The Supreme Court has just released its multi-page ruling on the constitutionality of the health reform law and the summary result is clear: The Patient Protection and Affordable Care Act (PPACA) is constitutional.
Some Key Political Points:
- Republican House leaders will quickly force a vote to repeal the law. House Democrats are carrying “pocket cards” (talking points) detailing how the reform law has already helped people (e.g., 86 million have received free preventive care).
- The administration will have to continue to provide much-needed – and overdue – guidance for states, employers and insurance companies, among others, to answer the many outstanding questions that are holding up implementation of the law.
- There will be a chorus of voices advising everyone to wait until after the fall elections before taking further action.
- There will be an outcry from some quarters to ramp up efforts to repeal PPACA.
- There will be more court cases challenging other provisions of PPACA.
Key Insurance Issues:
- Full-scale implementation of PPACA will continue unabated.
- All insurance reform provisions will remain in effect.
- Many of the hesitant states will move to build exchanges while some will continue to refuse compliance. Many states will have to engage in a partnership exchange or a federally facilitated exchange at least for the first few years as they will not be able to put the required pieces together to open a state-run exchange by January 2014.
- The premium subsidy for qualified people buying coverage through the exchanges will move forward uninhibited.
- The Medicaid program will largely remain as envisioned by PPACA. States achieved a victory, of sorts, in that they can refuse to expand Medicaid without losing all of the federal funds for Medicaid that they currently receive. States will continue to push for flexibility on the maintenance-of-effort provisions due to increasing state budget pressures; in response, the administration will grant 1115 Waivers, but with reform elements.
- Delivery reform will continue at the current pace, some provisions may be shelved due to budgetary constraints and HHS capacity.