Let’s just get right to it. We all know why I’m here today, rather than making my normal appearance on Wednesdays, and we all know what news we’re all waiting for, so here it is.
In a stunning 5-4 decision, the Supreme Court has upheld the most controversial segments of the Patient Protection and Affordable Care Act. Voting in favor of the law were Justices Breyer, Sotomayor, Kagan, Ginsburg and (the absolute surprise of the day) conservative Chief Justice John Roberts. Dissenting were Justices Kennedy, Alito, Scalia and Thomas.
As I write this, the opinions from both sides are still being read from the bench, but already, there is one big change to the law as dictated by the court. As the law was originally written, Congress would make funds available for the expansion of Medicaid programs, but could penalize states by withdrawing all Medicaid funds from a state if it refused to participate. The Supreme Court has invalidated this provision. As Justice Roberts clarified in his opinion:
“Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”
Other than this funding change to the mandate, the entirety of the law stands.
So to review, here’s what we have:
- People without insurance are required to purchase coverage. This is also known as the “individual mandate”. Those who do not would be subject to a tax. This will be equivalent to roughly 6% of the entire adult population;
- Because the individual mandate has been ruled constitutional, the question of “severability”, or separating the mandate from the rest of the law, is a moot point;
- Children up to age 26 can be covered under their parents’ plans;
- There will be no such thing as a “pre-existing condition” as of 2014;
- Medicaid will expand its definition of covered individuals to broaden the coverage pool;
- Medicaid RACs can now operate freely in order to detect improper payments from Medicaid plans across the country;
- New payment models that apply to hospitals can go forward uninterrupted; and finally,
- John Paul Spencer has the equivalent of a four-egg omelette on his face
Had I placed a high dollar bet on what today’s decision would have been, I would be declaring bankruptcy about 15 minutes from now. This is why my wife Leslie does the books in our house, and I type here for the general entertainment of the masses.
The decision that was released within the past hour is going to change things. There will certainly be attempts by one-half of Congress to overturn the entire law, but that path faces an impossible road in the short term based on the party make-up of the Senate and the White House.
I leave it to others to determine the political “winners and losers” of today’s decision, but the American health care system has been changed permanently with today’s decision. Cue your inbox, grab the popcorn and let the rhetorical games begin.