The United States Supreme Court today ruled the Patient Protection and Affordable Care Act (ACA) constitutional by a 5-4 vote, upholding the individual mandate as a tax but striking down the federal government’s ability to withhold existing Medicaid funding to states. Chief Justice John Roberts joined four liberal justices to cast the deciding vote.
The court ruled that it’s unconstitutional for the federal government to penalize states by taking back existing Medicaid funds, however, states can choose whether to accept future funds. Writing the majority opinion, Roberts opined that states “are given no such choice in this case: either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding.”
The individual mandate was seen as key to the high court’s decision but overturning it could have affected the other key issues to be decided. In his majority opinion, Roberts viewed the individual mandate as Congressional power to tax and spend, essentially increasing taxes on “those who have a certain amount of income, but choose to go without health insurance.” Associate Justice Anthony Kennedy, wrote in the dissent, “the entire act before us is invalid in its entirety.”
The National Health Council (NHC), a trade association for patient advocacy organizations whose mission is to be a voice for those suffering chronic diseases, was confident going into Thursday morning’s decision. “We believe the law, though not perfect and certain to evolve over time, is already improving the lives of people with chronic conditions,” NHC said in a statement following the ruling.
Observers on the right fear the impact of the ACA on personal liberty, as well as on the state and federal budgets. "By allowing government to require Americans to buy a product or service at the federal goernment’s direction, the court has seriously damaged the principle of limited government," said Edwin Feulner, president of The Heritage Foundation, a conservative think thank. "This law is very bad for American families: It drives up taxes, spending and debt, undermines doctor-patient relations, tramples on religious liberties, and expands the role of government in our everday lives. We cannot let it stand," he said, calling for a full repeal of "ObamaCare."
“Today, cancer survivors throughout the U.S. are celebrating. The Supreme Court ruling means they will retain protection from insurance discrimination for pre-existing conditions,” said Doug Ulman, president and CEO of the Austin, Texas-based Lance Armstrong Foundation.
The ACA, much of which goes into effect in 2014, contains provisions critical to cancer survivors and their families, including access to health insurance for 32 million Americans who would otherwise be uninsured; ending discrimination by insurers against those with pre-existing conditions; ending arbitrary annual and lifetime caps on insurance benefits; routine costs for clinical trials must be covered by insurance; covering young adults under their parents’ insurance policy until the age of 26; and covering preventive services like breast, cervical and colorectal cancer screenings with no co-pays and no deductibles.
“The decision ensures that critical patient protections benefitting cancer patients and survivors will be implemented, such as those prohibiting insurance companies from denying coverage to people with a pre-existing condition, requiring insurers to provide consumers with easy-to-understand summaries about their coverage and requiring health plans in the individual market to offer essential benefits needed to prevent and treat a serious condition such as cancer,” said John Seffrin, CEO of the American Cancer Society (ACS) and ACS Cancer Action Network.
The ruling also preserves provisions that improve the ability of people with cancer and their families “to access needed care by ensuring that proven preventive services such as mammograms and colonoscopies are offered at no cost to patients, eliminating arbitrary dollar limits on coverage that can suddenly terminate care and prohibiting insurance companies from unfairly revoking coverage when a person gets sick.”
The court ruled that the federal government can withhold future funds – but not existing funds – from states if they decided not to expand Medicaid.
ACS CAN is reviewing the ruling on Medicaid, said Seffrin. “We are concerned that the decision may limit the expansion of quality coverage to some of our nation’s most vulnerable citizens. We hope that ultimately, the decision will ensure access to quality health coverage through Medicaid for all low-income and disabled Americans with cancer or at risk for cancer,” he said. “For many hard-working Americans who have lost their health insurance because they are too ill to work or who have exhausted their savings, Medicaid coverage will provide critical access to proven preventive services and lifesaving treatments.”
Seffrin said access to care saves lives, citing ACS research that shows people without health coverage are more likely than those with private insurance to be diagnosed with cancer “at its more advanced stages and less likely to survive the disease.”
The ACA included a lot of elements that go beyond just health reform, according to Marc Boutin, executive vice president and chief operating officer at NHC. For example, issues around employees rights for women in breast feeding might interest March of Dimes, or Easter Seals might be interested in the reauthorization of the SCHIP program.