The Supreme Court Has Ruled, Now What?
The long-awaited Supreme Court decision on the Affordable Care Act arrived on Thursday, June 28. The court upheld the constitutionality of the individual mandate, but did strike down part of the Medicaid expansion provision.
Does this mean we’ve seen the last of challenges to the ACA? And what does the court’s ruling on Medicaid actually mean?
First things first. No, the ruling will not end the challenges to the ACA. The Republicans in Congress have vowed to continue to fight to repeal the law. Given the current makeup of Congress, a repeal will not happen this year. However, the elections of 2012 will play a major role in the future prospects for repeal. If the Republicans maintain control of the House and gain control of the Senate and the Presidency, then repeal of the ACA would likely be the first order of business in 2013. Even if the Republicans do not win the Presidency or gain control of the Senate, Congress can slow implementation of the ACA. For example, it could vote to defund certain provisions of the ACA (like the prevention fund) or decide not to appropriate funds to departments to implement the provisions. To ensure that people are complying with the individual mandate, the IRS will need more personnel and resources. If Congress does not allow more funding to the IRS, then the agency may be challenged to handle that task.
That leaves the question of Medicaid, which is a more complicated matter. In the very short term, the court’s decision on Medicaid doesn’t mean much. But over the next two to three years, it could have a major impact. Assuming that the ACA stands, states can now opt out of the Medicaid expansion provided for in the ACA without fear of losing their previous Medicaid funding. This is a vitally important change because an expanded Medicaid program within the ACA was meant to help many uninsured Americans obtain health insurance. With the recent ruling, states may opt out of the expansion—even though the federal government is covering the cost of the additional enrollees for the first few years—for any number of reasons, including concerns about the long-term cost to the state.
Will some states actually opt out? At this point it is too early to tell.
How will the ruling affect community oncology? ACCC is working to determine the answer to that question. ACCC will hold a conference call in the very near future to explore this ruling and its effects on community oncology. Watch the ACCC website and your email inboxes for more information.
Check out ACCC’s slide presentation on the future of the ACA.