ACA in the Headlines Soon, a Potential Boom or Bust for the Healthcare Industry

Since it was enacted into law in 2010, approximately11.4 million previously uninsured Americans have gained health insurance coverage since the Affordable Care Act (ACA). The ACA caused a significant upturn in business for most involved in the healthcare industry. Instead of making unplanned trips to the emergency room for treatment, previously uninsured Americans can now schedule regular appointments and receive follow-up non-emergency care as needed.

For medical billing and coding professionals this has translated into a greater volume of materials to process, and therefore a greater general demand for qualified professionals in this field. However, the full influx of demand that could be had by those in the billing and coding field has been thus far delayed by a Supreme Court decision in 2012, which ruled that Medicaid expansion is not obligatory for states. This resulted in 23 states’ governors opting out of this portion of the ACA, leaving more than five million Americans without eligibility for health care coverage under the Act.

This month the Supreme Court is expected to rule on another portion of the ACA that could effectively boot millions of Americans out of the ACA’s health insurance marketplace. Before detailing this, readers should understand two aspects of the ACA:

  • As part of the ACA, each state has the option of creating its own health insurance marketplace or allowing the federal government to manage its state-level health insurance marketplace.
  • Low and middle-income Americans are eligible for subsidies which allow them to afford full-market-priced health insurance in their state’s marketplace. Currently they receive these subsidies in state-managed health insurance marketplaces as well as federally-managed health insurance marketplaces.

This month the court will be ruling on a challenge to the Act that argues subsidies are illegal in state marketplaces that are managed by the federal government. There are 34 states with federally managed healthcare marketplaces, in which 6.39 million Americans recently received subsidies. If these subsidies are ruled to be unconstitutional, that means health insurance for these Americans could become too expensive. If more than six million people were effectively excluded from the ACA, this would likely undermine the entire Act’s viability.

Considering this latest Supreme Court challenge to the ACA (King v. Burwell) has been brought largely on a technicality, it seems likely the federal subsidy program will remain unchanged and the challenge will be overruled. This is because the law states that if the intent of Congress in passing the ACA is clear (and for the most part it is), then the Supreme Court must uphold the Act.

How the ACA has Affected Medical Billing and Coding

The following table shows the growth of medical billing and coding professionals in the United States from 2006-2014. Significant points to consider include the economic recession which started at the end of 2007 and lasted until the middle of 2009, and the passage of the passage of the Patient Protection and Affordable Care Act in March of 2010.

Growth of Medical Billing and Coding Professionals in the United States

% growth+.0054+.0184+.0114+.0323+.0238+.0116-.0088+.0220

Source: US Department of Labor 2015