If you were anything like me during the Supreme Court oral arguments on the Affordable Care Act, you jumped every
time a news alert came over your email, and then audibly groaned as you read missives such as: “THE ACA IS DOOMED! 9 OUT OF
10 LEGAL SCHOLARS AGREE!” Amazing
how conventional wisdom can change so dramatically in only a few days. I blame, among other things, the 29,057
news lists I’m subscribed to–as I devoured each email with “breaking news,” it
left little opportunity to take a step back and assess the big picture.
Now with a little more time for reflection, I have focused my energy on trying to “Keep Calm and Carry On”. The British government created
posters with that phrase at the beginning of WWII to raise morale in the event
of an invasion. It has now
re-emerged in popular culture and is a great reminder to take a deep breath and
remember that there’s no invasion yet, and the best thing to do is to continue with the important work of moving forward under the current law.
We can’t ignore that there is some risk that pieces, or
even the entire law, could be struck down. Making matters worse, the current dialogue and election year
posturing only elevates the black and white thinking that it’s ACA or no ACA.
Reality is often found in shades of grey and ACA is no exception. Let’s consider some of the possible
1. The entire Affordable Care Act stands.
2. The individual mandate is struck down, but insurance
reforms and Medicaid expansion stand.
3. The individual mandate and insurance reforms are struck
down, and the Medicaid expansion stands.
4. The mandate, insurance reforms, and Medicaid expansion
are struck down.
These are overly simplified scenarios, but help
illustrate the point that the majority of possible outcomes would maintain all
or some part of the law, notably new insurance marketplaces and the Medicaid
expansion in states, that will provide new paths to coverage for many
Would the work change under each? Sure. Dramatically? It
depends. But advocates are
certainly no strangers to dealing with uncertainty and overcoming challenges as
laws are implemented. Many of us remember a time when children’s coverage was
nowhere near the levels we see today–and there were plenty of bumps in the road
to success. No matter what happens, the hard work of defending the law – or
implementing the many key parts that remain–will continue after June and we
should be ready to adapt as needed.
Is it Doomsday? It may feel like it, but we cannot let
our anxiety take over and lose months of work that are crucial to preparing for
2014. Keep Calm and Carry On.