The ACA and the Supreme Court: What’s Next for States and the Federal Government?

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This post was written by Katie Keith, Assistant Research Professor, Georgetown University Health Policy Institute Center on Health Insurance Reforms.  Any questions or comments about this post can be directed to kmk82@georgetown.edu.

On June 28, 2012, the Supreme Court of the United States largely upheld landmark health reform legislation known as the Patient Protection and Affordable Care Act of 2010 (ACA). By ushering in significant changes to the regulation of private health insurance and Medicaid as well as creating new incentives in Medicare and funding for public health programs, the ACA has the potential to transform the accessibility, adequacy, and affordability of health coverage and health care in the United States.

Yet, because many of the ACA’s comprehensive reforms do not go into effect until 2014, states and the federal government have much to do to prepare for the significant regulatory changes to come. Here, I discuss the potential implications of the Supreme Court’s ruling on state and federal efforts to implement the ACA.

What Did the Supreme Court Rule?

With the exception of one provision, five justices—Roberts, Breyer, Ginsburg, Sotomayor, and Kagan—held that the entire ACA was constitutional. Writing for the majority, Chief Justice John Roberts held that the law’s most controversial provision, the individual mandate, was constitutional under Congress’ authority to tax and spend.

In upholding the mandate as a tax, Chief Justice Roberts concluded that 1) the Anti-Injunction Act did not bar the Supreme Court from considering the constitutionality of the mandate; 2) the mandate could not be sustained under Congress’ power to regulate interstate commerce; and 3) the mandate could not be upheld pursuant to Congress’ authority to enact laws that are “necessary and proper” to its exercise of congressional authority. Read More

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The Supreme Court Upholds the Affordable Care Act Upheld: The Individual Mandate is a Tax. States Have a Choice Whether to Expand Medicaid

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This post was written by Emily W. Parento, O’Neill Institute Research Assistant and Lawrence O. Gostin, Faculty Director of the O’Neill Institute. 

President Obama signed the Patient Protection and Affordable Care Act (ACA) into law in March 2010, and lawsuits immediately followed.  In March of this year, in consolidated cases National Federation of Independent Business v. Sebelius, the Supreme Court heard arguments on the constitutionality of four aspects of the ACA: whether Congress has the power to enact the individual purchase mandate, whether the Medicaid expansion amounts to unconstitutional federal government coercion of states, severability of the individual mandate and Medicaid expansion from other portions of the ACA, and whether the Anti-Injunction Act bars consideration of the individual mandate’s constitutionality prior to the penalties taking effect in 2015.

On June 28th, the Court handed down its historic ruling on all the issues in a 5-4 decision written by Chief Justice Roberts, upholding the law in its entirety with the sole exception that Congress may not revoke existing state Medicaid funding to penalize states that decline to participate in the Medicaid expansion under the ACA. The Court’s opinion is available here. The Court’s decision was surprising because Chief Justice Roberts joined with more liberal Justices Breyer, Ginsburg, Kagan and Sotomayor to find the individual mandate constitutional. More surprising was Robert’s reasoning under Congress’ power to tax. With simple elegance, the Court stated

Our precedent demonstrates that Congress had the power to impose the exaction in §5000A under the taxing power, and that §5000A need not be read to do more than impose a tax. That is sufficient to sustain it.[i]  Read More

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U.S. Supreme Court Upholds the Constitutionality of the ACA

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Today, the U.S. Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA) in a historic decision

The O’Neill Institute for National and Global Health Law has been engaged in this important conversation primarily with our research project Legal Solutions in Health Reform.  As early as 2008, Legal Solutions began to identify practical, workable solutions to the kinds of legal issues that would (and did) arise in the federal health reform debate.  These analyses can be found in a compendium of prescient papers authored by noted health law and policy scholars – of particular relevance is Mark Hall’s paper, “The Constitutionality of Mandates to Purchase Health Insurance,” which foreshadowed many of the arguments raised before the Supreme Court.  Additionally, a separate series of articles and O’Neill Institute briefings authored by our faculty director, Lawrence Gostin, discussed the parameters of the ACA itself and subsequent challenges raised before the Court.

In the coming days, the O’Neill Institute will provide a much more comprehensive and nuanced analysis of today’s decision as well a discussion on implementation of the ACA.  We hope to continue to provide stakeholders with both a concise analysis of the complex legal issues relating to health reform and a clear articulation of the range of solutions available – please stay tuned.

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Webcast Link: Honorable Nicola Roxon, “Why Are Plain Packs Making Big Tobacco So Angry? Australia’s World Leading Work to Combat Smoking.”

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The Honorable Nicola Roxon, Attorney-General of Australia will be speaking today at Georgetown Law on plain packaging of tobacco products. The presentation is titled “Why Are Plain Packs Making Big Tobacco So Angry? Australia’s World Leading Work to Combat Smoking.”

For those who cannot make it to the event, we will also be providing a live webcast here. The presentation will take place 2 – 3pm US EST.  The link will become active for live broadcast approximately 5 minutes prior to the event start time. Please make sure that you are using the most updated version of QuickTime and, if possible, please turn off your firewall protection while watching the live stream as it has blocked audience outside the law center network in the past.

In the event of any technical difficulties, please note the presentation will be archived at the same link shortly following the presentation.

Update: Presentation Slides; Cancer Research UK Video: ‘The Answer is Plain.’

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U.S. Congressional Briefing “Cholera and the Human Right to Health in Post-Earthquake Haiti”

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In October of 2010, less than ten months after being hit by a devastating earthquake, Haiti experienced a cholera epidemic that quickly spread throughout the small nation. The waterborne disease has now killed at least 7,050 Haitians and sickened over 531,000 others. Meanwhile, nearly half a million earthquake victims remain without adequate housing, and Haitians continue to face one of the most challenging clean water and sanitation situations in the world. As the rainy season sets in, the country is experiencing a notable increase in the number of deaths attributed to cholera, according to the UN.

On April 18, 2012, the O’Neill Institute for National and Global Health Law and the Center for Economic and Policy Research (CESCR) co-sponsored a U.S. Congressional Briefing that examined U.S. and international efforts to address what has become the world’s worst active cholera epidemic. With U.S. Representative John Conyers, Jr. (D-MI) giving introductory remarks and U.S. Representative Maxine Waters (D-CA) giving concluding remarks, the panel of speakers was composed of Dr. Luiz Augusto Galvão, Manager of Sustainable Development and Environmental Health Area at the Pan-American Health Organization/World Health Organization; Donna Barry, Director of Policy and Advocacy at Partners In Health; Brian Concannon, Jr., Director of the Institute for Justice and Democracy in Haiti; Mario López-Garelli, Senior Human Rights Specialist at the Inter-American Commission on Human Rights (Inter-American Commission); and Mark Weisbrot, Co-Director of CESCR. The briefing was organized and moderated by J.P. Shuster, research associate at the O’Neill Institute. The group of panelists discussed urgent measures needed to contain the spread of the disease and the longer-term proposals for preventing cholera from becoming endemic to Haiti, as well as the role of international legal mechanisms for protecting health and human rights violations in Haiti’s greater post-earthquake context.

Click here to watch the briefing

Public Health Perspective

Donna Barry set the context of the discussion by recalling that health and water are basic human rights and that it is the government’s responsibility to provide access to both, which is why Partners In Health’s work in focuses on strengthening government systems. Barry emphasized the importance of recognizing that, prior to the earthquake, Haiti had the worst health indicators and worst access to clean water in the Western Hemisphere and had one of the world’s worst sanitation systems. Barry also highlighted Partners in Health’s recently launched Haiti Cholera Vaccine Project. The project aims to reduce incidence of disease and transmission and starts with the vaccination of 50,000 individuals in a rural community in Saint-Marc. The vaccination project is intended as a complementary measure to prevention and treatment efforts and is part of Partners in Health’s recommended five-point comprehensive response to combat cholera in Haiti: 1) strengthen water and sanitation infrastructure; 2) identify and treat all those with cholera symptoms; 3) role out a safe, affordable, and effective cholera vaccine; 4) strengthen Haiti’s public health system; and 5) improve effectiveness of foreign assistance to Haiti. Read More

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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