During the week of March 26, 2012, the Supreme Court of the United States heard arguments about the constitutionality of the Patient Protection and Affordable Care Act (ACA), otherwise known as the Health Reform Law. As the Preeclampsia Foundation continues to advocate before state and federal policymakers on maternal health issues, we are watching closely to understand what affect the Court's decision(s) will have on women and their families.
The following is an overview of the key questions being considered by the Court after three days of debate - the longest hearing on a single case heard by the Supreme Court since 1966.
Should the law even be considered by the Court at this time - the Anti-Injunction Act? The court must determine whether the case can be decided now, or whether the court must wait until 2015, when the tax provisions of the law (individual mandate requiring individuals to purchase health insurance) go into effect. The basis for this decision is based on a 140 year-old law called the 1867 Tax Anti-Junction Act, which says that people can't sue over a tax until they actually pay the tax. This decision affects whether the court can consider the other issues below.
Is the individual mandate constitutional? The court must determine whether the federal government has the constitutional authority to require that every individual purchase health insurance or pay a penalty if they refuse to do so.
If the individual mandate is ruled unconstitutional, what happens to the rest of the health reform law? At issue is whether the individual mandate can be severed from the health reform law without dismantling the entire law. Funding from individuals purchasing insurance is meant to cover the costs of other programs in the law and ensure program viability. The Obama Administration is arguing that if the mandate is ruled unconstitutional, the rest of the law should stand with two exceptions: the law's requirement to cover people with pre-existing conditions and the requirement that insurers use a "community rate" that ignores individual health status.
What about the health reform law's Medicaid expansion? Medicaid is a joint federal-state program. Currently, individuals who earn up to 100 percent of the federal poverty level are eligible to participate, and states receive federal funds to support the program. Under the law, individuals who earn up to 133 percent of the federal poverty level will qualify for Medicaid in 2014. If any state does not comply with that expansion in eligibility, those states will forfeit any federal Medicaid funding. The court must determine whether the federal government has gone too far in pushing the states.
Here are some key provisions in the ACA that affect maternal health:
- Establishes state health exchanges - markets where individuals and small businesses can select the best health insurance coverage to meet their needs;
- Requires individual and small group plans within and outside the state exchanges to cover essential health benefits, including maternity and newborn care;
- Provides insurance subsidies for those with incomes between 100-400 percent of the poverty line;
- Expands Medicaid eligibility to individuals with income up to 133 percent of the poverty line;
- Eliminates lifetime and annual limits on benefits;
- Requires insurance companies to guarantee and continue coverage;
- Creates high risk insurance pools for people who can't get insurance on the market currently;
- Requires coverage of women's health preventive services without a co-payment;
- Prohibits excluding patients with pre-existing conditions from insurance plans.
Source: Drinker Biddle & Reath, Capitol Health Record Blog, www.capitolhealthrecord.com