Next Steps for HHS, CMS Following Supreme Court Decision to Uphold ACA

With the Affordable Care Act (ACA) upheld by the Supreme Court yesterday in a 7 to 2 ruling indicating that plaintiffs seeking to declare the law unconstitutional did not have standing, HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure discussed in a press call today next steps to continue to build the landmark law.

On the eve of the newly inaugurated federal holiday Juneteenth, Becerra opened the discussion by highlighting notable populations, including 133 million Americans with pre-existing conditions, who will continue to be insured under the ACA.

“At stake, women's health, the need for access to birth control, life-saving maternal care, preventative care for women would have been gone had the ACA disappeared. At stake, millions of Americans who can only afford their prescription drug medications because of the ACA—we can all rest a little easier,” said Becerra.

However, as spotlighted by COVID-19, there remains a significant proportion of the US population who continue to be affected by disparities in access to health care. Although progress has been made from 2010 to 2019 as the uninsured rates of Americans in the Latino community dropped by 10% and in the Black community by 8%, certain geographical locations still demonstrate markedly higher uninsured rates.

For example, in Colorado, where Becerra conducted the call from and is set to meet with a number of community leaders, the state’s uninsured rates are 8.5% for Black Americans and nearly 16% for Latino Americans.

So, what are the next steps to improve health care access following the ACA decision?

Becerra noted some of the ongoing efforts by HHS to address barriers to health coverage nationwide, which will leverage funding from the American Rescue Plan to support prevention services and COVID-19 response for 1400 HHS community-funded health clinics.

“The patients that we've been reaching through these dollars, about 91% of them live at or below 200% of the federal poverty guidelines, and nearly 63% of them, almost two-thirds, are racial or ethnic minorities.”

Additionally, Becerra detailed plans to tackle US maternal mortality rates, which have been shown to be 3 to 4 times higher for Black women compared with White women.

“The president's budget also dedicates about $138 million to improve maternal health, and specifically to reduce maternal mortality and morbidity. And it provides an additional $92 billion above what was provided last year,” said Becerra. “Those funds will support the maternal mortality review committee, which advances the administration's goals of reducing maternal death rates nationwide, and we're working with communities to reach those women who do need those services upfront.”

Working in a partnership with the state of Illinois, he said that they are implementing a full 360 days of coverage under Medicaid for a woman postpartum, compared with the 60 days of postpartum care currently provided.

This could have a significant impact on maternal mortality rates, as CMS Administrator Chiquita Brooks-LaSure discussed in the call that many of the health outcomes that we see in maternal deaths and other adverse events actually come in the several months after a baby is born, “which is why we really need to make sure that we have continuity of coverage.”

Speaking further on the importance of the Supreme Court decision, she said that the ACA has reduced or eliminated barriers limiting health coverage, including the donut hole gap in Medicare and gender rating, as well as expanded access to Medicaid.

“The Medicaid expansion has been found to significantly lower maternal mortality, and that impact is felt most acutely among black mothers, meaning that expanding the coverage can be a great key tool to decreasing racial disparities in maternal mortality and morbidity,” said LaSure.

Prioritizing health equity, LaSure said that CMS will continue to partner with states and trusted groups during the special enrollment period, and invest in navigators as they look ahead to open enrollment in the fall.

“We know that 4 million more Americans stand to gain access to quality health coverage in the remaining Medicaid nonexpansion phase,” said LaSure. “When it comes to guaranteeing that Americans in every community have access to comprehensive affordable health care, we will continue to work to ensure that no one is left behind.”

Asked about any particular next steps to expand health care coverage during the press call with reporters, Becerra said that HHS will work with Congress on expanding access to health care through the Medicaid program, which would reach working adults who are often overlooked and live close to the poverty line.

Moreover, he said they will leverage waivers in working with states to expand access at a more affordable price, begin work on increasing access to prescription drugs at better prices, and continue to build on the ACA.

“We will continue to work with states to encourage them to take advantage of the significant funding in the American Rescue Plan to expand the Medicaid program and encourage states to work with us on waivers, if that's the direction they want to go to continue to innovate,” added LaSure.