June 17 of this year will be remembered by some as perhaps the final action taken by the United States Supreme Court to uphold the tenets of the Affordable Care Act. In this case, the SCOTUS ruling focused on a 2018 lawsuit filed by Republicans in Texas and backed by several other red states. You may recall that in 2017, the Republican-controlled Congress passed a new law removing the penalty fee for people who don’t carry insurance. This recent suit before the Supreme Court argued that this change to the ACA invalidated every other part of the law, rendering the entire ACA moot. Lower courts upheld that contention, but the Supreme Court overruled them in a surprising and decisive 7-2 ruling. The court ruled that Texas lacked standing to bring the suit in the first place, without even weighing in on the suit’s basic argument.
While the ACA was upheld in this instance on a rather limited line of reasoning, this is the third time SCOTUS has ruled in favor of the law. Of significance, SCOTUS had the opportunity to consider the overall constitutionality of the eleven-year-old ACA in this and in previous decisions. Clearly, they are finished in their reviews, and the most recent decision affirms their ongoing and affirmative support for the ACA.
Now, the issue has turned into a political loser for Republicans. This conclusion is supported by a Kaiser Family Foundation poll that found Americans’ approval of the ACA is now 53% (35% unfavorable). Republicans may again try to kill the law, but the broader public has lost interest.
Perhaps the COVID crisis has helped many Americans find value in a national health plan available to all without fear of denials based on pre-conditions. As the coronavirus pandemic and resulting economic downturn gripped the nation, the Affordable Care Act served as a safety net for Americans who’ve lost their jobs — and their health insurance along with it — and for the uninsured seeking coverage.
Enrollment in both the Affordable Care Act exchanges and Medicaid have risen since the outbreak began in March 2020. Biden’s special enrollment period, which runs from mid-February through mid-August, has already added 1.2 million subscribers.
Where We Are Now (and a Refresher on Coverage Availability)
At present, 31 million people have coverage thanks to the Affordable Care Act, including through the Obamacare exchanges and the expansion of Medicaid to low-income adults. The law also allows parents to keep their children on their health insurance plans until age 26.
The ACA mandates that plans include maternity coverage and makes key preventive services available without cost sharing, including breastfeeding support services and supplies; cholesterol checks and birth control; mental health services; annual well-woman visits including mammograms; and screenings for cervical cancer, HIV, and interpersonal and domestic violence. The ACA also requires plans to cover substance use disorder (SUD) treatment as an essential health benefit. Without this requirement, only one in three people covered through the individual market would have had access to SUD treatment.
The ACA requires marketplace plans to cover at least one drug in each drug class and to count out-of-pocket drug expenses toward a beneficiary’s deductible. By expanding Medicaid eligibility as well as broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers.
In addition to banning insurers from basing coverage on people’s medical histories, the law ended annual or lifetime caps on benefits imposed by insurers, and it also placed limits on annual out-of-pocket spending. It prevents insurers from charging women more and restricts premiums for older adults to no more than three times those of young adults.
Implications for Healthcare Marketers
There is now much greater confidence among the general public that the Government can provide for the health of citizens. According to The Harris Poll, 54% of Americans view the healthcare industry more positively after COVID-19, and 71% believe healthcare had a good response to the pandemic.
Right now, the healthcare industry has a unique opportunity to ride the waves of public good faith. With the affirmation of the Affordable Health Care Act as the ongoing “law of the land”, healthcare marketers should confidently devise marketing plans that inform the general public of the ACA’s panoply of coverages, encourage those with coverage to seek preventive care, and convince those eligible (but without coverage) to enroll.
Now is also the time to capitalize on the goodwill your organization has achieved with the COVID vaccine rollout. Craft campaigns that promote vaccinations of all types and combat stubborn health issues such as obesity, high blood pressure, and diabetes. Maternity care, well-woman visits including mammograms, and screenings for cervical cancer are covered services that are essential and basic health services for your patients. Mental healthcare and substance abuse services have tremendous impact on both those affected as well as the community as a whole.
Marketers should devise marketing plans and strategies around the ACA coverages that are aligned with their organization’s Community Benefit goals. As most ACA enrollees are from the populace of economically disadvantaged, strategies can address goals of diversity, equity and inclusion. Here is an opportunity to tackle your community’s health and social inequalities, to improve your outreach processes, and fine-tune your consumer messaging and education.
Keep in mind that a recent Harris Poll found that Americans view their own healthcare provider as their second most important source of healthcare advice, following the Centers for Disease Control and Prevention.
We are fortunate to be employed as professionals working to improve the welfare of others. Perhaps that’s what caused you to choose this particular and exciting field of marketing. You have a unique opportunity to influence the future of the ACA and perhaps, save lives. Your current and future patients want to hear from you, a trusted source of information.
James Shulkin, a member of WHPRMS since 1999, is the Chief Brand Officer, Healthcare at NOISE, Inc.
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