks.

What does this mean for Employers?

The requirements for employers under the ACA will continue, and we could see greater enforcement. 

Industries with variable hour employees will need to stay compliant or face significant fines from the IRS.

There will be no shortages of challenges to the ACA, but it has survived every challenge brought against it. 

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