Ballad Health Relies on Partnerships to Excel With Difficult Payer Mix

https://www.healthleadersmedia.com/finance/ballad-health-relies-partnerships-excel-difficult-payer-mix?spMailingID=15495934&spUserID=MTg2ODM1MDE3NTU1S0&spJobID=1621203648&spReportId=MTYyMTIwMzY0OAS2

Ballad CFO Lynn Krutak said the health system faces significant financial challenges but has the discipline and leadership to navigate obstacles ahead.


KEY TAKEAWAYS

CFO Lynn Krutak said the system’s most significant challenge is its payer mix.

Luckily, she says, Virginia’s decision to expand Medicaid will help somewhat in terms of recouping from years of cuts.

Ballad Health also has a $308 million, 10-year spending plan in the works.

Last year, Mountain States Health Alliance (MSHA) and Wellmont Health System, merged to form Ballad Health. The fact that the two rural systems merged was not typical because it formed under a certificate of public advantage (COPA).

This legal agreement governs the merger through joint oversight from both the state of Tennessee and Virginia and also includes “enforceable commitments” to invest in population health, expand patient access, and boost research and education opportunities.

According to the Millbak Memorial Fund, the COPA acts as a “state-monitored monopoly—or a public utility model of healthcare delivery.”

Related: Ballad Health Launches Changes Across Newly Merged Hospital Network

Lynn Krutak, who served as CFO for both MSHA and its corporate parent Blue Ridge Medical Management, was elevated as CFO at Ballad Health. In an interview with HealthLeaders, Krutak emphasized how she implemented effective cost-cutting strategies within a challenging payer mix and low-wage index area.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: Can you describe the challenges and opportunities for Ballad Health in its provider market?

Krutak: The majority of our hospitals are either in southwest Virginia or northeast Tennessee, so we have high-use rates. From the payer standpoint, as more people move into managed Medicare and managed Medicaid, we know those use rates are going to fall.

Our population growth is flat to even declining; a lot of our counties in southwest Virginia are coal counties that have been hit hard by the [employment] reductions. So, with the use-rates decline, population decline, and the reimbursement decline that we’re all faced with, we know that there are going to be issues going forward.

As far as our payer mix, we’re heavily governmental. Over 70% of our payer mix is Medicare, Medicaid, or self-pay. We can continue to see the payer mix decline as well. We are also faced with high-deductible health plans out there now, with the patient portion of those deductibles being so high our bad debt has increased over 30%.

Fortunately, Virginia has implemented a Medicaid expansion program, so we will get some relief. However, we’ve had years of ACA cuts and this is a small portion. With the cuts that we’ve had versus what we’re going to gain back from Medicaid expansion, we’ll still be in the red.

Our wage index with Medicare is another hurdle we have. We are in the fourth-lowest wage index area in the country; we’re getting about half of what other [systems] are getting. We’ve done a good job of controlling our costs because we have to.

We’re excited about the potential with some of the things that we’re going to be able to do as a merged organization. We have $308 million in spending commitments over the next 10 years, but we have about twice as much in estimated savings. We’ve been able to achieve a lot of that already and we’re working hard on our continued integration.

This merger’s unique and what we’re going to be able to do is take costs out of the system, as far as redundant and duplicative costs go, and then reinvest them back.

HL: Can you describe some initiatives Ballad is looking to pursue in the next few years?

Krutak: As far as the labor costs, we’ve done a great job controlling our labor by not using contract labor for nursing. During the nursing shortage, other systems were using contract labor, it was something that MSHA did not have to do.

We have East Tennessee State University right in our backyard in Johnson City, where we work with them to develop nursing programs and offer scholarships to students in return for a work commitment.

Of the investments through COPA, where we have committed $308 million over a 10-year period, [is] $75 million is going to common health issues facing children. We’ve made a commitment to bring on specialists—specifically pediatrics—and be able to keep these patients and their families in the region and not have to send them elsewhere.

We’ve also committed $140 million to mental health, addiction, or rural health [initiatives] with $85 million going to behavioral health. That’s an issue for our service area in northeast Tennessee and southwest Virginia.

Finally, we have $8 million set for clinical effectiveness and patient engagement mainly related to health information exchange. Wellmont was on Epic, MSHA was on Cerner, so we agreed to convert the whole system to Epic, which will happen in April 2020.

HL: How is Ballad best positioned to navigate the direction healthcare is going while still providing the best quality service to its patients?

Krutak: We’ve been working with our state representatives to craft a fair wage index bill, where Ballad would get some relief and revamp how those calculations are done. In other words, you would not be penalized if you do a good job controlling your costs.

Our CEO, Alan Levine was secretary of health in Florida and secretary of health in Louisiana. We have Tony Keck, who is the executive vice president of our development, innovation, and population health improvement, who was secretary of health in South Carolina. We have a lot of insight on the [governmental] side of things from them.

We’re positioning ourselves to take costs out of the system but also to switch over from fee-for-service plans to looking at risk-based contracts. How do we get paid more for showing better patient outcomes? We’re looking over the next five years to transition into more of that than your traditional payments.

HL: What advice would you give to CFOs from rural systems to make the most of what are sometimes challenging financial situations?

Krutak: As a result of the merger, I’m relieved that we’re going to be able to have these savings to reinvest in rural areas. The largest issue we face with the payer mix shift is that it’s hard to get physicians in rural areas.

My advice to them is just make sure that you are controlling your costs as much as you possibly can and look to partner with other systems that may be near you that could provide physician-sharing arrangements.

For the reimbursement side, it’s always actively looking at how you’re being paid and what you’re being paid. Work with your government officials and partner with your hospital associations, to say, ‘Hey, if we’re going to continue to keep these rural hospitals and provide access, then there’s going to have to be changes as far as how that reimbursement is calculated and how those facilities are compensated.’

On the cost side, make sure that that you’ve situated yourself appropriately and then as things transition to outpatient, be sure the investments that you’re making are being made in the right places.

 

 

 

 

Red states’ Medicaid gamble: Paying more to cover fewer people

https://www.axios.com/republicans-medicaid-affordable-care-act-expensive-d7057a8e-0a55-4f0d-906e-e42aa3f00ba9.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Illustration of a price tag hanging from an IV stand

Red states are getting creative as they look for new ways to limit the growth of Medicaid. But in the process those states are taking legal, political and practical risks that could ultimately leave them paying far more, to cover far fewer people.

Why it matters: Medicaid and the Children’s Health Insurance Program cover more than 72 million Americans, thanks in part to the Affordable Care Act’s Medicaid expansion. Rolling back the program is a high priority for the Trump administration, and it needs states’ help to get there.

The big picture: The Centers for Medicare & Medicaid Services, under the leadership of Administrator Seema Verma, has made clear that it wants to say “yes” to new limits on Medicaid eligibility, and has invited states to ask for those limits.

  • But CMS hasn’t actually said “yes” yet to some of the most significant limits states have asked for.
  • In the meantime, states are left either with vague ambitions they’re not sure how to implement, or with risky plans that put their own budgets on the line.

What we’re watching: State-level Republicans are waiting for CMS to resolve two related issues: how much federal funding their versions of Medicaid can receive, and the extent to which they’re able to cap enrollment in the program.

  • “These issues are going to continue to be intertwined,” said Joan Alker, the executive director of Georgetown University’s Center for Children and Families.

Verma has reportedly told state officials that she wants to use her regulatory power to convert Medicaid funding into a system of block grants — which would be an enormous rightward shift and probably a big cut in total funding.

  • CMS probably cannot do that on its own, experts said, but it could achieve something similar by approving caps on either enrollment or spending.

Where it stands: GOP lawmakers in a handful of states are looking to Utah, which has bet big on Verma’s authority, for signals about what’s possible.

  • Utah voters approved the full ACA expansion last year, but the state legislature overruled them to pass a more limited version.
  • By foregoing the full expansion, Utah passed up enhanced federal funding. It’s still asking for that extra money — a request CMS has never previously approved.
  • Utah will also ask CMS to impose a per-person cap on Medicaid spending — a steep cut that was part of congressional Republicans’ failed repeal-and-replace bill, and which may strain CMS’ legal authority.
  • If Utah doesn’t get those two requests, its backup plan is simply to adopt the full expansion.

What’s next: Utah is not the only red state leaning into Verma’s agenda, but it’s further out on a limb than any other.

  • Idaho, like Utah, overruled its voters to pass a narrower Medicaid bill. But it preserved an option for people to buy into the ACA’s expansion.
  • Alaska Gov. Mike Dunleavy has said he wants to take Verma up on her offer of block grants; so have legislators in Tennessee and Georgia. But in the absence of any detail about what that means, or what CMS will approve, that’s all pretty vague right now.

If CMS does move forward on any of this, it could face the same threat of lawsuits that have stymied its first big Medicaid overhaul — work requirements.

  • Those rules are on ice in two states because a judge said they contravene Medicaid’s statutory structure and goals. The same argument could await a partial expansion or tough spending caps.

“There’s a clear agenda here to get a handful of states to take up these waivers, which fundamentally undermine the central tenets of the Medicaid program — which [are] that it is a guarantee of coverage, and a guarantee of federal funding,” Alker said.

 

 

 

Las Vegas hospital doesn’t contract with any payers

https://www.beckershospitalreview.com/payer-issues/las-vegas-hospital-doesn-t-contract-with-any-payers.html?origin=cfoe&utm_source=cfoe

Image result for elite medical center las vegas

Elite Medical Center, a Las Vegas-based acute care hospital that some experts say is operating similarly to a 24/7 freestanding emergency room, doesn’t contract with any payers, according to the Milbank News.

EMC is a state-licensed hospital. It is an unaccredited hospital that has no agreements with insurers, meaning patients have to pay out-of-network prices for care. Under state law, EMC isn’t required to be accredited by CMS or accept public or private insurance.

On EMC’s website, the medical center states, “This facility is not a participating provider in any health benefit plan provider network. However, under the [ACA], your health insurance company is required to process your emergency visit at in-network benefit levels. The physician providing medical care at this facility may bill separately from the facility for the medical care provided to you.”

While Nevada doesn’t provide licenses for freestanding ERs — though hospitals can open satellite ERs at other locations — EMC obtained a state license to operate as a hospital. As a result, it has to be able to admit patients for 48 hours.

Bill Welch, president and CEO of the Nevada Hospital Association, told Milbank News: “We think that Elite Medical Center, if they want to operate as a hospital in the state, that they should operate as a CMS-certified center and they should be accredited and Medicare participating. Without those things, we’re concerned.”

EMC CEO Butch Frazier defended the hospital in an emailed statement to the publication, saying it often has higher online patient ratings than University Medical Center in Las Vegas.

“EMC tries hard to make sure that the ultimate charges paid by the patients and by the insurers to EMC are in line with what they are paying for the same services at other hospitals in the area,” Mr. Frazier said. He added that EMC is seeking CMS accreditation.

 

Considering “Single Payer” Proposals in the U.S.: Lessons from Abroad

https://www.commonwealthfund.org/publications/2019/apr/considering-single-payer-proposals-lessons-from-abroad

Flags and sky 21x9

ABSTRACT

  • Issue: When discussing universal health insurance coverage in the United States, policymakers often draw a contrast between the U.S. and high-income nations that have achieved universal coverage. Some will refer to these countries having “single payer” systems, often implying they are all alike. Yet such a label can be misleading, as considerable differences exist among universal health care systems.
  • Goal: To compare universal coverage systems across three areas: distribution of responsibilities and resources between levels of government; breadth of benefits covered and extent of cost-sharing in public insurance; and role of private insurance.
  • Methods: Data from the Organisation for Economic Co-operation and Development, the Commonwealth Fund, and other sources are used to compare 12 high-income countries.
  • Key Findings and Conclusion: Countries differ in the extent to which financial and regulatory control over the system rests with the national government or is devolved to regional or local government. They also differ in scope of benefits and degree of cost-sharing required at the point of service. Finally, while virtually all systems incorporate private insurance, its importance varies considerably from country to country. A more nuanced understanding of the variations in other countries’ systems could provide U.S. policymakers with more options for moving forward.

Background

Despite the gains in health insurance coverage made under the Affordable Care Act, the United States remains the only high-income nation without universal health coverage. Coverage is universal, according to the World Health Organization, when “all people have access to needed health services (including prevention, promotion, treatment, rehabilitation, and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.”1

Several recent legislative attempts have sought to establish a universal health care system in the U.S. At the federal level, the most prominent of these is Senator Bernie Sanders’ (I–Vt.) Medicare for All proposal (S. 1804, 115th Congress, 2017), which would establish a federal single-payer health insurance program. Along similar lines, various proposals, such as the Medicare-X Choice Act from Senators Michael Bennet (D–Colo.) and Tim Kaine (D–Va.), have called for the expansion of existing public programs as a step toward a universal, public insurance program (S. 1970, 115th Congress, 2017).

At the state level, legislators in many states, including Michigan (House Bill 6285),2 Minnesota (Minnesota Health Plan),3 and New York (Bill A04738A)4 have also advanced legislation to move toward a single-payer health care system. Medicare for All, which enjoys majority support in 42 states, is viewed by many as a litmus test for Democratic presidential hopefuls.5 In recent polling, a majority of Americans supported a Medicare for All plan.6

Medicare for All and similar single-payer plans generally share many common features. They envision a system in which the federal government would raise and allocate most of the funding for health care; the scope of benefits would be quite broad; the role of private insurance would be limited and highly regulated; and cost-sharing would be minimal. Proponents of single-payer health reform often point to the lower costs and broader coverage enjoyed by those covered under universal health care systems around the world as evidence that such systems work.

Other countries’ health insurance systems do share the same broad goals as those of single-payer advocates: to achieve universal coverage while improving the quality of care, improving health equity, and lowering overall health system costs. However, there is considerable variation among universal coverage systems around the world, and most differ in important respects from the systems envisioned by U.S. lawmakers who have introduced federal and state single-payer bills. American advocates for single-payer insurance may benefit from considering the wide range of designs other nations use to achieve universal coverage.

This issue brief uses data from the Organisation for Economic Co-operation and Development (OECD), the Commonwealth Fund, and other sources to compare key features of universal health care systems in 12 high-income countries: Australia, Canada, Denmark, England, France, Germany, the Netherlands, Norway, Singapore, Sweden, Switzerland, and Taiwan.

We focus on three major areas of variation between these countries that are relevant to U.S. policymakers: the distribution of responsibilities and resources between various levels of government; the breadth of benefits covered and the degree of cost-sharing under public insurance; and the role of private health insurance. There are many other areas of variation among the health care systems of other high-income countries with universal coverage — such as in hospital ownership, new technology adoption, system financing, and global budgeting — that are beyond the scope of this discussion.

 

 

 

 

 

 

COMMUNITY HEALTH CENTERS MORE FINANCIALLY STABLE UNDER MEDICAID EXPANSION

https://www.healthleadersmedia.com/finance/community-health-centers-more-financially-stable-under-medicaid-expansion?source=EHLM8&effort=B&utm_source=HealthLeaders&utm_medium=email&utm_campaign=MeritWelcomeB&emailid=&utm_source=silverpop&utm_medium=email&utm_campaign=Warming-Merit-Finance-040319%20(1)&spMailingID=15443417&spUserID=Mzc4MjM1NTY0ODgyS0&spJobID=1620654151&spReportId=MTYyMDY1NDE1MQS2

Facilities are faring better in states that expanded Medicaid, according to a new Commonwealth Fund report.


KEY TAKEAWAYS

A year after facing a federal funding cliff, CHCs in expansion states are thriving. 

CHCs provide care to 27 million patients each year, according to the Health Resources and Services Administration.

The financial stability of CHCs, which serve medically vulnerable communities, is a benefit for health systems.

Community health centers (CHC) operating in states that expanded Medicaid under the ACA are 28% more likely to report improvements to their financial stability, according to a Commonwealth Fund report released Thursday morning.

CHCs in Medicaid expansion states reported were more likely to report improvements in their ability to provide affordable care to patients, 76%, than their counterparts in non-expansion states, 52%.

More than 60% of CHCs in expansion states reported improved ability to fund service or site expansions and upgrades for facilities, while only 46% of CHCs in non-expansion states said the same.

These facilities reported higher levels of unfilled job openings for mental health professional and social workers, while also implying a greater openness to operating under a value-based payment model.

The success and viability of CHCs are essential for larger health systems, according to Melinda K. Abrams, M.S., vice president and director of the Commonwealth Fund’s Health Care Delivery System Reform program, adding that CHCs act as a strong foundation for providing primary care to medically vulnerable populations in rural communities.

Abrams said that by making sure patients are insured and receiving care up front, rather than delaying treatment and exacerbating their condition, they are less likely to end up in a hospital emergency room and contribute to a rise in uncompensated care for hospitals.

She also told HealthLeaders that populations with higher enrollment rates make it easier for CHCs to innovate, invest in technology, hire new staff, train existing the workforce, and adopt new models of care.

“[Medicaid expansion] makes it a lot easier to provide high-quality comprehensive care when [a CHC’s] patients have health insurance,” Abrams said. “In this particular instance, it’s a lot easier to innovate and have financial stability when you have more paying patients, which means that it is easier if you are [a CHC] in a state that has expanded Medicaid.”

The Commonwealth Fund report provides a welcome note of positivity for CHCs, which serve vulnerable populations primarily composed by the uninsured, but have faced funding challenges in the past.

During the budget battles that produced multiple government shutdowns throughout the early portion of 2018, advocates wondered anxiously whether Congress would provide long term funding to the nearly 1,400 CHCs operating at nearly 12,000 service delivery sites across the country.

According to the Health Resources and Services Administration, CHCs provide care to more than 27 million patients annually.

The Community Health Center Fund (CHCF), created in 2010 as a result of the ACA, is the largest source of comprehensive primary care for medically underserved communities, according to the Kaiser Family Foundation.

However, Abrams said that Medicaid expansion has also been a beneficial tool for CHCs, as they have begun to see more insured patients while also benefiting from Medicaid reimbursements, even though they are low compared to other reimbursement rates.

CHCs in states that expanded Medicaid have been able to grow the services that are offered while assisting in the ongoing fight against the opioid epidemic, according to the Commonwealth Fund report.

Abrams said that one downside to the growing success of CHCs have been the unfilled positions, mostly for mental health providers, that are falling behind rising demand levels, though she added that this finding is not surprising.

“I think it’s in part because the supply of the workforce is lagging a little bit behind the demand,” Abrams said. “There’s no reason to think that over time that this gap wouldn’t be closed. But we did find that as a challenge, that [CHCs] have a lot of positions open [yet] they’re hiring. A number of these CHCs are in economically depressed areas, so the good news is that there are some jobs available.”

CHCs are much more likely to participate in value-based payment models as a result of Medicaid expansion, with Abrams explaining that changes in payments and delivery models are common during insurance expansions.

She sees the continued progress made on the value-based front by CHCs as a way to “promote better healthcare and save money” over time.

 

 

Walking back plans for an ACA replacement plan

https://mailchi.mp/5a57c9e710d7/the-weekly-gist-april-5-2019?e=d1e747d2d8

Image result for about face

Reversing course in the face of strong pushback from his own party’s leaders in Congress, President Trump this week backed off his earlier pledge to deliver a Republican healthcare plan to replace the Affordable Care Act (ACA).

After the Department of Justice switched positions on the Texas court case testing the constitutionality of the ACA, urging the Fifth Circuit Court of Appeals to invalidate the 2010 law entirely, Trump doubled down by declaring that Republicans would be known as the “party of healthcare”, going so far as to tap four GOP senators to craft a replacement bill.

However, the White House received a rare rebuke from Senate Majority Leader Mitch McConnell (R-KY), who said this week that in private discussions with the President, “I made it clear to him that we’re not going to be doing that in the Senate.” In tweets and a subsequent speech, Trump signaled his frustration with Congressional Republicans on the issue (“We blew it the last time. Man, I was fed a bill of goods.”), vowing to return to the issue after the 2020 elections.

By highlighting GOP divisions on the issue, this week’s public dust-up and Presidential about-face all but guarantee that healthcare will be a marquee issue in the upcoming elections, allowing Democrats to campaign on an issue that proved a strong suit for them in the 2018 midterms. Expect the politics of healthcare to remain front and center in the months to come.

 

 

Insurers, hospitals, physicians united in stance on ACA lawsuit

https://www.healthcarefinancenews.com/news/insurers-hospitals-physicians-united-stance-aca-lawsuit?mkt_tok=eyJpIjoiWldGbU16WmxOak00TmprMiIsInQiOiIzeGkycUpwcmtPUk42Z2R0b1k4RHd0NUVoY0k3UmE5TktUSkhMUzVtNVVWOWtWY3BhWkdUbjcrZndNS0tZRnA1cWFSajhWdmlZcUc4VE5DbFB4VEZNNkJyYTkyXC9XK3hxZVMwVzhSaVF2ZjZIdUFjbzZwcnF6aGE0UmowZ2w1eHcifQ%3D%3D

Hospitals, physicians and insurer groups are united in wanting to preserve the Affordable Care Act and have defended it in briefs filed with the Fifth Circuit Court of Appeals.

The American Hospital Association, the American Medical Association and America’s Health Insurance Plans are among groups that are fighting a lower court ruling in Texas that struck down the law.

On the other side is the Department of Justice, which last month reversed an earlier opinion and sided with the Texas judge who ruled that without the individual mandate, the entire ACA has no constitutional standing.

WHY THIS MATTERS

The ACA has insured millions who otherwise may not have been insured, allowing them to get care when needed instead of going to the more expensive emergency room when they have a medical crisis.

Hospitals and physicians see less uncompensated care under the ACA.

Without the ACA, patients would no longer have protections for pre-existing conditions, children would no longer have coverage under their parents’ health insurance plan until age 26, insurers would no longer be held to the 85 percent medical loss ratio, 100 percent coverage for certain preventive services would cease and individual marketplace and subsidies based on income would be eliminated.

Also, federal funding for Medicaid expansion would end.

TREND

Republicans under President Trump have tried unsuccessfully to repeal and replace the law.

The lawsuit, brought by 19 Republican governors, puts the GOP in a political bind over supporting the repeal of a law that is popular with consumers and their constituents. President Donald Trump recently said Republicans would unveil an ACA replacement after the 2020 election.

Democrats are also facing a crisis within their party over healthcare as it becomes a priority issue in the presidential election. Some of the leading candidates, such as Senator Kamala Harris, support Medicare for all. The Medicare for All Act of 2019  has been introduced in the Democratic-led House of Representatives.

Veteran politician and attorney Earl Pomeroy said he believes the Texas versus United States appeal changes the political course for 2020. The entire MFA argument will move to the back burner because of the Texas lawsuit, he said.

“The fight is going to be trying to underscore the Congressional importance of the provisions of the ACA and enhancing them,” Pomeroy said. “I do not believe that supporting Medicare for all is an advantageous position for a Democratic candidate running in a district that is not a secure Democratic seat. I believe Kamala Harris will spend much of the campaign walking back her comments on health insurance.”

Pomeroy is a former member of the U.S. House of Representatives for North Dakota’s at-large district, a North Dakota Insurance Commissioner and senior counsel in the health policy group with Alston & Bird.

“The safe political ground is defending a law people have warmed up to,” he said. “All politics is local but all healthcare is personal. There is little risk tolerance in the middle class for bold experiments in healthcare.”

BACKGROUND

The lawsuit was brought by Texas and the 19 other Republican-led states, based on the end of the individual mandate. In February, U.S. District Court Judge Reed O’Connor agreed that the federal law cannot stand without the individual mandate because if there is no penalty for not signing up for coverage, then the rest of the law is unconstitutional.

Twenty-one Democratic attorneys general appealed and the House of Representatives has intervened to defend the ACA in the case.

Either outcome in the appeals court may see the case headed to the U.S. Supreme Court.

WHAT THE PROVIDERS AND INSURERS ARE TELLING THE COURT

In a court brief filed by the AHA, the Federation of American Hospitals, The Catholic Health Association of the United States, America’s Essential Hospitals, and the Association of American Medical Colleges urged the Fifth Circuit Court of Appeals to reject a district court decision they said would have a harmful impact on the American healthcare system.

“Those without insurance coverage forgo basic medical care, making their condition more difficult to treat when they do seek care. This not only hurts patients; it has severe consequences for the hospitals that provide them care. Hospitals will bear a greater uncompensated-care burden, which will force them to reallocate limited resources and compromise their ability to provide needed services,” they said.

In a separate friend-of-the-court brief, 24 state hospital associations also urged the Fifth Circuit to reverse, highlighting specific innovative programs and initiatives for more coordinated care.

The American Medical Association, the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics and the American Psychiatric Association filed a brief. AMA President Dr. Barbara L. McAneny said, “The district court ruling that the individual mandate is unconstitutional and inseverable from the remainder of the ACA would wreak havoc on the entire healthcare system, destabilize health insurance coverage, and roll back federal health policy to 2009. The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support.”

AHIP said the law impacts not only the individual and group markets, but also other programs such as Medicaid, Medicare and Part D coverage.

“Since its passage in 2010, the ACA has transformed the nation’s healthcare system,” AHIP said. “It has restructured the individual and group markets for purchasing private health care coverage, expanded Medicaid, and reformed Medicare. Health insurance providers (like AHIP’s members) have invested immense resources into adjusting their business models, developing new lines of business, and building products to implement and comply with those reforms.”