Thursday, June 28, 2012

Supreme Ct finds individual mandate in the Affordable Care Act constitutional

Today the US Supreme Court (SCOTUS) issued its ruling that the part of the Affordable Care Act (ACA, also known as Healthcare Reform and Obamacare) that requires individuals to purchase health insurance does not violate the US Constitution. Chief Justice Roberts issued the majority opinion in the 5-4 decision (Ginsburg, Breyer, Sotomayor, and Kagan joined Roberts in the majority, Kennedy, Scalia, Alito, and Thomas voted no).

Chief Justice Roberts actually rejected the Commerce Clause argument made by the government to support the mandate, explaining that the ACA creates commerce rather than merely regulating it, and that is not a valid exercise of federal power. The opinion relies instead on interpreting the mandate as creating a tax on citizens via the penalty for those who do not purchase health insurance, and the federal government's power to tax is well settled.

Also at issue in the case was the constitutionality of requiring the states to expand their Medicaid programs by broadening their eligibility criteria and therefore requiring more matching funding. Though the majority found that Congress did act within its constitutional power in the ACA provisions by offering states additional federal funds to expand Medicaid, but found that it would not be constitutional to cut off all federal Medicaid funding to states who refuse the expansion. Rather, those states must have the option of continuing to receive federal Medicaid funds if they keep their current Medicaid plans in place.

What does this decision mean for WV seniors?

None of your Medicare benefits are taken away by the ACA or by this SCOTUS decision, including the right to choose your own doctor, hospital, and other medical providers. The ACA actually increases some benefits under Medicare including eliminating cost-sharing for preventive services and eventually eliminating the "donut hole" of coverage under Medicare Part D (the point of spending in the year when people with high drug costs would no longer have any prescription drug coverage at all until they reached a level of need considered "catastrophic").

The ACA creates several quality initiatives that remain in place after the decision. They include new reporting requirements for providers, linking payments between hospitals and other providers to increase more effective transitional care, a standardized complaint form for nursing home residents and creation of new complaint procedures, criminal background checks for nursing home staff and new reporting requirements regarding nursing home staffing, and care coordination programs to reduce preventable hospitalizations.

The ACA includes new initiatives aimed at improving the long-term fiscal health of Medicare, including adjustments to the federal government's Medicare Advantage plan payments and creating the Independent Medicare Advisory Board to study and make recommendations for long-term savings.

The Money Follows the Person demonstration programs designed to encourage states to transition Medicaid nursing home residents back out to the community, of which West Virginia currently has one, are extended through 2016 under the ACA.

There are several initiatives designed to expand and improve the geriatric care workforce under the ACA, including money to Geriatric Education Centers, of which we have one in West Virginia, to training, curriculum development, and best practices among various professionals in geriatrics.

Transgender people may benefit from the ACA's elimination of pre-existing conditions as a barrier to purchasing health insurance. LGBT people should benefit from the new data collection requirements aimed at uncovering LGBT health disparities, the new Patient Bill of Rights, and expanding the National Health Service Corps which among other things provides cultural competence training to healthcare workers in LGBT issues.

The ACA is a large-scale reform that includes many details, so the above is merely a short list of highlights for older West Virginians. To learn more about the ramifications of the ACA decision check out


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