Today, the Supreme Court affirmed the 4th Circuit, holding that tax credits are available in states using the federal exchange. PwC’s Health Research Institute (HRI) performed an analysis of publicly available information – including ACA enrollment data and CMS data on hospital spending – to assess the financial impact of the loss of subsidies in the federal marketplace. The Court’s decision in King v. Burwell removes uncertainty for some 8 million Americans who were at risk of losing coverage and locks in $36 billion in premium revenue for health plans next year.
Also, PwC’s Health Research Institute (HRI) recent report Five Trends to Watch as the Affordable Care Act Turns Five provides a roadmap into the future of the evolving New Health Economy.
HRI’s report examined five key trends fueled by the ACA that are even more relevant today in light of the Court ruling. These five trends have ignited sector-wide transformation:
1. Risk Shift: Raising the stakes for all healthcare players
The ACA added force to new payment models that reward outcomes and penalize poor performance such as high rates of readmission and hospital-acquired conditions.
2. Primary care: Back to basics
Experimentation in new payment models and expansion of insurance coverage are making primary care once again the critical touch point.
3. New entrants: Innovators in the New Health Economy
New entrants are rushing into the market to meet the demand for lower-cost, consumer-oriented care options in the post-ACA era. More than 90 new companies have been created since 2010, according to HRI analysis.
4. Health insurance: From wholesale to retail
Rapid enrollment in the ACA’s public exchanges has demonstrated the potential of retail-style health insurance and spawned renewed interest in private exchanges.
5. States: Reform’s pivotal stage
States have emerged as key players in the reconfigured healthcare landscape, as the ACA gave states notable discretion in how the law could be implemented.
