For years, a debate simmered around President Barack Obama’s Affordable Care Act (the ACA). Lawsuits challenged mandated healthcare as an unconstitutional intrusion by Congress on individual liberties. States challenged the ACA’s required expansion of Medicaid roles as an intrusion on their sovereignty. Finally, June 28, an unseasonably hot day in Washington, D.C., Chief Justice John Roberts of the U.S. Supreme Court, delivered the 5-4 decision, finding the ACA constitutional. Americans must purchase healthcare insurance. Now what?
When the ACA was signed into law on March 23, 2010, a stream of benefits began well before the 2014 deadline for mandated insurance coverage. Now, individuals could receive coverage despite pre-existing conditions. Emergency hospital care could come from outside the patient’s insurance network. Children are now covered under their parent’s plan to age twenty-six.
For seniors, free preventive services became available in 2011. Seniors on Medicaid who reach the coverage gap receive a 50% discount when buying Medicare Part D covered brand-name prescription drugs. For the disabled, the ACA offers home and community-based services through Medicaid as opposed to only nursing home care. Soon, insurance companies will no longer be able to charge higher rates due to gender or health status.
By 2014, everyone must have health insurance. Coverage may come from private insurance, employers, or the government. In 2015, anyone without health insurance may be assessed a financial penalty. This assessment was the pivotal issue in the U.S. Supreme Court’s decision supporting the ACA. Under the ACA, the financial penalty for failing to acquire health insurance is paid on an individual’s tax form. The Court determined the financial penalty for not obeying the ACA was a tax. Congress has the power to tax. Therefore, the ACA is constitutional.
For those unable to afford healthcare or with religious restrictions, there are penalty waivers. In 2014, if an employer does not offer insurance, each person will be able to buy insurance directly from an Affordable Insurance Exchange, or marketplace, where individuals and small businesses can buy health benefits at competitive rates. Under the ACA, even members of Congress agreed to receive their health care insurance through these insurance Exchanges.
For small businesses, the ACA provides tax credits. Starting in 2014, qualified small businesses and small non-profit organizations receive a credit up to 50% of the employer’s contribution to employee health coverage while small non-profit organizations will receive a 35% credit for their employee contribution.
Physicians receive financial incentives to practice in rural and other underserved areas. Under the ACA, physicians are encouraged to form “Accountable Care Organizations” to better coordinate patient care. If the Accountable Care Organization provides high quality care and reduces costs to the health care system, the members can keep some of the money they have helped save.
Hospitals, under the ACA, receive financial incentives to improve quality of care. The ACA contains a Value-Based Purchasing program, as part of Traditional Medicare. Hospital performance relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care, is reported to the public. Financial incentives are given to hospitals positively increasing their patient care performance.
By 2013, the ACA will establish a national pilot program to encourage hospitals, doctors, and other healthcare providers to work together to improve coordination and quality of patient care. Under payment “bundling,” instead of a surgical procedure generating multiple claims from multiple providers, the medical team is compensated with a “bundled” payment. This is an incentive to deliver healthcare services more efficiently while maintaining or improving quality of care.
In 2013, the ACA will require States to pay primary care physicians treating Medicaid patients no less than 100% of Medicare payment rates in 2013 and 2014. This increase in payment is fully funded by the federal government.
States were initially required, under the ACA, to expand eligibility for Medicaid benefits or lose all federal Medicaid funding. Those States cooperating with the ACA’s Medicaid expansion requirement would receive additional financial benefits to offset the cost of thousands of new Medicaid patients.
However, the U.S. Supreme Court, in its June 28 decision ruled that this provision of the ACA was unconstitutional. Congress could provide incentives to expand Medicaid roles. However, Congress could not force the States to expand Medicaid eligibility by denying funds to those States refusing to participate in Medicaid expansion.
Healthcare disparities will be under review. The ACA requires all ongoing and new federal health programs to collect and report racial, ethnic, and language information. The Secretary of Health and Human Services will use this data to determine how to identify and reduce healthcare disparities.
It may currently stand as the most significant social reform since Franklin D. Roosevelt’s New Deal. However, Republicans have vowed to repeal it. “Repealing the Affordable Care Act would have a devastating impact on all Americans, especially those in our most vulnerable communities,” says Emanuel Cleaver, II, U.S. Representative (D-MO), and Chair, Congressional Black Caucus.
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Gloria J. Browne-Marshall, an Associate Professor of Constitutional Law at John Jay College in New York City, is author of “Race, Law, and American Society: 1607 to Present,” and a journalist covering the U.S. Supreme Court. Her forthcoming book is “Black Women and the Law: Salem Witches to Civil Rights Activists – A Legal History.”
