By The Center for Health and Wellness Law
The Patient Protection and Affordable Care Act (ACA) of 2010, known as Obamacare, became law 10 years ago. The law, when enacted, was expected to expand health insurance coverage to 30 million people who could not afford it otherwise, through an expansion of Medicaid, cost-sharing subsidies in the private insurance market, and growth in Medicare enrollment.[i]
Since enactment, various events have changed the ACA’s original scope – including lawsuits, executive orders, and new legislation – but the law is still intact, for now.
Continued ACA litigation at the U.S. Supreme Court has now reached a boiling point. Wellness professionals and organizations should have strategic plans in place should the ACA be overturned in its entirety, the outcome that petitioners in California v. Texas are requesting.
In California v. Texas, the petitioners argue that the entire ACA should be struck down because Congress repealed the ACA’s individual mandate, which required uninsured persons to become insured or pay a monetary penalty (on their taxes) and helped support the ACA’s fiscal impact.
The plaintiffs include Republican attorneys general and governors from a number of states, including Texas. The respondents include Democratic attorneys general from various states, including California. Upon appeal, the case now sits in the hands of the U.S. Supreme Court, which may determine the ACA’s fate this term or, more likely, in the 2021 term.
ACA Wellness Promotion
The ACA has provided a number of programs to help wellness professionals and organizations bridge gaps between healthcare and wellness services, which are largely viewed as separate. While traditional health care treats (and insures against) sickness and disease, wellness initiatives address lifestyle, environmental, and behavioral factors that contribute to sickness and disease, such as physical activity, nutrition, stress management, or tobacco use.
The ACA has attempted to shift more focus on prevention through various mechanisms, including the development of prevention strategies to improve health and wellness.[ii] “Part of that strategy is to enhance coordination and integration of clinical, behavioral, and complementary health strategies and to promote self-improvement care.”[iii]
In addition, the ACA has encouraged wellness professionals and organizations to leverage other initiatives by coordinating care to improve quality outcomes, including the extension of primary care services into nontraditional settings or collaboration with health promotion activities.
Numerous ACA provisions promote such collaboration between traditional health care and wellness initiatives, through grants and other incentives. In turn, the ACA has bolstered the efforts of wellness professionals and organizations who have leveraged these provisions.
One example is the annual wellness visit for Medicare beneficiaries “with the goal of health promotion and disease detection and fostering the screening and preventative services that may already be covered and paid for by Medicare.”[iv] Wellness professionals, such as licensed nutritionists and dieticians, may conduct these visits under physician supervision.
Another ACA initiative allows health plans to implement health and wellness promotion activities as a quality improvement strategy, allowing the health plan to provide incentives for exhibiting healthy behaviors, accessing nutrition counselors, or seeking preventative care.[v]
The ACA includes many provisions intended to create more collaboration between health care and wellness and encourage innovation to improve quality outcomes and behaviors. Those established initiatives, including incentives, would likely be eliminated if the ACA is overturned.
Where Do We Go from Here?
Wellness professionals and organizations must monitor and understand the impact of any decision that implicates ACA provisions, including complete invalidation.
Provider and payor contracts, coordinated care programs, wellness initiatives, and collaborative efforts could be significantly impacted by adverse decision delivered by the U.S. Supreme Court, especially if those relationships are conditioned or contingent on ACA provided incentives.
That means those arrangements and collaborations should be reviewed to determine the potential impact of any legal changes in the near future, based on the specific circumstances.
In addition, wellness professionals and organizations should be engaged in strategic planning to determine how the industry can continue to bridge gaps between healthcare and wellness regardless of ACA-backed provisions that encourage such coordination.
Such strategic planning will necessarily involve legal roadmaps to navigate the regulatory environment, and include continued education and advocacy on the importance of preventative care and the value of collaboration with wellness providers and vendors.
[i] Keehan, S.P., Sisko, A.M., Truffer, C.J., Poisal, J.A., Cuckler, G.A., Madison, A.J.,
Lizonitz, J.M., Smith, S.D. (2011). National Health Spending Projections Through 2020:
Economic Recovery and Reform Drive Faster Spending Growth, Health Affairs, 30(8),
[ii] Roundtable on Obesity Solutions; Food and Nutrition Board; Institute of Medicine. Cross-Sector Responses to Obesity: Models for Change: Workshop Summary. Washington (DC): National Academies Press (US); 2015 Jun 9. 6, The National Prevention Council: Bringing Federal Agencies Together to Build Health and Resilience in Americans. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305199/
[iii] B. Zabawa and J. Eickoff-Shemek, Rule the Rules of Workplace Wellness Programs (ABA 2017).