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Rural Americans Must Stay Vigilant as Legal Battles Continue on ACA

Last December, a federal district court in Texas struck down the Affordable Care Act (ACA) in its entirety.  Though the court left the ACA intact pending a likely intervention by the Supreme Court, the atmosphere of uncertainty created by this decision is alarming and will likely contribute further to the instability of the individual insurance market. 

The case, Texas v. Azar, determined that the 2017 Tax Cuts and Jobs Act (TCJA), which zeroed out the tax penalties associated with the ACA’s individual mandate, renders the mandate unconstitutional. The judge further concluded that since the individual mandate is “essential” to the ACA, it could not be severed from the rest of the ACA, and the entire ACA was therefore unconstitutional. 

Though the law remains intact pending future legal actions, it’s future is precarious. Therefore, it’s important to recognize the profound impact of the ACA on rural America and demand Congress shield it from future assault and improve upon its implementation in rural America. 

Health insurance coverage has increased by 8% in rural counties since the implementation of the ACA.  Medicaid is overwhelmingly important to rural patients who are disproportionately poorer.  Additionally, expansion of the 340B drug program, which was included in the ACA, has been a financial lifeline for many rural providers. If the district court’s ruling were to stand, other protections of the ACA could be eliminated, such as:
  • Access to their parents’ plan coverage for young adults up to age 26;
  • Elimination of annual and lifetime caps on benefits;
  • No pre-existing condition coverage exclusions or medical underwriting;
  • Coverage of prevention and screening benefits with no deductibles or copayments;
  • Required coverage for mental health and addiction treatment services;
  • Federal support for expanded Medicaid eligibility; and
  • Premium subsidies for low- and moderate-income individuals and families to purchase coverage and cost sharing subsidies to lower out-of-pocket costs.

The National Rural Health Association continues its fight to improve access to care for rural Americans.  Rural Americans are poorer and more likely to be uninsured.  The expansion of Medicaid is critical to rural Americans having access to care.  As the rural hospital and rural health clinic closure crisis continues, we are all too aware of the importance of Medicaid expansion in keeping rural facilities open.  While Medicaid is not a great payor, there is a notable difference in operational margins of rural hospitals in states that have expanded Medicaid.  (Fifty-two percent of rural hospitals operate at a financial loss in states that have not expanded Medicaid. Forty-four percent operate at a loss in states that have expanded Medicaid.)

While there are several aspects of the ACA that are not working in rural America (plan choice, affordability and associated Medicare hospital cuts), NRHA has long advocated that the ACA must be supported and improved upon to make health care accessible and affordable for the 60 million patients who live in rural America.

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