June 28, 2012 | Comments Off on PPACA Upheld by Supreme Court
Posted by Sharlene Hunt
Today, the United States Supreme Court issued its eagerly awaited decision in the case challenging the constitutionality of the Patient Protection and Affordable Care Act (“ACA”). The Supreme Court has in effect upheld the constitutionality of the ACA, not by upholding the individual mandate, which requires individuals to maintain minimum levels of health insurance, but by upholding the government’s ability to impose a tax on individuals who do not comply with the mandate. With respect to the Medicaid provision of the ACA, the Court upheld the expansion of the Medicaid program with the conditions imposed by Congress, but for States that do not comply with the expansion, the Court held that federal government cannot take away existing Medicaid funds as provided under the ACA.
Chief Justice Roberts issued the opinion of the Court regarding the individual mandate. He also issued a separate opinion regarding several issues, including the expansion of the Medicaid program and loss of funding to States that refuse to expand their Medicaid programs. He concluded that the loss of funding was unconstitutional, but that the flaw could be fixed by nullifying the loss of funding. Justice Ginsberg issued a separate opinion, joined by Justice Sotomayor, and joined in part by Justices Breyer and Kagan, as to four issues, concurring in part, concurring in the judgment, and dissenting in part. A separate dissenting opinion was issued by Justices Scalia, Kennedy, Thomas and Alito, and Justice Thomas issued a separate dissenting opinion. Thus, the opinion was far from unanimous and from a legal point of view therefore lacks precedential guidance to the courts, patients, providers or payors on a number of issues.
Now that the Supreme Court has issued its decision, the uncertainty regarding the Court’s ultimate holding has been addressed. However, the uncertainty surrounding the ACA is far from resolved. The results of the election in November will still have a huge impact on the implementation of the statute. The statute itself requires the issuance of voluminous regulations interpreting a broad spectrum of the statutory provisions. Whether Mitt Romney or Barack Obama win the Presidential election will determine who controls the issuance of the regulations. Because the statute is so broadly written, a great deal of discretion can be exercised through the implementing regulations.
In addition, control of the Houses of Congress could also have an impact on the statute, and on implementation of the statute. If the Republican party gains control of both Houses, while there will most likely be a push for repeal of the statute in whole or in part, unless the Republicans have a filibuster proof majority in the Senate, it is highly unlikely such a repeal will occur. If the Democrats control both Houses, then one would assume it will be full speed ahead with implementation, unless the Democrats do not have filibuster proof majority in the Senate, in which case grid lock could occur. If control of the Houses is split between the two parties, then funding the implementation of the statute will most likely be an ongoing problem.
Stay tuned as we delve further into the Supreme Court’s opinion and the impact it will have.