What Now? Health Reform in the Aftermath of the Supreme Court Decision.
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Transcript of What Now? Health Reform in the Aftermath of the Supreme Court Decision.
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What Now? Health Reform in the Aftermath of the S. Ct. DecisionJaime S. King, JD, PhDUCSF/UC Hastings Consortium on Law, Science and Health PolicyJune 29, 2012
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Two Major Holdings Individual Mandate upheld
4 Justices upheld it via the Commerce Clause (Ginsburg, Sotomayor, Kagan, and Breyer)
Chief Justice Roberts upheld it as a tax.
Medicaid Expansion Federal government may incentivize the expansion
Roberts, Kagan, Breyer, Ginsburg, Sotomayor But, the Federal Government cannot withdraw all
Medicaid funds for failure to expand Roberts, Kagan, Breyer, Scalia, Alito, Kennedy,
Thomas
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Major Elements of the ACA Upheld
Individual Mandate
Employer Mandate/Play or Pay
Premium and Cost Sharing Subsidies
Medicaid Expansion (limited)
Health Insurance Exchanges
No Preexisting Condition Exclusion
Community Rating
Dependents can stay on insurance until age 26
Payment Changes in Medicare
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Health Law and Policy Initial Implications2014 – Nearly all individuals will have to
purchase health insurance or pay a tax.
Medicaid Expansion – Opt In
State Exchanges – Back on Track
Future Litigation/Repeal Efforts
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No “Broccoli Horrible”
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Mandate vs. Tax
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Medicaid Expansion – Opt InPrior Medicaid
Eligibility Disabled
Blind
Families with Children
Elderly
ACA All individuals with
incomes under 133% of the Federal Poverty Level
ACA Following S. Ct. Ruling 133% only if state
decides to expand
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What will the States do?
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Medicaid/Tax Credit Ineligible? $15,000 Total Income for 2 $90,000 Total Income for 4
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Exempt from the Individual Mandate, but No Subsidy?
100% FPL
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Strategies to Undermine the Health Law
Repeal and Replace Entire Bill
Repeal Portions of the Bill
Litigate HHS Regulations
Limit Appropriations
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Difficult to Repeal and Replace All of it….
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Is This the End of the Fight?Repeal and Replace Entire Bill
Repeal Portions of the Bill
Litigate HHS Regulations
Limit Appropriations
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Intersection of Law, Science and Health Policy