By Lorraine Gonzalez-Camastra, Children’s Defense Fund – New York
The letter of the law versus the spirit of the law is an idiomatic antithesis. When one adheres to the letter but not the spirit, one is following the literal interpretation of the language, but not the intent of those who created the law. Conversely, when one does the opposite, one is holding to what is intended, though not necessarily adhering to literal wording. The best case scenario is when the two are in sync and the language of the law can clearly convey the intent, so that what is practiced achieves the desired outcome. In most cases, this level of harmony is never completely achieved. Therefore, it is essential that when the law is executed, the spirit by which it was created serves as the litmus test for success in administration.
The Patient Protection and Affordable Care Act (ACA) – the United States’ law of the land – was enacted in 2010 with the intention of affording all Americans the opportunity to access health care. One significant provision of the law requires that states establish health insurance exchanges and subsidize insurance premiums for individuals in households with income up to 400% of the federal poverty level.i As states work to execute this mandate, it is of utmost importance that these exchanges do not fall short of the law’s spirit, or expectation that they effectively achieve the desired outcome – to successfully enroll and retain consumers in health insurance plans in order to grant all Americans access to health care.
In building health insurance exchanges, unique characteristics of all populations need to be carefully considered to fruitfully meet the ACA’s objective. Adherence to the letter of the ACA but not the spirit can, potentially, exploit technicalities, loopholes and any ambiguous language of the law. Therefore, it is important that states build sound infrastructure in their exchanges to ensure user-friendly systems for consumers.
New York has historically been a leader and innovator in developing policies and systems for affordable, accessible health coverage for children and families. More specifically, as one of a handful of progressive states in offering “universal coverage” for children since 2008, New York State has built an entrée for health care for all children. Creating a Child- and Family-Friendly Health Insurance Exchange in New York can be realized as this trendsetting state leverages the existing provisions of the ACA in combination with the lessons learned from the existing framework for coverage. It’s critical that New York’s state officials seize this moment and not scale back in investing in exchange infrastructure that offers robust outreach and education, secures a seamless enrollment pathway, eliminates coverage gaps and churning and adopts a benefit package that offers optimal care for consumers. In accomplishing these objectives, the progressive Empire State will be offering a meaningful exchange for all children and families.
