The Supreme Court Has Ruled: Now What?
On June 28, the U.S. Supreme Court released a landmark decision regarding the constitutional challenges to the Patient Protection and Affordable Care Act (ACA). The main issues under consideration by the Court were the constitutionality of the “individual mandate” section of the law, requiring all Americans to be insured by 2014, and the Medicaid expansion provisions. The Court’s 5-4 decision largely affirmed the constitutionality of the ACA, while limiting the impact of the Medicaid expansion provisions. In a majority opinion written by Chief Justice John Roberts, the individual mandate was upheld under Congress’ authority to levy taxes. There was not a majority of the Justices to uphold the individual mandate under the Commerce Clause or the Necessary and Proper Clause, which were the two primary arguments the government presented during its oral arguments. Private and state plaintiffs had argued that Congress did not have the power to enact a law that would require all citizens to purchase health insurance or pay a penalty. With this decision, the majority of Americans must purchase “minimum essential” health insurance coverage by 2014. If they opt to not purchase the coverage, they must pay a penalty to the IRS together with their taxes. Since the Court upheld the individual mandate, the Court did not have to decide whether the individual mandate would be severable from the law. When the Court addressed the Medicaid expansion provisions, it limited, but did not invalidate, the provision that sought to cover all adults younger than 65 with household incomes below the poverty level. The Court held that Congress cannot threaten the states with the loss of all federal Medicaid funding if the states declined to expand Medicaid coverage as mandated by the ACA. However, if a state decides to accept the new ACA Medicaid expansion funds, it must abide by the new expansion coverage rules. If a state chooses not to participate in the expansion, it is limited to the loss of Medicaid expansion funds, and cannot lose all of its funds under the current Medicaid program. The states thus have a financial incentive to comply, but they must choose to accept or reject the new requirements without consequences to existing programs. Since the release of the Court’s decision, states have felt the pressure to move forward with complying with the majority of the ACA’s provisions. The states’ actions leading up to the Court’s decision will now influence their progress in implementing healthcare reform. As of September, 16 states and the District of Columbia had already established exchanges and other states have made substantial steps toward creating exchanges. In addition, a number of states have indicated they will not participate in the Medicaid expansion program. Although the AAO-HNS did not support the final version of the healthcare reform law when it was enacted in March 2010 due to reasons unrelated to the individual mandate and Medicaid provisions, the Academy recognizes the need for, and supports substantive reforms to, the nation’s healthcare delivery system. With the Court’s decision, the AAO-HNS expects the next few months to be challenging as the next chapter of the healthcare reform debate is written, and the national elections approach. The Academy’s Government Affairs team will continue to actively monitor Congressional and Administrative responses to the Court’s ruling and their effect on Academy members and their patients. Immediately following the Court’s decision, the Republican-controlled U.S. House of Representatives passed legislation to repeal the ACA. As expected, the proposal stalled in the U.S. Senate. Repeated efforts to repeal all or some of the provisions are expected to continue into 2013. As this debate continues, please help us ensure the specialty’s voice is heard on Capitol Hill to protect the interests of both physicians and their patients. To receive timely updates on legislative and political issues and access to legislative action alerts, join the ENT Advocacy Network today—a free AAO-HNS member benefit. If you have questions regarding the Supreme Court’s decision, implementation of the ACA, or the Academy’s legislative priorities, please email the Government Affairs team at govtaffairs@entnet.org.
On June 28, the U.S. Supreme Court released a landmark decision regarding the constitutional challenges to the Patient Protection and Affordable Care Act (ACA). The main issues under consideration by the Court were the constitutionality of the “individual mandate” section of the law, requiring all Americans to be insured by 2014, and the Medicaid expansion provisions. The Court’s 5-4 decision largely affirmed the constitutionality of the ACA, while limiting the impact of the Medicaid expansion provisions.
In a majority opinion written by Chief Justice John Roberts, the individual mandate was upheld under Congress’ authority to levy taxes. There was not a majority of the Justices to uphold the individual mandate under the Commerce Clause or the Necessary and Proper Clause, which were the two primary arguments the government presented during its oral arguments. Private and state plaintiffs had argued that Congress did not have the power to enact a law that would require all citizens to purchase health insurance or pay a penalty.
With this decision, the majority of Americans must purchase “minimum essential” health insurance coverage by 2014. If they opt to not purchase the coverage, they must pay a penalty to the IRS together with their taxes. Since the Court upheld the individual mandate, the Court did not have to decide whether the individual mandate would be severable from the law.
When the Court addressed the Medicaid expansion provisions, it limited, but did not invalidate, the provision that sought to cover all adults younger than 65 with household incomes below the poverty level. The Court held that Congress cannot threaten the states with the loss of all federal Medicaid funding if the states declined to expand Medicaid coverage as mandated by the ACA. However, if a state decides to accept the new ACA Medicaid expansion funds, it must abide by the new expansion coverage rules. If a state chooses not to participate in the expansion, it is limited to the loss of Medicaid expansion funds, and cannot lose all of its funds under the current Medicaid program. The states thus have a financial incentive to comply, but they must choose to accept or reject the new requirements without consequences to existing programs.
Since the release of the Court’s decision, states have felt the pressure to move forward with complying with the majority of the ACA’s provisions. The states’ actions leading up to the Court’s decision will now influence their progress in implementing healthcare reform. As of September, 16 states and the District of Columbia had already established exchanges and other states have made substantial steps toward creating exchanges. In addition, a number of states have indicated they will not participate in the Medicaid expansion program.
Although the AAO-HNS did not support the final version of the healthcare reform law when it was enacted in March 2010 due to reasons unrelated to the individual mandate and Medicaid provisions, the Academy recognizes the need for, and supports substantive reforms to, the nation’s healthcare delivery system. With the Court’s decision, the AAO-HNS expects the next few months to be challenging as the next chapter of the healthcare reform debate is written, and the national elections approach.
The Academy’s Government Affairs team will continue to actively monitor Congressional and Administrative responses to the Court’s ruling and their effect on Academy members and their patients. Immediately following the Court’s decision, the Republican-controlled U.S. House of Representatives passed legislation to repeal the ACA. As expected, the proposal stalled in the U.S. Senate. Repeated efforts to repeal all or some of the provisions are expected to continue into 2013.
As this debate continues, please help us ensure the specialty’s voice is heard on Capitol Hill to protect the interests of both physicians and their patients. To receive timely updates on legislative and political issues and access to legislative action alerts, join the ENT Advocacy Network today—a free AAO-HNS member benefit. If you have questions regarding the Supreme Court’s decision, implementation of the ACA, or the Academy’s legislative priorities, please email the Government Affairs team at govtaffairs@entnet.org.