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- The Supreme Court ruled on the constitutionality of the Affordable Care Act in 2012
- The case of NFIB v. Sibelius was an attempt to declare the law invalid
- The Court ruled on the individual mandate In NFIB v. Sibelius
- The Court ruled on the Affordable Care Act’s subsidy provisions in 2015
- The Court upheld the power of the IRS to make subsidies available to citizens in states that failed or refused to establish insurance exchanges
The Supreme Court reviewed the Affordable Care Act in many of its parts. Among other issues, these cases involved contraception, employer religious objections, subsidies, and the constitutionality of the individual mandate. Two major challenges to the Affordable Care Act were the cases entitled NFIB v.Sibelius, and King v. Burwell. Both cases had substantial backing from opposition groups and were aimed at judicial repeal of the Affordable Care Act.
The earlier case was NFIB v. Sibelius decided in 2012, and the later was the King v. Burwell case decided in 2015. The Court ruled in favor of the Affordable Care Act on both occasions but modified parts of the Medicaid Expansion in King v. Burwell.
The Affordable Care Act made drastic changes in the healthcare and insurance industries. These fundamental reforms favored the consumer in ways not seen before.
Consumers got powers and protections along with a wide array of coverage choices. They got spending limits, guaranteed economic value, and additional assurances that the insurance they purchased would provide minimum effective coverage.
Insurers could no longer deny coverage and not leave them wanting in times of medical need by cancellations or price increases.
The Individual Mandate
The heart of the Affordable Care Act is the requirement that every person get and keep health insurance coverage. The law set standards for insurance policies, and the plans must be qualified health plans within the meaning of the rules.
The Supreme Court reviewed the power of the Congress to enact the individual mandate. The Court supported the requirement on tax grounds rather than as a mandate. The Court endorsed the power of the Congress to enact the individual mandate inNFIB.v Sibellius.
Lawsuits Challenge the Affordable Care Act
Immediately upon signing the law, the Obama Administration received some legal challenges from states, private political groups, and industry associations. Although the law had extensive fact-finding, Congressional Committee hearings, and a solid record to justify the need for reform and coverage, it attracted deep and determined opposition.
Florida and Virginia were among the first to file, and they refused to expand Medicaid despite the fact that a substantial number of its uninsured citizens would gain insurance coverage.
The ACA offered generous provisions for covering state costs and providing technical assistance. The theme of the opposition was similar throughout. It had little to do with the benefits to the public and a great deal to do with a philosophy of government.
The nation voted for national health insurance in 2008, and again in 2012. By a wide majority, the voters expressed their support for the grand experiment in national health insurance. The public concerns included the rising costs of medical care and the potential collapse of public health infrastructure due to the burdens of uninsured patients and unpaid medical bills.
As a nation, the US paid far more for health costs than other advanced nations and got far less in return as both the costs of healthcare and the national health levels were unsatisfactory.
The political opposition to the Affordable Care Act was fierce and by many accounts unprecedented for a social program that involved giving citizens better health and longer life spans. Well financed opposition groups spent hundreds of $millions to stop the law from passage and implementation.
The Supreme Court modified the rules that carry out the Affordable care Act by determining that states have the power to opt out of Medicaid Expansion.
The court ruled that the Secretary of HHS could not act to withhold all of a state Medicaid funds for noncompliance with the expansion.
The Court limited the authority of the Secretary to force compliance. Since the Secretary cannot withhold funds for noncompliance, the compliance is essentially voluntary. States can opt out by giving due notice.
Repeal in Congress
During the Obama Administration, after the mid-term elections in 2010, the Republican Congress voted to repeal the Affordable Care Act. They also proceeded to cut and block parts of the law through the appropriation process. Without funds, some parts of the law faltered or failed. The COOPs ( Consumer-Owned and Operated Programs) were a prime example.
Congress cut the risk protection needed to start a new generation of health care insurers and providers. The benefits intended by the Congress when it passed the law, were systematically interfered with by the later Congress. The effect was to block the law’s benefits from getting to the beneficiaries.
Other major reform legislation such as Social Security and Medicare did not get such a hostile reception in Congress nor the states. There was a sense that, once enacted and signed into law, the public interest required an effort to make the law work.
States with Republican Governors and legislatures uniformly tended to refuse to work with the Affordable Care Act. Some took extreme measures such as banning Obamacare navigators.
One state abolished its insurance regulation department to avoid cooperation. States that worked with the Affordable Care Act such as California, New York, and Illinois got federal funding to create management functions, organize assistance resources, and extend vital benefits to their citizens. These included the below-listed state actions.
- Establish a state insurance exchange.
- Monitor pricing and plan quality as an active purchaser.
- Expanding Medicaid to cover persons unable to afford marketplace plans.
The Affordable Care Act Passes Constitutional Review
In King and NFIB, the Supreme Court endorsed the constitutional basis for the Affordable Care Act. It does not represent a major extension of government power. The mandate is a vehicle to encourage insurance coverage, and any person affected by it can get coverage, pay the penalty, or get an exemption.
The Congress took care to extend benefits and financial assistance to individuals, and the state governments could play a vital role in improving medical care and health for its citizens.
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