In a 5 to 4 decision written by Chief Justice John Roberts, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (ACA) as a valid exercise of the Congress's power to tax. The ACA requires non-exempt individuals to maintain a minimum level of health insurance or pay a non-enforceable tax penalty. The Supreme Court examined four questions:
- whether it was within Congress's constitutional power to impose an individual mandate to purchase health insurance;
- whether all or any part of the law must be struck down if the individual mandate fell;
- whether an expansion of Medicaid enrollments to the working poor in 2014 was unduly coercive on states;
- whether these questions could be reviewed before the mandate takes place.
The Court held that, while the individual mandate is not a permissible exercise of Congress to regulate interstate commerce under the Commerce Clause of the U.S. Constitution, it is a valid power of Congress to do so under its taxing authority. The entire ACA was upheld, with the exception that the federal government's power to terminate states' Medicaid funds was narrowly interpreted. In effect, the Court held that the withholding of Medicaid funds violates the Constitution by threatening states with the loss of their existing Medicaid funding if they decline to comply with the expansion.
In upholding the law, the Court effectively upheld provisions that prevent insurers from denying coverage to children with preexisting conditions and allow coverage for children up to age 26 to be included in their parents' plans. The decision means the law can continue to support creation of accountable care organizations (i.e., groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated, high quality care to their Medicare patients) and state health insurance exchanges where consumers may purchase plans.
ASHA remains involved in addressing how these state health exchanges include habilitative and rehabilitative services performed by speech-language pathologists and audiologists for participating health plans under the ACA.
If you have questions, contact George Lyons, ASHA's director of government relations and public policy, at [email protected].