Many in the cancer community watched this decision closely, as there are provisions in the ACA that have a direct impact on the lives of those touched by cancer.
As with many other issues related to cancer, there is a lot of confusion about the ACA and about what the Supreme Court decided. Even major news organizations initially misunderstood the ruling and announced that the law had been struck down.
It is important to realize that the ACA was signed into law on March 23, 2010, and has been in effect since then. Many parts of the law have already been implemented, but there is still work to be done by each state as well as by federal agencies, such as the U.S. Department of Health & Human Services. In addition, some parts of the law will not go into effect until January 1, 2014, including the one that keeps insurance companies from denying health insurance coverage to adults with pre-existing medical conditions, such as cancer. For information on the first two years of the ACA’s implementation, click here.
Here are the questions answered by the Supreme Court:
May Congress require most Americans to have health insurance coverage or pay an annual penalty?
In a 5-4 decision, written by Chief Justice John Roberts (appointed by President George W. Bush), the Supreme Court held that although the law used the word “penalty” the consequence for not having health insurance was really just a tax, something that Congress is permitted to create under the Constitution. Chief Justice Roberts wrote “taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry.”
So, Americans have a choice: have health insurance and pay lower taxes, or not have health insurance and pay higher taxes. The reason this one provision of the ACA is so important is because the ability to lower health care costs relies on everyone (with limited exceptions of undocumented immigrants, those with religious objections, etc.) participating in the system. The ACA does allow you to be without insurance for up to 3 months during the year. It is also important to understand that the penalty/tax for not having health insurance coverage in 2014 will be $95.
The Supreme Court ruled that it is constitutional for Congress to ask states to expand Medicaid programs, writing “[n]othing in our opinion precludes Congress from offering funds under the Affordable Care Act 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.” In other words, even if states do not expand their Medicaid programs they will continue to get federal funds to run their programs, they just won’t get the extra federal funds to expand their Medicaid programs.
This is concerning to many in the cancer community, because it leaves it up to states to decide if they want to expand their Medicaid programs. The potential problem is that the subsidies that will be available to individuals with incomes between 133-400% of the FPL to buy health insurance coverage are NOT available to individuals with incomes under 133% of the FPL. Those individuals are supposed to have access to Medicaid. However, if they live in a state that does not expand Medicaid coverage, we do not know what will happen with those individuals.
This is just an overview of the decision, as the decision is 193 pages and includes concurring and dissenting opinions from multiple Supreme Court Justices. To read the whole decision, click here. Just like digesting and understanding the original bill, fully sorting out the impact of this decision will take some time. And, certainly, these issues will continue to be discussed through the elections in November.
It is important to get the facts about health care reform and how they might impact you. If you have questions about the ACA, its provisions, and its timeline, www.HealthCare.gov is an excellent source of national and state information.
This blog post was contributed by Joanna L. Morales, Esq. Joanna has served the cancer community as a cancer rights attorney, advocate, speaker, and author for over 18 years. She is CEO of Navigating Cancer Survivorship, a nonprofit organization providing education on the continuum of cancer survivorship issues. She was formerly an Adjunct Professor at Loyola Law School, teaching cancer rights law. She can be followed on Twitter @CancerRights.