On June 28, 2012 the Supreme Court announced its decision to uphold the Affordable Care Act (ACA).
The court ruled that Congress had the authority to impose a tax (penalty) on people who choose not to buy health insurance. It also upheld the constitutionality of the expansion of Medicaid to all persons with incomes up to 133 percent of the federal poverty level, with limits on the ability of the federal government to terminate existing Medicaid funding to states that choose not to expand coverage. This part of the decision will require further analysis of the potential impact on coverage for the poor and near-poor.
By definitively settling the legal questions, the Supreme Court decision to affirm the law allows the country to move forward on the ACA’s programs to improve access to health care. When the ACA is fully implemented in 2014, it will be a huge step forward universal health insurance coverage. While the individual insurance mandate and its impact on access to care were the main focus of this Court case, the ACA is about so much more than this. The law expands health insurance coverage; increases reimbursement and expands training programs for primary care physicians; and substantially reforms our payment and delivery system. The independent Congressional Budget Office estimates that the ACA will lead to $143 billion in savings over the next decade.
The law eliminates limits on annual and lifetime coverage; requires that insurers spend more of their premium dollar on direct patient care; allows coverage of young adults on their parents’ plans; guarantees essential benefits; provides funding for states to expand Medicaid to all persons with incomes up to 133 percent of the Federal Poverty Level; provides no-cost preventive benefits; phases-out the Medicare Part D doughnut hole; raises Medicare and Medicaid payments and funding of programs to support primary care; tests new patient-centered payment and delivery models; and funds research on the effectiveness of different treatments. Taken together, these reforms aim to improve health care for everyone, even those of us who are already insured.
We have already seen the early impact of the ACA: increasing the number of young adults with insurance, thanks to allowing them to remain on their parents’ policies until age 26, prohibiting withdrawal of health insurance when people get sick, reducing the amounts seniors must pay for prescription drugs, and eliminating cost sharing for preventive services in Medicare and private insurance.
The Supreme Court decision will clearly be front and center during this fall’s elections. As both voters and patients it is important we educate ourselves on the issue as the ultimate outcome will affect the health of our country for decades to come.