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Supreme Court upholds Affordable Care Act

Gerard N. Magliocca
Gerard N. Magliocca View print-quality imageHeather McCabe
Heather McCabe Eric Wright
Eric Wright View print-quality image


June 28, 2012

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IUPUI faculty react to today's Supreme Court ruling on the Patient Protection and Affordable Care Act:

Eric R. Wright, Ph.D., professor and interim chair, Department of Public Health, IU School of Medicine, and director, Center for Health Policy at Indiana University-Purdue University Indianapolis:

In all actuality, the Supreme Court’s ruling today will not be the definitive “game changing” moment that the media, many politicians and some average Americans seem to hope it will be. The debate and ultimate passage of the Affordable Care Act in March 2010 focused national attention on some deep and fundamental problems in our health care system. The law set the wheels of change in motion across the health care system. The unfortunate truth is that the road to real reform will be long, bumpy and take many turns. Where we end up will depend on who participates in the decision-making along the way.

The U.S. Supreme Court’s ruling on the ACA today will allow the federal government to remain a full and active partner in the reform process. Few can argue with the fact that the expansion, and threat of further expansion, of federal oversight of health care has been a major catalyst and driven many of the positive changes that we have begun to see since the law was passed just two years ago.

Regardless of one’s opinion regarding the high court’s ruling, one thing is clear: The decision puts more pressure on state governments to join the debate and take a stronger leadership role in the reform efforts. The ACA itself, as well as many of the ensuing ACA-related rules and regulations issued by the Obama administration so far, place enormous responsibility on state governments to make reform actually happen.

With some notable exceptions such as Massachusetts, California and Utah, which seem to be trying to get out ahead of the reform process, many governors and state legislators have remained content to “wait and see” as if the question before the Supreme Court was “to reform or not to reform?” That was not nor has it ever been the question. Everyone knows that reform must happen and that it must happen soon. The long-term vitality and success of our country very well may depend on how good a job we do in fixing our health care woes.

States that deliberately and proactively tackle the formidable dual challenges of reducing health care costs and improving access to high-quality health care for all their citizens will be the states that emerge from this deep and protracted economic recession in a much stronger and better economic position.

Rising health care costs and an unhealthy workforce will remain important drags on our struggling economy for the foreseeable future until we address them, and the Supreme Court’s ruling suggests that it is now time for our governors and state legislatures to step up to the plate, roll up their sleeves and get involved.

Heather McCabe, J.D., MSW, an assistant professor the IU School of Social Work. She also served as the director of the Public Health Law Program and then executive director for the Hall Center for Law and Health at the Indiana University Robert H. McKinney School of Law before coming to her current position. McCabe’s research is primarily in the areas of public health, health policy, health disparities, health reform, nd disability-related policy.

Today, June 28, 2012, we finally have an opinion on the Patient Protection and Affordable Care Act from the Supreme Court. The decision is a win for public health.

First, the court upheld the individual mandate which requires the purchase of insurance (with some exceptions) or the payment of a fine for failure to do so.

Second, because the mandate was found constitutional, the court did not have to reach a decision on severability (whether the rest of the law would stand if one portion was struck down). There was a concern that if the mandate was found unconstitutional, the court might find that the whole law had to be struck.

Third, and most concerningly, the court ruled on whether or not the federal government could use its spending powers to force states to enact Medicaid expansions under the law. The court upheld the Medicaid component of the law but held that states would only lose the new funds if they chose not to participate rather than all Medicaid funding. In other words, rather than losing all federal Medicaid funds if they do not meet the minimum requirements under the PPACA, they only lose the funds related to the new requirements. Over the next few days, it will be very important to examine the opinion to see how the narrow reading of the spending clause may or may not affect the overall spending powers granted to the federal government.

What does this mean?

The ruling means that the PPACA stands overall. The issues concerning pre-existing conditions, coverage of those age 26 and under on parents' insurance, insurance exchanges and others all remain under the ruling. Of concern for those hoping to enact sweeping changes to the Medicaid system will be the extent to which states agree to participate in expansion of Medicaid. Before the ruling, the expansion was mandatory to receive federal Medicaid funds. At this point, it appears the ruling allows states to refuse the expansion and remain with Medicaid in the current form. We will need to read the opinion and watch the states to see how this ruling will affect those who might have been covered by an expanded Medicaid.

Gerard N. Magliocca, Samuel R. Rosen Professor of Law, associate dean for research, Indiana University Robert H. McKinney School of Law:

Following the law and reading the Affordable Care Act in the most natural way (failing to buy health insurance leads to a penalty, not a tax) would have forced (Chief Justice Roberts) to strike down the individual mandate. So he didn't do that. Why? Because a 5-4 straight-line party decision invalidating part or all of the act would have brought the Court into a terrible clash with President Obama.