The Patient Protection and Affordable Care Act is out of the ER after an extensive examination by the U.S. Supreme Court.
Now, advocates of health care reform are prescribing action in the states that refuse to implement the landmark legislation, including Wisconsin.
“Our continuing challenge will be to make sure that states opt to expand Medicaid so that more low-income people, and particularly those with HIV, can get the health care they urgently need,” said Scott Schoettes, the HIV project director for Lambda Legal, a civil liberties group based in New York.
Lambda filed an amicus brief defending the ACA before the High Court, which, on June 28, released its 5-4 decision upholding key elements of the most significant health care reform in the United States since the creation of Medicare and Medicaid in 1965.
The act contains many provisions, some of them already being implemented at the federal level; others are set to go into effect in 2013 and 2014. The legislation:
• Prohibits insurance companies from canceling or denying coverage due to a pre-existing condition and from charging women more than men.
• Requires insurers to provide certain free preventive care, such as mammograms for women and wellness visits for seniors.
• Provides for rebates from insurance companies that spent too much from health care premiums on administrative costs and corporate bonuses.
• Guarantees continued prescription drug savings for seniors.
• Enables young adults to stay on family insurance plans.
• Creates insurance exchanges for people and businesses to find the best coverage for the best price.
• Bans discrimination in coverage and care, including discrimination based on sexual orientation and gender identity.
The most controversial provisions of the act were taken to the High Court: the requirement that people secure health insurance – the so-called individual mandate – and the expansion of Medicaid to guarantee care for lower-income people.
Chief Justice John Roberts wrote the majority opinion, joined by Sonia Sotomayor, Stephen Breyer, Elena Kagan and Ruth Bader Ginsburg. Anthony Kennedy, Antonin Scalia, Clarence Thomas and Samuel Alito dissented.
Roberts wrote that the individual mandate can stand, as a tax, which Congress has the authority to enact.
“This ruling is a victory for millions of people – including LGBT people and our families – who don’t have access to adequate, affordable health care,” said Rea Carey, executive director of the National Gay and Lesbian Task Force in Washington, D.C.
Kali Lindsey of the National Minority AIDS Council said, “The ACA does more to improve America’s response to the HIV/AIDS epidemic than any piece of legislation since the Ryan White CARE Act. Whether banning the practice of denying cover- age to Americans with pre-existing conditions like HIV infection, or caps on lifetime expenditures, this law will improve access to care for hundreds of thousands of people living with HIV.”
But the Court’s ruling on the expansion of Medicaid caused concern.
“That the Medicaid expansion must be voluntary means that millions of low-income Americans, including thousands living with HIV, may still lack access to the program,” Lindsey said. “The law’s subsidies, which are aimed at helping individuals purchase insurance through state health exchanges, were not designed to cover those who would have otherwise been eligible for Medicaid under the expansion.”
The ACA provides for an expansion of Medicaid to cover people with incomes up to 133 percent of the federal poverty level. Under the law, the federal government would cover the costs of the expansion until 2017, when the states would absorb some expenses.
But the Court said the federal government cannot withhold all Medicaid funds from states that decline to take part in the expansion. So, states can decide not to enter the expansion without fearing the loss of funds.
At least seven governors, including Gov. Scott Walker have indicated they will not participate in an expansion of Medicaid. And eight governors lean toward a “no.”
Walker said he would implement no aspects of the Affordable Care Act – now both derided and cheered as “Obamacare” – before the November election. That’s close to the deadline when states must tell the federal government whether they will build health-insurance exchanges.
“While the Court said it was legal, that doesn’t make it right,” Walker said at a news conference. “For us to put time and effort and resources into that doesn’t make a lot of sense.”
That’s an opinion shared by a number of other Wisconsin Republicans in the days after the Supreme Court ruling. Those at the federal level, such as U.S. Rep. Jim Sensenbrenner, vowed to work for a repeal.
“The individual mandate is a massive infringement on our freedom, and it’s bad policy,” he said.
Wisconsin Democrats, meanwhile, cheered the ruling and praised the law.
U.S. Rep. Gwen Moore said, “So many in my home state of Wisconsin will benefit and are already benefitting from the ACA. They can now breathe a sigh of relief that they will continue to benefit from critical patient protections, lower costs, expanded coverage and greater account- ability from the insurance industry.”