This article is more than 5 years old. Information may no longer be current.
UPDATE: Supreme Court upholds Affordable Care Act
The US Supreme Court today ruled that the health care mandate is constitutional. It upheld the entire Affordable Care Act, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read. Justice John Roberts read the majority opinion.
The Patient Protection and Affordable Care Act was passed by Congress and signed into law by President Barack Obama in March 2010. Twenty-six states have challenged the constitutionality of the law’s mandate for all US citizens to purchase health insurance by 2014.
In early 2011, Florida Attorney General Pam Bondi challenged the health care law on behalf of Florida and 25 other states. In August 2011, the 11th Circuit Court of Appeals ruled that parts of the law are unconstitutional, and in November 2011, the US Court of Appeals in Washington ruled the law unconstitutional.
The Supreme Court agreed to hear a legal challenge to the law, and in March the court held 3 days of oral arguments surrounding the constitutionality of the health care mandate.
The court considered four separate components of the law: 1) whether or not its individual mandate is constitutional; 2) whether the mandate is severable from the rest of the law; 3) whether the ACA levies a tax that must take effect before being challenged in court; 4) and whether the law’s proposed expansion of Medicaid is legal.
The American Academy of Pediatrics (AAP) said in a statement that it commended the Supreme Court’s 5-4 decision to uphold the ACA.
“Today, the Supreme Court upheld a law that invests in children's health from the ground up,” AAP President Robert W. Block, MD, said in a press release. “The academy endorsed the ACA because it addresses the same ‘A-B-C’ goals that are entrenched in our mission and in our 82 years of child health advocacy: providing all children in this country with Access to health care services, age-appropriate Benefits to meet their unique needs, and high-quality, affordable health care Coverage.”
The AAP endorsed the law in 2010 and filed three amici curiae (friends of the court) briefs to the Supreme Court in support of the ACA’s Medicaid expansion, individual mandate and the mandate’s severability from the rest of the statute.
“Today is one for the history books,” Block said. “As pediatricians, our No. 1 goal is to keep children healthy, and we can now do so knowing that a landmark law has strong policies in place to prioritize children’s health needs and provide them with the access to care, age-appropriate benefits and coverage options they need and deserve.”
The court supported the law’s constitutionality and ruled that its tax does not need to take effect before being challenged in court.
Perspective
Back to Top
The Supreme Court ruling today has winners and continued challenges but lays to rest the question of what the American people, the health care community, physicians and payers will be working on for the next 10 years. Since many aspects of the ACA have been “in process” for 2 years now, it does not remove the challenges. It just shows us all the target. The volatility of the health care world will continue. I don’t know about our readership, but I plan to continue to focus on what is most important to me: my patients and families. I wish us all good luck.
Perspective
Back to Top
The Pediatric Infectious Diseases Society supports the US Supreme Court decision regarding health care for all Americans, and will continue to work with our members, institutions and fellow health care providers to provide cost-effective prevention and treatment for all children, and conduct research demonstrating the best approaches to carry this out.
Perspective
Back to Top
As I am unsure of all of the ramifications of the ACA, so I would like to comment only on some of what I consider the positive points.
First, the expansion of health care coverage under a parent's policy for their children up to the age of 26 years is important in today's economy.
The cost of higher education continues to skyrocket, causing many young people to accumulate significant debt. Unemployment is very high and since these young people cannot find jobs, or must take positions where they are underpaid, they have been unable to afford health insurance.
They are receiving periodic emergency care in various settings — hospital emergency departments, urgent care centers, retail-based clinics, etc. — none of which afford continuity of care nor encourages the concept of the medical home. Of course, the astronomic, ever increasing cost of health insurance is an issue for everyone, young and old alike.
Second, is that under the ACA, insurance companies will not be able to deny an individual insurance based on pre-existing conditions. With all the wonderful advances of modern medicine, very premature and sick newborns are surviving, albeit some with life-long health issues.
Childhood cancers are no longer necessarily a death sentence, but there is a large financial cost to treat and control them. In addition, diabetes and asthma — to name just two disease states — are affecting more children today than ever before. Ensuring that these children live long lives will necessitate pharmacy costs that could cause financial disaster for most families who were unable to obtain insurance previously because of their children's uninsurabiity.
The third point to bring up is the expansion of Medicaid coverage to the uninsured. This affects millions and millions of people, many of them children. Unfortunately, the Supreme Court decision leaves it in the hands of the states. Several states have already communicated that they will not expand their Medicaid numbers. It is not a child's fault if their parent doesn't have insurance for them. Why should the children have to suffer? Perhaps the next big project our nation should tackle is welfare reform. That certainly is a big ticket item!