Recently, the United States Supreme Court issued its long-awaited decision on the constitutionality of the Patient Protection and Affordable Care Act (the “Act”). In a 5 – 4 decision, with Chief Justice Roberts writing for the majority, the Court upheld the constitutionality of the controversial individual mandate and, thus, the remainder of the Act, with one exception discussed below. The Court upheld the individual mandate on the grounds that it was within Congress’ taxing power to require those who choose to not purchase health insurance to, in essence, pay a tax. A majority of the Court did not agree that the individual mandate was a valid exercise of Congress’ power to regulate interstate commerce.
Importantly, the Court overturned the provision of the Act that would have allowed the federal government to take away all Medicaid funds from states that chose to not extend Medicaid coverage to all individuals under the age of 65 with incomes below 133% of the federal poverty level. This could mean that a number of states will opt out of the Medicaid expansion thereby reducing the number of currently uninsured who will receive coverage in 2014.
The Court’s decision means that all of the other provisions of the Act will remain in place including guaranteed issue, no lifetime caps, no exclusions for preexisting conditions, payment and delivery system reforms such as ACOs, and enhanced fraud and abuse enforcement powers.
The decision does not necessarily mean that the Act cannot be repealed by congress or a new president. Congressional Republicans have stated they will continue their efforts to defund the Act, and to repeal it if Gov. Romney becomes President and Republicans take control of both houses of Congress.