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Court upholds Affordable Care Act

The U.S. Supreme Court, in a landmark ruling, has upheld the individual mandate in the Affordable Care Act, the chief domestic measure of President Barack Obama’s first term.

The decision on June 28 was seen as the most significant of the High Court’s 2012 term.

With the ruling expected sometime after 10 a.m., hundreds of activists, reporters and photographers assembled outside the court building.

The Court kept them – and audiences monitoring the morning’s events on the Web, radio, television and smart phone apps – waiting, releasing a ruling in a free-speech case first.

The decision on the Affordable Care Act was released at about 10:15 a.m.

A number of LGBT groups had participated in a friend-of-the court brief to the Court that defended the challenged elements of the ACA as constitutional and noted the law would help to close the health care gap for LGBT Americans.

Supreme Court arguments on the ACA took place March 26-28, nearly two years to the day after Obama signed the legislation into law. Almost immediately after the White House signing, the series of constitutional challenges were filed.

The central component of the law examined by the Court was the individual mandate requiring that uninsured people purchase health coverage – with government help for those who can’t afford the premiums. The question before the Court was whether the U.S. Constitution allows the government to require Americans to obtain insurance or pay a penalty?

The Court, in a lengthy 5-4 opinion, ruled that the individual mandate is constitutional.

The Court also explored whether, with an expansion of Medicaid, the federal government would be unconstitutionally forcing states to spend more on health care for the poor. That provision also was upheld.

LGBT leaders this week, with the observation of National HIV Testing Day, were stressing the importance of the Affordable Care Act in expanding access to HIV testing as they anticipated the Court decision.

When the president signed the ACA, LGBT leaders celebrated its provisions:

• A National Prevention Strategy that says, “All Americans should have the opportunity to live long, healthy, independent, and productive lives, regardless of their … sexual orientation or gender identity; geographic location; or other characteristics.”

• Data collection, beginning in 2013, to better understand LGBT health disparities.

• A Patient’s Bill of Rights to end insurance company abuses. The law ended lifetime limits on coverage in 2010 and by 2014 will phase out annual limits on coverage, which is seen as critical to quality care for people living with HIV and cancer.

• Expanded Medicaid eligibility so that adults under age 65 and earning less than $15,000 a year become eligible. Studies show that LGBT people, with discrimination in employment and relationship laws, are disproportionately more likely to make less than $15,000 a year and be uninsured.

• A health insurance exchange in 2014 that offers subsidies to small employers and individuals earning $15,000 to $43,000 a year to purchase coverage.

• A prohibition in the exchange on discrimination on the basis of sexual orientation and gender identity in coverage and requires that benefits include drugs, hospital stays, mental and behavioral health services.

• Web-based resources that help same-sex couples find plans that include domestic partner coverage.

• A tripling in the size of the health service corps in underserved areas of the country, expanding community health centers and increasing support for LGBT sensitivity training from Health and Human Services.

• A prohibition, beginning in 2014, against insurance companies denying or canceling coverage on the basis of a pre-existing conditions, including HIV or gender dysphoria.

• A system for making HIV/AIDS drugs more affordable and eliminating the requirement that people with HIV wait for an AIDS diagnosis before qualifying for Medicaid.

• A prohibition against insurance companies charging co-pays or other fees for preventive services recommended by a U.S. task force, including testing for HIV and STDs, depression screening, vaccinations, cholesterol and blood-pressure screening.

This story will be updated throughout the day.

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