Affordable Care Act will greatly benefit women

The Supreme Court’s ruling upholding the Affordable Care Act marks a critical victory for women’s health, and the health of all Americans. Because of this landmark decision, millions of women and families will continue to have access to affordable, quality health care — many of whom previously had inadequate coverage or no coverage at all.

At Planned Parenthood of Illinois, we understand how this law will have an unprecedented effect on women’s health. The law guarantees women direct access to OB/GYN providers without referrals, and ends discriminatory practices against women, such as charging women higher premiums and denying coverage for “pre-existing conditions.” And in just six weeks, women will gain access to birth control without a co-pay — which will have a tremendous economic impact on already stretched family budgets.

Since August 2010, more than 45 million women have already received full coverage for preventive health screenings, including mammograms and Pap tests. Now with this ruling, 17 million more women will have access to health insurance for the first time. And millions more young adults will be able to stay on their parent’s health insurance plans, just like the 3.1 million young adults who have done so since September 2010.

In Illinois alone, 469,469 women of reproductive age will now gain coverage under the Affordable Care Act by 2014.

The increased access to preventive health care and family planning under the Affordable Care Act provides immeasurable economic value to women, families and society. Not only does every dollar invested in federal family planning save taxpayers and families nearly $4, but unintended pregnancies are already costing U.S. taxpayers $11 billion a year.

Women realize that health and wellness are key to prosperity and independence. In times of economic uncertainty, it is more important than ever to stay healthy. For women, birth control isn’t a political or social issue — it’s basic health care and an economic concern. The money — up to $600 on average — that women will save on birth control each year is equal to five weeks of groceries for a family of four, nine tanks of gas in a minivan, or one semester of college textbooks.

Planned Parenthood of Illinois health centers already provide basic health care to nearly 75,000 patients every year, and to 3,321 patients in Springfield alone. Because this landmark law has been upheld, we know we’ll be able to do even more for the communities we serve in the months and years ahead.

Carole Brite

President and CEO

Planned Parenthood of Illinois

(Originally posted on July 10 in the State Journal-Register)

Since When is 2% Considered Massive?

I don't know about you but I've been enjoying watching all of the reactions to yesterday's decision. In addition to the chuckle I got when a few major news outlets got it wrong, I've been smirking about opponents' claims that the law places a "massive tax" on all Americans.

Let's just put things in perspective here: Only a tiny fraction of people will be impacted by the individual responsibility provisions - those who can afford coverage but choose not to buy it.

What is that "tiny fraction" you ask? Researchers at the Urban Institute told us earlier this year that only TWO out of one hundred would be impacted (more here on this from the Center on Budget and Policy Priorities). And again: These are people who can afford coverage but choose not to buy it.

What IS massive? The millions of Americans who now have peace of mind that they will have access to secure health coverage even when they get sick, change jobs, ore face challenging health conditions. They can rest assured that getting the health treatment they need won't bankrupt their families.

Elisabeth Burak
Senior Program Director
Georgetown University Center for Children & Families

(originally posted here on the Say Ahhh! Children's Health Policy Blog)

The Affordable Care Act Upheld: Addressing America's Health Care Crisis

Today’s Supreme Court decision in National Federation of Independent Business v. Sebelius means that the Affordable Care Act remains the law of the land. As Chief Justice Roberts said in the majority opinion, Congress has the power to enact the individual mandate and the Medicaid expansion, the two provisions challenged in the case.

People with insurance and people without insurance should be relieved that the process of reform can now move forward and make health care more secure. All of them have spent sleepless hours worried about the cost, lack of control, lack of choice, and absence of peace of mind associated with our current system. The Affordable Care Act (ACA) has tools to address all of these issues, although much still depends on decisions made at the state and local level, where officials must now continue implementing this important work.

The Court’s decision means that the benefits of the Affordable Care Act that are already in place will not have to be reversed.

• Health insurers will have to make their policies easier for customers to comprehend.
• Insurance companies will have to spend a higher portion of your premiums actually providing health care.
• Young adults up to age 26 can now remain on their parents’ insurance policies.
• Over 60,000 “uninsurable” people have health insurance through the ACA’s Pre-Existing Condition Insurance Program.
• No child can be denied coverage by an insurance company due to a pre-existing health condition. Adults will win that protection in 2014.
• Every Medicare beneficiary who hits the prescription drug “donut hole” receives a 50% discount on their brand name and generic prescription drugs. As of March, Illinois Medicare beneficiaries who had triggered into this benefit were getting about $636 a month in savings.
• States receive significant federal grants to help them hold insurance companies accountable for unreasonable rate increases.
• Preventive services are free under all types of public or private health insurance. Thus, last year 18.9 million Medicare recipients received free annual checkups and preventative services.
• Women no longer need a referral from a primary care physician before seeing a gynecologist.
• Medicare premiums are lower than they would have been without the law.

Looking down the road a bit, the Court’s decision means that the full benefits of the law will be implemented on schedule:

• In 2014, 30 million Americans will gain coverage and no longer be uninsured.
• In consumer-friendly marketplaces, insurers will have to disclose all of their information in uniform and comprehensible language, so consumers can compare and make choices.
• No one will be denied coverage or charged a discriminatory rate due to a preexisting condition.
• Starting in 2014, all health plans will have to include maternity care.
• Seniors will have even more help paying for their prescriptions, eventually closing the Medicare doughnut hole.

Starting in 2014, the Affordable Care Act expands Medicaid to cover all 16 million Americans with incomes under 138% of the federal poverty level who are not currently eligible for Medicaid. The Act provides 100% federal funding to cover the costs of this expansion for the first years, and then settles in at 90% funding after five years. The Supreme Court’s decision today upholds Congress’s power to enact this expansion, and we encourage all the states to take full advantage of this wonderful opportunity.

The decision, however, also says that the federal government may not take away all of a state's existing Medicaid funding if it decides not to participate in the expansion. Medicaid law has always provided that, if states disobey the conditions Congress has imposed on the receipt of Medicaid funding, the federal government has several different remedies, one of which is to withdraw all federal funds. That remedy has never actually been used by the federal government, even though there have been many disputes involving state noncompliance with Medicaid conditions. So the threat that the federal government might deploy that remedy if a state failed to carry out the ACA's Medicaid expansion was highly theoretical. In today's decision, however, the Court ruled that a state's refusal to adopt the ACA's Medicaid expansion cannot trigger the removal from a state of all of its existing Medicaid funding. The ruling is unclear about exactly what the states' options are and what other remedies the federal government may have in those circumstances. As we study the decision further, we will address these Medicaid issues more in depth in future blogs. Of course, we urge all states to take advantage of the federally funded Medicaid expansion to bring coverage to their lowest income uninsured.

Tonight, people all over the country, men and women, of all ages, socioeconomic statuses, and political beliefs, can breathe a bit easier knowing that the reforms launched in March 2010 will continue and that America is moving toward quality, affordable, comprehensive health care for all.

John Bouman, President
Sargent Shriver National Center on Poverty Law

(This post was co-authored by Caitlin Padula and originally appeared in the Shriver Brief on June 28, 2012)

Health Reform Upheld: A Summary of the Supreme Court's Decision

In a 5-4 decision, the Supreme Court handed down its long-awaited decision on the health reform bill, National Federation of Independent Business v. Sebelius, this morning. This historic decision has upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA) as a whole (striking down only one penalty provision as unconstitutional), upholding measures improving access to and the quality of healthcare in the United States by expanding coverage, increasing benefits, and ensuring access to preventive services for many. This is a victory for communities and public health advocates throughout the country, and a relief for the many Americans already benefiting from some of the ACA’s programs.

Chief Justice Roberts delivered the opinion of the Court, and upheld the constitutionality of the individual mandate under Congress’s Taxing Power. [See here for a table of how all of the Justices' voted]. The individual mandate provision of the ACA states that individuals shall purchase health insurance, or pay a penalty. The Court considered the substance and application of the payment, and not its label. It was noted that the payment is collected by the IRS through the normal means of taxation. While undoubtedly intended to induce individuals to purchase health insurance, that a tax may have the purpose of influencing behavior rather than generating revenue is not problematic. This payment was likened to the taxes imposed on cigarettes for the purposes of smoking deterrence. Furthermore, the fact remained that the payment for failing to obtain insurance did not amount to a punishment for unlawful activity since it was not limited to willful violations of the mandate (as unlawful actions frequently are). Consequently, the Court concluded that mandate “leaves an individual with a lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice.” Page 44.

The Court was unpersuaded by the argument that the individual mandate fell within Congress's Commerce Power. The Constitution grants Congress the power to regulate commercial activity, however, the Court found the mandate not a regulation of existing commercial activity, but instead compulsion to engage in commercial activity, an action beyond the limited power given to the government under the Constitution.

While the individual mandate was upheld, the Supreme Court, however, did strike down the penalty of the Medicaid expansion provisions of the ACA as unconstitutional. Under the Medicaid program, the federal government provides funds to participating states, and in return the states agree to follow certain standards. The ACA expanded eligibility for Medicaid, and required states to expand coverage of their state’s Medicaid programs in accordance with the ACA, or lose all federal Medicaid funding (typically 50 to 83 percent of the state’s Medicaid program spending).

Although the Spending Power grants Congress the authority to create cooperative state-federal spending programs such as Medicaid, states must voluntarily accept the terms of such spending programs. The Court held that, because the ACA penalizes states who choose not to participate in the Medicaid expansion by withholding existing federal funding under the Medicaid program, the provision was coercive. In choosing not to participate in the Medicaid expansion, states would lose over 10 percent of their overall budget (page 51), an effect the Court found to leave states with no real option but to accept the terms of the program, making participation non-voluntary and the program unconstitutional.

Furthermore, the expansion was found to be not a modification of an existing program, but instead the creation of a new one. Medicaid as initially enacted covered four distinct categories of people: “the disabled, the blind, the elderly, and needy families with dependent children.” However, the expansion changes the program into one that covers the entire nonelderly population with incomes less than 133 percent of the poverty level (or 138% FPL if you count the 5% modified adjusted gross income or MAGI). The Court found this not to be a mere modification of an existing program to provide healthcare to needy populations, but instead a transformation of the program into “an element of a national plan to provide universal health coverage.” Pages 53-54. The Court concluded by explaining that its opinion did not prevent the federal government from offering funds to expand Medicaid eligibility, only that states choosing not to participate in the new expansion could not be penalized through the loss of their existing federal Medicaid funding.

Today the United States has taken a great step towards reshaping the American healthcare system. The ACA and its reforms to the system will have a lasting affect on the way people receive and pay for personal medical care, improving access and quality while containing costs, and improving the health of our nation as a whole.

Amanda Swanson
Guest Blogger for Illinois Health Matters

*To read a summary of the Supreme Court hearings on the ACA, please see the post Supreme Court Wrap Up – A Law Student’s Perspective.

The Anticipated Fate of the Affordable Care Act: Post-Decision Resources

The long history of health care reform in the United States has finally arrived at the hands of the Supreme Court. Since its passing in March of 2010, the Affordable Care Act has stirred the nation with questions as well as uncertainties for its promising future. As we are just a day away from the long awaited outcome of the Supreme Court’s decision regarding the health care law’s constitutionality, it is crucial to maintain contact with the future implications of the ACA. Here is a list of a few resources to stay connected post decision, to make sure we keep moving forward and stay informed on healthcare reform in Illinois as well as nationwide.

Be sure to check back with Illinois Health Matters on Facebook and Twitter to keep up with additional Illinois-specific next steps!

Supreme Court of the United States Blog – providing up to date information as well as live blogging on what’s going on at the Supreme Court, with special focus on the ACA
http://www.scotusblog.com/

Families USA Conference Call: Supreme Court Decision and Beyond
http://fusa.convio.net/site/Calendar/451929173?view=Detail&id=100921

Supreme Court Decision: The Future of Small Business & Healthcare
http://www.eventbrite.com/event/3678909718

Statewide Conference Call - Campaign for Better Health Care
http://www.cbhconline.org/action/conferencecalls/ccall-registration/

Jaquelene Peysakhovich
Illinois Health Matters

Emergency Speak Out: Rally in Response to the U.S. Supreme Court’s Health Care Decision

The U.S. Supreme Court is expected to rule by Thursday of this week on whether two key provisions of the Affordable Care Act - the landmark health care law - are constitutional:

• The requirement for people to have health insurance as of 2014 and
• The expansion of Medicaid.

We can’t go backward on health care. Protections at risk include:

• Ensuring over 200,000 Illinoisans with pre-existing conditions can buy quality and affordable health insurance.
• Ensuring 102,000 youth under the age of 26 can stay on their parents’ insurance plan.
• Creating a Health Benefits Exchange so 1.2 million Illinoisans and small businesses can shop for quality and affordable health insurance in a transparent and competitive marketplace.

As we prepare for the Supreme Court decision on the Affordable Care Act, we need to keep mobilizing our base, getting stories to the media on the impact of the ACA, and continue pressuring our state and Federal elected officials. With that in mind, we are planning an Emergency Speak Out on the day of the decision.

When: The Day of the Decision, 5 PM (rain or shine)
(Decision can be any day in June: likely to be Thursday June 28)

Where: Daley Plaza, Chicago
(Located in Chicago on Washington Street, between Dearborn and Clark)

Regardless of the outcome, we will call upon Governor Quinn to move forward on health care reform, including the creation of the Health Benefits Exchange. We must speak out – We must win. For more information, contact me at info. below.

John Gaudette
Citizen Action - IL
(312) 427-2114 x208
john@citizenaction-il.org
Twitter: @citizenactionil

Do What’s Best for Illinois

The dispute in Washington, D.C. over health-care reform is stirring debate everywhere. Opinions on what aspects of reform matter to many puts us at risk of losing sight of what matters to all — quality, affordable health care. Regardless of what the Supreme Court decides, Illinois lawmakers should ensure that Illinoisans see lower costs, better quality and more stability in their health coverage.

They can start by creating a health insurance exchange program that allows individuals and small businesses to pool their buying power and negotiate for better prices for health-care coverage. Smart economic decisions are based on ample choice and price comparison. The more health-care options, the better the cost and access to primary care. An exchange program would provide consumers the opportunity to be in control of their own health coverage.

More than 8,000 of our patients are uninsured and do not qualify for Medicaid or Medicare. An insurance exchange program could secure affordable coverage for their primary health-care needs and keep them from seeking routine care in a hospital emergency room. As a Federally Qualified Health Center, we know the importance of primary care for not only promoting better health, but preventing diseases. Illinois should do what is best for its residents, not for big insurance companies.

Warren J. Brodine, CEO,

Chicago Family Health Center 

Originally published in the Chicago Sun Times on April 4, 2012

Supreme Court Wrap Up - A Law Student's Perspective

Last week the Supreme Court heard oral arguments on the Affordable Care Act (ACA), commonly known as health care reform. Hearings were held for more than six hours over three days -- more time than has been given to a case in over 50 years.  At least 170 briefs were filed -- more than any other case in history.  Efforts to overturn provisions of the history-making law are proving to make history themselves.

On the first day, the Court heard arguments on the impact of the Anti-Injunction Act (AIA) on the constitutional challenge to the ACA’s minimum coverage provision.  The AIA works to prevent federal courts from hearing cases in which taxpayers are seeking court orders to prevent the government from assessing or collecting a federal tax - the theory being that the proper time for a court’s involvement in such cases is after the tax in question has already been paid (which for the ACA could be not for a couple more years).  As a consequence, before the Supreme Court can consider whether the ACA is constitutional, it must determine whether the AIA takes away the authority of federal courts to hear the case, or whether it does not apply to this controversy.  Counsel for the states argued that even if the penalty is a tax, the controversy should still be heard by the Court because the respondents are not seeking to enjoin the assessment or collection of a tax, but instead the requirement that everyone purchase health insurance.  The Justices considered the use of the word “penalty” in the ACA, the relationship between the insurance mandate and the penalty, and the effect of both provisions (individually and together) on the public and the states.
 
On Tuesday, the Supreme Court heard arguments on the minimum coverage provision of the ACA, which requires that all Americans (with limited exceptions) maintain a minimum level of “essential health care coverage.”  The issues the Court must address are whether it is within Congress’s power under the Commerce Clause of the Constitution to mandate the purchase of health insurance coverage, and whether Congress has the authority to assess a penalty against those who refuse to do so.  Americans have already been subjected to a number of mandates before the ACA, such as filing income tax returns and serving on a jury, but challengers to the ACA argue that purchasing health insurance is not a duty of citizenship, as other mandates have been.

Under the Commerce Clause, Congress has the power to regulate an activity that has a substantial affect on interstate commerce.  The questioning on Tuesday centered mostly around which market was being regulated by the ACA: the insurance market, health services generally, or the portion of health services utilized by the uninsured.  The Justices also posed many questions with regard to the argument that everyone is in the healthcare market, noting that almost everyone is going to require some kind of healthcare during their lifetime, that having health insurance is often a requirement for people to access the healthcare they need, and that the government is able to mandate vaccinations when a public health emergency arises.

On the third day of oral arguments, the Court heard arguments on the severability of the individual mandate provision and state sovereignty in the Medicaid expansion.  The severability issue considers whether Congress would have intended the rest of the ACA to stand if the individual mandate provision was found to be unconstitutional.  Challengers to the ACA argue that the individual mandate is the essence of the ACA, and that Congress would not have intended the additional “miscellaneous” provisions of the ACA to stand without it.  The Court also heard arguments in support of leaving the rest of the ACA intact and letting Congress decide whether to enact further amendments if needed, and the government’s argument in favor of striking also only those additional provisions found closely linked to the individual mandate; the guaranteed-issue and community-rating provisions.

The hearings concluded with arguments on the Medicaid expansion.  Under the Medicaid program, the federal government provides funds to participating states, and in return the states agree to follow certain standards.  The ACA set new standards for the Medicaid program in expanding eligibility to individuals with incomes up to 133 percent of the poverty level, the increased costs of which will be paid for entirely by the federal government until 2016, and then decrease to 90 percent federal coverage by 2020.  As a result, states would be required to expand coverage of their state’s Medicaid programs, or lose all federal Medicaid funding (typically 50 to 83 percent of the state’s Medicaid program spending).  Arguments on this issue addressed the possible coercion created by the ACA, by offering states an offer that cannot be refused.  Whether coercion depends on how much the federal government threatens to take away or what it is offering and the relationship between both was also discussed.  At the end of the hearing, Justice Ginsburg sought clarification that the challengers to the ACA would be satisfied with providing states the opportunity to opt out of the Medicaid expansion, instead of striking the expansion from the bill entirely.
            
Finally, last Friday, the Supreme Court Justices cast their votes on the constitutionality of the ACA in a conference room with no one else present.  In the weeks to come, the Justices will draft opinions and dissents on the case, and one Justice may be assigned to write the majority opinion, or multiple will be assigned to each write about different issues.  While each Justice’s vote can certainly change over the course of the next several weeks as they draft their opinions, most often changes are from the minority to the majority after reading the opinion, although it is possible that a vote change will affect the outcome of the controversy.  It will be late June or early July before the decision is finalized and the opinion is made available to the public.  Until then, we can only speculate as to where the Justices will fall on the issue.

Amanda Swanson

LL.M. in Health Law Candidate

Loyola University Chicago School of Law

In Short: SCOTUS and the ACA

For three days this week, the Supreme Court of the United States heard oral arguments on the Patient Protection and Affordable Care Act. The case against the ACA is broken up into four main arguments, primarily on the constitutionality of the Individual Mandate and Medicaid Expansion. The historic health law case has made a splash across Capitol Hill and beyond; and the responses range from adversarial to insightful to amusing and back:

The New York Times profiles Jonathan Gruber, the M.I.T. professor responsible for the academic research and number-crunching behind the ACA’s individual mandate.

CommonHealth’s Carey Goldberg talks with Kevin Outterson, director of Boston University’s Health Law Program and a frequent contributor to the Incidental Economist, on the court hearing, and then turns the conversation into a humorous animated video.

AHIP compiled various independent studies on the negative impact of severing the Individual Mandate from the ACA in this infographic.

For those who want to go straight to the source, download the audio recordings and transcripts of the oral arguments from March 26th, March 27th and March 28th.

The Supreme Court will announce its decision by the end of June, at which point, the bill will be handed back to Congress. Will this Congress, notoriously unable to come to agreement across party lines, be up to the challenge? The Hill Health Watch reports.

No matter what happens, Illinois Health still Matters; the State will be transitioning Medicaid into managed care, providers will be challenged to develop new payment models, and we still need to innovate to effectively serve vulnerable populations in tough fiscal times.

Preview: Medicaid and the Supreme Court

Tomorrow the United States Supreme Court will be in its third day of arguments about the constitutionality of the Affordable Care Act (ACA). Tomorrow's argument will focus not on the Individual Mandate (which has gotten the most press and political rhetoric) but on challenges to the constitutionality of the Medicaid expansion that will take place in 2014.

Under the ACA, Medicaid coverage will be expanded to any adult with an income at or below 133% of the Federal Poverty level, making low income levels the primary qualification for the program. In Illinois, alone, the Medicaid Expansion will impact 610,000 people. The Federal government will provide funding to cover 100% of the expansion costs for the first three years and 90% thereafter.

The primary argument against the constitutionality of the Medicaid expansion is that the expansion is unlawfully coercive. The plaintiffs argue that the 100% federal funding offered to states for the expansion is so advantageous that states must choose to continue to participate in the Medicaid program. 

Medicaid is, and always has been, voluntary to states. The funding offered for the expansion is not a new idea for Medicaid which has always involved government funding. Historically, the Federal government has funded a substantial percentage of each state’s Medicaid program, ranging from 50-83% of states’ costs and, on occasion, 100% of certain expenditures. Due to the vagueness and lack of legal precedent regarding what is “coercive,” this argument may be difficult to prove to the Supreme Court. 

A secondary argument is that the expansion, in tandem with other parts of the ACA law, creates changes that are extreme to the point of revolutionizing Medicaid. The Plaintiffs argue that the minimum essential coverage requirements outlined in the ACA render State participation in Medicaid indispensable thus turning Medicaid into “a program to provide a minimum level of coverage to every needy person.”

The Defendants counter that, Medicaid is not the only source of coverage for low-income individuals; they may also receive coverage via Medicare, Veteran’s Assistance benefits, other types of government funded care (such as ICHIP or IPXP in Illinois), or through an employer-provided insurance plan. Also, many individuals who would become eligible for Medicaid in 2014 may not be subject to the individual mandate due to their low income and non-taxpayer status. 

Finally, just as participation in Medicaid is voluntary to States, enrollment is voluntary for individuals. This argument also reflects a weak understanding of Medicaid. From its inception, Congress has reserved the right to make changes to the Medicaid program. None of these changes, however, have changed the core features of the program. Instead, these changes have followed a path that leads logically to the reforms called for in the expansion. Minimum coverage offered by a state has gradually expanded over time as criteria for certain low-income populations such as pregnant women, children and adults with a disability and elderly adults were put in place. The types of services covered have increased such as expansions to home- and community-based services that keep beneficiaries out of institutions.  Many of these reforms began as options, and were then converted into requirements for states’ participation in the program. 

A final piece of the Plaintiff’s argument claims that Medicaid is already too large of a program, and that the expansion will cause it to become too much of a financial burden on states. The Defendants counter that the size of a state’s Medicaid program is controlled, in large part, by the state itself. The Federal government creates the baseline requirements for a state’s Medicaid program, but also allows—and funds—many optional programs and experimental demonstration projects that allow each state to best serve the needs of the population. Many states have created programs that go well beyond the federal baseline. In fact, a large part of all Medicaid spending is on these programs—in Fiscal Year 2007, it comprised 60.4% of all Medicaid expenditures.

For more information about the argument to uphold the Medicaid expansion, see the National Health Law Program's Amicus Brief here. For transcripts and recordings of the Supreme Court's Affordable Care Act arguments, go here and here.

Stephanie Altman
Health & Disability Advocates

EDIT: 4/9/2012: For NHelp's recap of the oral arguments on the Medicaid Expansion, click here.