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AAMC Contacts :

The Supreme Court’s Decision on the Affordable Care Act July 6, 2012. AAMC Contacts : Lori K. Mihalich-Levin, J.D. Director, AAMC Health Care Affairs Telephone: 202-828-0599 E-mail: lmlevin@aamc.org Scott Wetzel Program Specialist, Health Care Affairs Telephone: 202-828-0495

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AAMC Contacts :

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  1. The Supreme Court’s Decision on the Affordable Care Act July 6, 2012 AAMC Contacts: Lori K. Mihalich-Levin, J.D.Director, AAMC Health Care AffairsTelephone: 202-828-0599E-mail: lmlevin@aamc.org Scott Wetzel Program Specialist, Health Care Affairs Telephone: 202-828-0495 E-mail: Swetzel@aamc.org

  2. The Court’s Decision • Chief Justice John Roberts wrote the 5-4 majority decision (joined by Justices Ginsburg, Breyer, Sotomayor, and Kagan) upholding the ACA, with changes to the Medicaid expansion. The Court’s opinion can be found here: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf • Justices Scalia, Kennedy, Thomas, and Alito wrote a joint dissenting opinion arguing that the entire ACA was unconstitutional

  3. Key Ruling: Individual Mandate • The individual mandate is Constitutional: • Permissible use of Congress’s taxing power • Not permissible under the Commerce Clause

  4. Key Ruling: Medicaid Expansion • States will not lose current Medicaid funding should they chose not to expand their Medicaid programs • ACA said that if states did not expand coverage to individuals under the age of 65 with incomes below 133% of the federal poverty level, they would lose all Federal funding for their Medicaid programs • The Federal Government initially pays full cost of expansion; offers substantial subsidies for states to expand coverage to Medicaid eligible individuals • It is unclear at this time which states will choose to expand their Medicaid programs

  5. Anti-Injunction Act • Under the Anti-Injunction Act, the Supreme Court is prohibited from considering the implementation of a Federal tax before the tax is enforced. Under the ACA, the tax penalties for not purchasing individual health insurance will go into effect in 2014 • The Court ruled that since Congress did not use the word “tax” in the statute, the Anti-Injunction Act does not apply

  6. Important Takeaways from the ACA Ruling • With the exception of the Medicaid expansion, all other provisions of the ACA remain in place • This includes: VBP, PCORI, CMMI, demonstrations, resident slot redistribution, DSH cuts, changes to physician and hospital quality reporting, etc

  7. Next Steps • Congressional Republicans have pledged to repeal all or parts of the ACA. Repeal is unlikely as long as Democrats control the Senate and the White House • Some states may choose not to expand their Medicaid programs • The AAMC is working with its member institutions to better understand the implications of the Court’s ruling on Medicaid and how it relates to other ACA provisions

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