COLLEGE PARK, Md. - Maryland and other states have a lot riding on the U.S. Supreme Court's upcoming decision on the Affordable Care Act (ACA), regardless of how the justices rule, University of Maryland experts say.
The ACA was intended to help states rein in health care costs, driven up in recent years as the weak economy pushed more low-income individuals onto Medicaid.
Maryland is one of 15 states that have begun to build health care exchanges - a centerpiece of the reform care law, designed to make health insurance more accessible. If the Supreme Court upholds the ACA, Maryland still will have to figure out what to do with the exchange while trying to meet growing Medicaid expenses.
And if the justices strike down the entire law, the red ink will continue to rise, with no firm solution in sight, says Don Kettl, dean of the UMD School of Public Policy. "Only one thing is certain, and that is that states will buckle under the status quo," he says.
"There's no fix for the ongoing state and local fiscal crisis without a fix for health care," says Kettl, citing the findings of a recent study from the Government Accountability Office. He adds that many governors might wish for a proposal the Reagan administration made decades ago - to swap the federal assumption of health care for the state assumption of welfare. "I don't doubt there's a governor alive who wouldn't want another bite at that apple."
One of the central questions before the court is the constitutionality of the ACA's requirement that individuals purchase health insurance. Striking just the so-called individual mandate, "would be a survivable wound," says health care economist Jack Meyer, a joint professor at the UMD School of Public Policy and School of Public Health.
"It would require using some carrots and sticks in place of the mandate, such as allowing people to buy health coverage at standard rates only in limited enrollment periods, whil
|Contact: Neil Tickner|
University of Maryland