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The King v. Burwell Decision: Clear-Sighted and Grounded in the Real World

July 13, 2015

The Supreme Court’s decision in King v. Burwell is one that is solid in its 6-3 vote, clear-sighted in its reading of the law, and grounded in the financial realities of what is required to make health coverage affordable for millions of Americans.

“Clear-sighted” is exactly how I would describe the AAMC’s long-standing support for the expansion of health insurance coverage at the core of the Affordable Care Act (ACA). Prior to the AAMC Board’s unanimous endorsement of it in March 2010, making us the first national organization representing hospitals to publicly support the final legislative package, we had been deeply involved in reviewing all of the preliminary health care reform proposals and advocating for necessary changes. The decision to endorse was not easy because the proposal contained drastic cuts to federal payments to hospitals in general, and teaching hospitals in particular, but, as more than one board member said at the time, it was “the right thing to do.” 

As the only organization representing medical education, patient care, and medical research, we knew we brought a unique perspective to the debate. We understood that the ACA would pose major challenges—funding cuts, regulatory complexities, and new payment systems that could be fraught with potential problems for academic medicine. And while we certainly recognized the intensity of the politics surrounding the legislation, we also knew that the ACA represented a unique moment in American history, a once-in-a-lifetime opportunity to bring affordable health coverage to millions of uninsured Americans and make a major stride toward the ultimate goal of universal coverage.

With the bill’s final passage, AAMC President and CEO Darrell G. Kirch, MD, unequivocally said, “The nation’s medical schools and teaching hospitals have expressed their full support for this bill to President Obama, and now stand ready to work with the administration and Congress to implement these significant changes to our health care delivery system.”

The AAMC did not waver in its endorsement then, and we have not wavered since. We joined other national hospital organizations in filing a series of friend of the court briefs in support of the ACA before the Supreme Court upheld most of the law in National Federation of Independent Businesses v. Sibelius, and we did that again when the Supreme Court took up King v. Burwell.

At the same time, we have been working hard for the law’s effective implementation. Medical schools and teaching hospitals across the country have urged their elected officials to support the ACA. They also have been champions for coverage, guiding thousands of patients and others through enrollment in the law’s health insurance exchanges. And they have been among the first to sign up for multiple demonstrations of new financing and delivery models the law promotes.

The years since the ACA’s enactment have brought considerable challenges to the goal of universal coverage—political opposition at times bordering on vicious, a Supreme Court decision that Medicaid expansions are optional, the botched initial rollout of the federal website and some of the state exchange websites, the mass and complexity of regulations, and the rejection of adjustments to address the impact of socioeconomic status on health care needs and outcomes.

One of the biggest challenges for the ACA’s successful implementation is ensuring that the nation’s physician workforce is adequate to meet the needs of a diverse and rapidly aging population. The best, most comprehensive projections to date, in our judgment, foresee a shortage of somewhere between 46,000 and 90,000 doctors in just 10 years. To address the shortage, Congress needs to lift the cap on Medicare funding for residency training and expand support for an additional 3,000 residencies per year. Medical schools and teaching hospitals also will need to do their part by taking the lead on delivery and financing reform and accountability for graduate medical education. Fixing this shortage so that all Americans can see a doctor when they need one is no small job, and we have our work cut out for us.

Even with the challenges that still face the ACA, our support for it was always, and still is, the right thing to do. Speaking both personally and professionally, being a part of the AAMC’s leadership on health care reform will always be one of my proudest experiences.

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About the Author

Atul Grover, MD, PhD AAMC Executive Vice President

Atul Grover, MD, PhD
AAMC Executive Vice President

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For More Information

Peters Willson
Sr. Specialist, Policy and Constituency Issues
Telephone: 202-862-6029