Extreme disruption of Medicare funding forecast if Affordable Care Act is tossed out

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U.S. Supreme Court
U.S. Supreme Court

Healthcare experts on both sides of the political spectrum are warning that the Medicare program could unravel if the Supreme Court deems the Affordable Care Act unconstitutional. Nursing homes, and others might not get paid, at least one expert says.

At the crux of the issue is the fact that payment rates for all types of Medicare services must be set by a legal authority. For the last two years that authority has been the Affordable Care Act, according to a Kaiser Health report. If the law is stricken, those payment rates will cease to exist, George Washington University health law and policy professor Sara Rosenbaum says.

"Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take affect for the elderly, closing the doughnut hole might not happen. We don't know," Rosenbaum told Kaiser.

Gail Wilensky, who headed up Medicare and Medicaid for President George H.W. Bush, said the fate of Medicare under an invalidated ACA could be on-and-off, like Medicare's formula for paying doctors with Congress has been unable to agree on a permanent “doc fix.” The result has been short lapses in funding authority.

"So we've had these kinds of smaller-version 'what happens if Congress does or doesn't do something,'” Wilensky told Kaiser. “This would be much bigger. And it would be extremely disruptive."