Supreme Court Upholds Most ACA Provisions
June 29, 2012
After two years of legal review, the nation's highest court issued a ruling yesterday on several combined cases regarding the Constitutionality of the 2010 Patient Protection and Affordable Care Act legislation. The justices upheld or partially upheld the constitutionality of the law in all four arguments before the court. Perhaps the most important ruling in terms of keeping the law alive was a narrow 5-4 decision with Chief Justice John Roberts joining with the four more liberal justices to uphold the individual mandate on the grounds that although it is referred to as a penalty, it is in fact structured as a tax.
The justices in a 7-2 ruling partially upheld the Medicaid expansion provision, but also ruled that the states that fail to accept the expansion cannot be penalized by withdrawal of their current Medicaid benefits. This may be a problematic development in that states that have an ideological hostility towards Medicaid might choose to exercise their option not to expand. However, it does allow the benefits of the expansion, including federal matching payments that start at 100% in 2014 for three years then dropping to 90% by 2020 to remain in place. These matching funding levels, even at 90%, exceed what is currently available. The court also resolved the issue of whether or not it was too early for people to sue, by deciding that the penalty was not a tax for the purposes of the anti-injunction act and that therefore they could bring the lawsuits. Since they upheld the law, the issue of severability -- whether or not the court was obligated to strike down the entire law if they found parts of it unconstitutional -- was not reached.
In a political sense the court's ruling will likely have two strong effects. First it makes access to health care a campaign issue with sharp contrasts between Republican and Democratic candidates at most levels of the government. Republicans have sworn to repeal the Affordable Care Act, although they have also said that they would replace it with some type of access to care. There has not been a serious effort to describe what a Republican plan would look like, however. Second, it is very clear that some states may not accept the Medicaid expansion due to philosophical grounds. This is an extremely problematic issue since the people most affected would be low income individuals below 100% of the Federal Poverty Level who would not be eligible for Medicaid but would also not be eligible for subsidies for the health insurance exchanges. This is also a population that is overrepresented with people living with HIV about which AIDS United is especially concerned. Going forward, AIDS United has called on all states to move forward on the expansion and will focus strongly on ensuring that this happens.
This article was provided by AIDS United. Visit AIDS United's website to find out more about their activities and publications.
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