“We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”
– Chief Justice John Roberts
When the United States Supreme Court proceeded to uphold the constitutionality of the most significant components of the 2010 Patient Protection and Affordable Care Act (ACA), many Americans were surprised. Those who follow me on Twitter, Facebook, or LinkedIn know from my posts over the last few months that I was predicting that Justices Roberts and Kennedy would be the swing votes and that they would ultimately decide to uphold the ACA. Not because these Justices agree with the principles of the ACA, but because both justices believe very strongly that the Court’s role in our democracy is very narrow and limited. Congress and the executive branch of the federal government make policy; the Court does not. Whether one agrees or disagrees with the ACA, the Court’s willingness to overturn such massive legislation has traditionally been limited.
The two primary issues before the Court were the constitutionality of (1) the ACA’s “individual mandate,” which requires virtually everyone in the United States to buy health insurance or to pay a penalty for failing to do so (like automobile insurance), and (2) its requirement that states adopt new standards that would have significantly increased the number of Medicaid-eligible individuals (the so-called “Medicaid expansion”), or face loss of federal Medicaid funding.
The “individual mandate” was found to be constitutional and the “Medicaid expansion” provision was upheld, but with a significant limitation. A majority of the Court held that it was unconstitutional for the federal government to cut off all Medicaid funds for states that choose not to go along with the ACA’s “Medicaid expansion.” Such would be “a gun to the head” of the states. Under the Court’s ruling, states that elect not to adopt the more liberal eligibility standards simply will not get the enhanced federal funding provided for the “Medicaid expansion.” States who reject the Medicaid expansion will continue to retain existing Medicaid funding.
Assuming that there are no additional legislative changes, all other requirements under the ACA remain untouched and will (or already have) go into effect as provided in the ACA. Without question, there will be efforts in Congress to revise the ACA. In fact, many Republicans are already positioning their November 2012 campaigns around their commitment to repeal “Obamacare”. But as I outline in my book The New Health Age: The Future of Healthcare in America www.thenewhealthage.com, regardless whether Congressional revision or repeal efforts are successful, many business sectors in America have been hard at work implementing the ACA initiatives that deal with the future world of health care. Physicians are integrating with larger groups or hospitals to prepare for the substantial changes that are coming to the health care reimbursement systems. Health insurance companies are developing new solutions for businesses and people impacted by the individual mandate. Medical device companies are restructuring and realigning their products and relationships. The examples are virtually endless.
Whatever may happen to the ACA in Congress in the years to come, The New Health Age has arrived.
Blalock Walters’ Health Care Group will be providing further information and analysis in the days and weeks to come, concerning how the ACA requirements might affect you and other health care reform-related initiatives.
A copy of the Court’s majority and dissenting opinions (193 pages) are available atwww.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf