2. Medicaid Expansion: A provision of the law, known as Medicaid Expansion, makes all adults under the age of 65 with incomes at or below 138 percent of the Federal Poverty Level (FPL) eligible for Medicaid. This means a single adult earning up to $14,404 or a family of four with income up to $29,327 will now be eligible for Medicaid. Prior to this ACA provision, low-income parents and childless adults were ineligible in most states. Now roughly 15 million low-income Americans will be able to enroll in Medicaid, thereby sharply reducing the number of people without health insurance and ultimately leading to a decline in care costs for the uninsured. Medicaid Expansion will also help protect residents against preventable illnesses and likely result in a healthier workforce.

[Feature: Are politics extinguishing state health insurance exchanges?]

If the Supreme Court rules that the individual mandate is the only unconstitutional element of the law – leaving the rest of the ACA standing, including Medicaid Expansion – states should harness the financing that will presumably remain available as part of the ACA to continue implementing Medicaid reform measures, as well as improving and replacing outdated, siloed IT systems that today inefficiently support Medicaid.

3. Health Insurance Exchanges: At the core of the Affordable Care Act is the mandate for states to establish health insurance exchanges, utilize the federal insurance exchange or enter into a partnership with CMS to stand up an exchange.

The purpose of an Exchange is to provide consumers and small businesses a single point of entry to obtain health coverage or buy affordable health insurance coverage. Health insurance exchanges could certainly function without the mandate in the event it is struck. Indeed, there is great benefit in providing consumers the opportunity to select among competing insurers offering standardized products so they can easily compare offerings and make smart choices.

A critically important component of the ACA is the offer of insurance affordability programs including Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions (CSRs), as well as other incentives that will likely remain in place if the Supreme Court strikes the individual mandate only. These programs will assist people who earn too much money to qualify for Medicaid, but are still lower-income households struggling to afford health insurance. By using the APTC and CSR to offset the cost of monthly insurance premiums, coverage will now be more affordable for this population.

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Lowering out-of-pocket costs can make a big difference and, hopefully, will offer a real incentive for these consumers to purchase health insurance. Increasing the number of people who have insurance helps to lower the overall risk pool and, it follows, the overall costs. Legislation-driven or otherwise, this is a win-win strategy and states should not abandon such programs in the event the mandate is struck from the ACA.

ACA: win or lose – patients still stand to win
Let there be no doubt, the ACA ruling is on everyone’s mind. But, win or lose, the core tenets of the ACA – modernizing eligibility and enrollment systems, expanding coverage for those in need, making insurance more affordable, understandable and accessible for millions of uninsured Americans – are issues the nation must continue to address.

Our national fiscal health and the well-being of many residents depend upon these types of reforms. Indeed, with so much at stake, changes can, and must, happen with or without the ACA as we know it today.

For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.