U.S. Supreme Court Upholds Health Care Statute
By a narrow and surprising 5 to 4 margin, the Supreme Court voted to uphold most of the Patient Protection and Affordable Care Act (ACA) on June 28. Even more surprising was the deciding vote which was cast by conservative Chief Justice John Roberts, Jr. Thus barring future Congressional or court action regarding the ACA, the law will become fully effective on January 1, 2014. The one major component of the decision that narrows the ACA relates to Medicaid coverage.
ACA Significance to Disability
Numerous provisions in the ACA are intended to broaden coverage for people with disabilities. For example, health insurers will 1) no longer be able to limit or alter coverage due a person’s pre existing health condition, 2) be prohibited from canceling coverage due to a change in health status, and 3) be disallowed from placing lifetime caps on health care costs. Already in effect is an ACA provision that has saved seniors and people with disabilities approximately $3.7 billion on prescription drugs. Most importantly, the Court’s decision does not alter any current Medicaid eligibility or services.
The Medicaid Ruling
By a 7 to 2 vote, the Court did limit a key ACA provision that sought to significantly expand Medicaid benefits to low income individuals and families. That provision was intended to provide Medicaid services to 16 million Americans with incomes below 133% of poverty. A number of individuals with milder forms of intellectual disability who earn at or near the minimum wage could receive Medicaid coverage under this provision. The ACA would have required every state to expand its Medicaid program or lose existing Medicaid funding. During the unusual three day arguments before the Court, a full day was dedicated to this provision.
The states that opposed the Medicaid expansion argued, successfully, that the Medicaid expansion and its sanctions were coercive and punitive. The Court decision allows the Medicaid expansion to stand but permits any state to opt out without having its existing Medicaid program undermined. A number of states are expected, at least initially, to opt out. The Governors of Florida and Texas have already announced their intention to opt out. Many other states, particularly those dominated by conservatives, are pondering whether or not to go forward with the expansion. The ACA provides strong incentives for states to expand their Medicaid coverage. The law provides 100% federal funding for the expansion for the first three years and states would have to contribute no more than 10% in the out years. This compares very favorably with the average 40% Medicaid state match under current law. Overall, the Medicaid expansion is expected to cost $619 billion over 10 years. According to a USA Today poll of states, New York is among the top states that are preparing to fully implement the ACA.
What Does the Future Hold for ACA Implementation?
With just less than a year and one half before implementation, lots must be done and several potential pitfalls loom ahead. More lawsuits are anticipated to scale back the law or further delay its implementation. Every state must work out its plans for implementation. The federal government must continue its ongoing efforts to assist states and to build its own capacity to shape and monitor the law’s implementation.
The Republican-dominated U.S. House of Representatives scheduled another ACA repeal vote on July 11, which passed 244 to 158. The Senate, however, is unlikely to schedule such a vote, thus killing a repeal this year. Congressional conservatives may also attempt to derail implementation by reducing funding to those federal agencies charged with implementation.
The ultimate future of the ACA will be dependent on the upcoming November election. Republican presidential candidate Mitt Romney has repeatedly expressed his intention to repeal the ACA if elected president. House and Senate Republican leadership have expressed similar desires. The repeal efforts will be stymied if President Obama is reelected.
Expect many more bumps in the road before the ACA’s promise is realized.
Consultant on Governmental Affairs, NYSARC, Inc.