BC Experts: SCOTUS & the Affordable Care Act
PROF. MARY ANN CHIRBA-MARTIN
BOSTON COLLEGE LAW SCHOOL
(617) 552-4381 (office)
(508) 320-5175 (cell)
Chirba is an expert on the Affordable Care Act and has written on the law’s employer mandate. She lectures on various health law issues at area medical schools and hospitals. She earned her doctorate of science in health policy and a master's in public health from the Harvard School of Public Health, and her J.D. from Boston College Law School. A former litigator, she has also been certified by the American Health Law Association as a mediator and arbitrator. She is co-author of Health Care Reform: Law and Practice (M. Chirba, A. Noble, O’Melveny & Myers; Lexis/Matthew Bender 2013), which provides a section by section analysis of statutory and regulatory compliance obligations under the Affordable Care Act.
FACULTY MEMBER ALICE NOBLE
BOSTON COLLEGE LAW SCHOOL
(617) 893-8073 (cell)
As both a practicing attorney and as a legal educator, Noble’s career has been focused on issues of health law and policy. She is an expert on the Affordable Care Act and co-author of Health Care Reform: Law and Practice (M. Chirba, A. Noble, M. Maddigan; Lexis/Matthew Bender 2013), which provides a section by section analysis of statutory and regulatory compliance obligations under the Affordable Care Act. She holds a law degree from Villanova University School of Law and a master of public health degree from Harvard School of Public Health. Noble was a fellow in medical ethics at Harvard Medical School and a Senior Researcher at The American Society of Law, Medicine & Ethics. She has a number of peer-reviewed publications on topics such as genetic technology, law and ethics; medical malpractice; managed care; and hospital law. She is a contributor to the Health Affairs Blog and Health Law Professors Blog.
It's the federal healthcare law that's been on the books since 2010, and this morning's hearing before the Supreme Court will go a long way in determining just how strong the Affordable Care Act remains. The high court will hear arguments pertaining to tax credits that help people in 37 states pay for health insurance. If those tax credits, or subsidies, are voided, millions would no longer be able to afford health insurance.
"Practically, the Court’s ruling may dismantle a major strategy for expanding and financing coverage in the individual market," says Boston College Law Lecturer Alice Noble, co-author of the book, Healthcare Reform: Law and Practice (2013), which examines the landmark federal healthcare law. “The need for health insurance by individuals without access to employment-based insurance was one of the central problems the ACA was intended to remedy. This lawsuit threatens to undermine any gains the ACA has made in this regard."
"The essential question is one of classic statutory interpretation," says Boston College Law Professor Mary Ann Chirba-Martin, J.D., D.Sc., M.P.H, co-author along with Noble in writing Healthcare Reform: Law and Practice. "May individuals who receive health insurance coverage through the federal exchange qualify for a subsidy, or did the ACA expressly limit subsidies to individuals who receive their health insurance through an exchange established by their particular state?"
Both Noble and Chirba-Martin say a win for the plaintiffs could have a devastating effect on the Affordable Care Act, given an estimated eight million people could no longer sign up for it.
"In addition to the impact on individuals needing subsidized coverage, there are also a number of spill-over effects to the dismantling of the federal exchange: Subsidies for individuals means increased business for providers," says Noble, an expert on health law and policy. "Without this new pool of 'customers,' health care professionals and hospitals will once again be caught between the need for financial viability and their ethical obligation to patients who cannot afford care. Major hospitals agreed to Medicaid and Medicare cuts with understanding that insurance expansion, due in large part to subsidies, would make up for that shortfall. They may be left with the shortfall and the historic problem of balancing budgets while also caring for uninsured and underinsured patients."
If the subsidies are no longer allowed in 37 states, healthcare providers are expected to lose billions of dollars.
"Insurers will also be facing pre-ACA problems," says Chirba-Martin. "The risk pool may be more diverse, since the likeliest to purchase coverage without subsidies will be those who need healthcare. Costs of individual coverage--and perhaps coverage in the large group market as well--are predicted to increase significantly."
A blow to affordable healthcare will also have far reaching ripple effects in the states affected.
"States may be faced with thousands of individuals losing insurance QUICKLY," says Noble. "Those individuals will still seek and will often get care. This will have an impact on state budgets as well."
"With a victory for the petitioners, the ACA will remain viable, but its effectiveness will be undermined," says Chirba-Martin. "Despite the passage of health reform, inequality in coverage will persist. The biggest hit will be to people who care but can no longer afford to get it, despite available mechanisms through the ACA to avert this result."
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