With its ruling released on June 28th, the Supreme Court has, absent an unexpected legislative repeal, cemented the Patient Protection and Affordable Care Act (PPACA) into U.S. law. Now that the judicial challenges have run their course, there is some clarity around the impacts this law will create.
In the short term, I view this development as moderately positive for the health Insurance industry and perhaps even stimulative for the health insurance labor market. Over the past several months, as the uncertainty around the Supreme Court decision grew, I have seen countless health insurance decision makers put developmental projects on hold until some clarity emerged. I now expect a bit of a dam break in the flow of these projects. Additionally, health insurers can now plan for an expected increase in covered lives due to the survival of the “individual mandate tax.” Together, these impetuses should lead to a modest, industry-wide uptick in hiring over the near term. Moreover, the industry avoided what would have been a major negative shock had the Supreme Court struck down the individual mandate but upheld other aspects of the law including the “Guaranteed Issue” provision.
My view of the longer term impacts of this law is less sanguine. The health care crisis in this country is a crisis of cost, not one of evil health insurers who need to be reigned in via a central authority dictating the terms of their market. Throughout history, central control of markets has invariably led to mal-investment, skewed markets and unintended consequences. I have argued since 2009 that the health care cost crisis needed to be solved with market friendly reforms that took advantage of the immense power of capitalistic choice (aka consumerism). One can make a strong argument that the seeds of our cost crisis were planted by the very body that passed the PPACA, as the endless stream of Washington generated coverage mandates, managed care restrictions and cost-less (to the consumer) benefit increases led to an economic imbalance that ensured consistent health care cost inflation.
The long-term consequences of yet more market interference is not in doubt. We will see continued and likely accelerated, cost escalation. Further, the medium to long-term marginal impact of this law on the labor market will clearly be negative. For all the talk of job creation, every high school economics student understands that an increase in tax decreases economic activity. In this case we have both an individual tax and a tax on employment – and one that will disproportionately impact the segment of the economy most responsible for job growth: small businesses.
All that said, this is not the first time that lawmakers – in their zest to improve the conditions of their constituents – have passed counter-productive laws. Even with the PPACA, the United States continues to have one of the most supportive economies for entrepreneurship and innovation. I expect that our health insurance organizations and other businesses will learn to innovate within the framework of the new law and our economy will continue to outpace the rest of the developed world.