This morning, the Supreme Court upheld the Affordable Care Act (ACA) on a 5-4 vote.
In a largely unexpected decision, Chief Justice John Roberts joined with the four Democratic appointees on the court to uphold the law, classifying the individual mandate as a tax, not a legitimate government regulation made possible by the Constitution's Commerce Clause.
The court did, however, substantially limit a major piece of the law, one that expanded Medicaid, the joint federal-state program that provides health care to poor and disabled people.
Seven justices agreed that Congress had exceeded its constitutional authority by coercing states into participating in the expansion by threatening them with the loss of existing federal payments. Chief Justice Roberts argued that the federal government could not compel states to comply by cutting off all federal money they receive for existing Medicaid programs. That aid represents over 20 percent of the average state's total budget, with federal funds covering anywhere from 50 to 83 percent of those costs.
Here are some key provisions of the ACA:
- Insurance companies will no longer be able to impose lifetime coverage limits.
- The use of annual coverage limits will be sharply limited as well, and will be entirely eliminated in 2014.
- Insurers can no longer limit children's coverage to exclude a specified preexisting condition (preexisting condition exclusion).
- A special, temporary program will help adults with preexisting conditions get coverage. The program is set to expire in 2014, when the health insurance exchanges—basically big pools of businesses and individuals—will come online. At that point, all insurers will have to cover everyone, regardless of preexisting conditions.
- Insurance companies will no longer be able to drop coverage when a person gets sick (rescissions).
- Young adults will be eligible to stay on their parents' insurance until age 26.
- Seniors will receive $250 towards closing the "doughnut hole" in their prescription drug coverage. Currently, prescription drug coverage ends once a senior has spent $2,700 on drugs and it doesn't kick in again until he or she has spent nearly $6,200. The AARP has more on immediate health care benefits for seniors.
- Medicare's preventive benefits will come with a free annual visit to a primary care doctor to plan prevention services. In addition, there will be no more co-payments for preventative services in Medicare.
- Small businesses will get big tax credits—up to 50 percent of premium costs—for offering health insurance to their employees.
- Insurers with unusually high administrative costs will have to offer rebates to their customers and every insurance company will have to reveal how much it spends on overhead.
- Free birth control and other preventative services for women will be available for all women who do not work for faith-based organizations that oppose birth control.
Check out this EdWeek piece on the ruling's implications for education spending.
So, what do you think? What questions do you have?
Stay tuned this Monday, July 2, for resources to help you understand and implement the requirements of health care reform in your district.