• US Supreme Court Upholds Most Provisions of Federal Health Reform Law
  • July 5, 2012 | Author: Charles F. Dingman
  • Law Firm: Preti, Flaherty, Beliveau & Pachios, LLP - Augusta Office
  • In its announced decision of this morning, the United States Supreme Court, by a 5-4 margin, upheld the individual mandate provision of the Affordable Care Act, widely understood to be essential to the economic sustainability of the insurance reform provisions of the law. In various opinions in which different groups of Justices joined, all but one of the remaining provisions of the sweeping federal health reform law enacted in 2010 were upheld. The primary affirming opinion was authored by Chief Justice Roberts.

    Although we recognize that this alert may largely duplicate the numerous news alerts you may also receive, we wanted to be sure that our clients and friends had links to the opinion and a preliminary analysis of the Medicaid portion of the decision. We will be analyzing the opinion and its implications, both generally and specific to Maine, further in the days to come.

    A number of significant changes created by the ACA are already in effect or being implemented, but the insurance exchange provisions and many others do not take full effect until 2014 and beyond. The following is a link to the Court's decision of this morning in National Federation of Independent Business v. Sebelius, as the opinion was captioned (combining several cases that reached the Court on the issue): http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.

    For the moment, what is clear is that all of the health insurance reform provisions of the law and virtually all of the other reforms remain intact following the Court's review. One very significant limitation was imposed, however: the only provision that the Court invalidated was the requirement that states that refuse to accept the law's expansion of the Medicaid program (with attendant new federal funding) would risk losing the entirety of their federal support for their Medicaid programs. This result on the Medicaid issue was only reached by complicated interplay among various minorities of the nine-member court, so it will require particularly careful, additional analysis. Kevin Russell, on SCOTUSblog.com, has provided a helpful summary of the way in which the Court reached this unusual provision of its decision: http://www.scotusblog.com/2012/06/court-holds-that-states-have-choice-whether-to-join-medicaid-expansion/. Of key importance is that the Court declined to strike down the Medicaid expansion, itself, just as it had declined to strike down the mandate. Thus the entire design of the health reform package remains in place, except that the extent of individual state participation in the reduction of the number of uninsured individuals now seems harder to predict.

    Of particular interest in Maine will be the following:

    • The impact of Maine's decision earlier this year to forgo the creation of a state-based exchange, leaving the establishment of an exchange in Maine to federal authorities: Does time remain for the state to reconsider that decision? Will the deadline for that decision be revised in light of the delays that have occurred in many states while the Supreme Court considered the matter?
    • What impact will the partial invalidation of congressional power to require the Medicaid expansion have in Maine? Will this have any impact on the current administration's efforts to cut back Medicaid services in Maine? How does it affect the likelihood of expanding Medicaid coverage in this state in 2014?

    We will follow up shortly with further analysis of these and other impacts of the Decision on healthcare in Maine.