The Affordable Care Act & How It Affects You

On June 28, 2012 the U.S. Supreme Court handed down a historic ruling upholding the constitutionality of the Affordable Care Act’s (ACA) individual mandate. In a 5-4 decision, the Supreme Court ruled that Medicaid expansion can be optional, and prevents the federal government from cutting off existing Medicaid funding to states that choose not to proceed with the expansion. The ruling was ultimately decided by the majority opinion of Chief Justice Roberts and joined by Justices Breyer, Ginsburg, Sotomayor, and Kagan. Justices Scalia, Kennedy, Thomas and Alito however, issued a dissenting opinion and argued the entire ACA be struck down.

The ultimate question becomes, how will this decision affect you?

The main points to highlight in this ruling are as follows:

  • The Federal Government will now cover 100% of Medicaid costs until 2017. However, states can still decide not to expand Medicaid eligibility in 2012 to 133% FPL.  Depending on how many states decide to expand coverage, over 14 million people could be left with no access to Medicaid or exchange subsidies.
  • Consumers who can no longer afford their insurance or have been denied coverage for preexisting conditions are now more likely to gain access to insurance through exchanges beginning in 2014.
  • And yes, health plans will still continue to pursue Medicaid managed care, individual insurance products, regional consolidation, and broader engagement with the care delivery system.
  • Many providers will begin to see a greater number of patients with insurance coverage after 2014, relieving some of the financial burden they previously experienced when treating uninsured patients.

This historic ruling is expected to make a huge positive impact on health care, and predicted to move ahead at a very fast pace.

Information retrieved July 3, 2012 from Avalere Health LLC. Article; Supreme Court Ruling on the ACA overview and implications. (pp.1-9)

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