- Posted June 16, 2012 by
This iReport is part of an assignment:
Supreme Court Ruling on ACA More than Political Implications
It is expected that the US Supreme Court will release its finding on President Barack Obama's signature domestic policy, the Affordable Care Act, some time within the next 2 weeks. USA Today and the New York Times look at possible outcomes and implications beyond the political fall-out that is expected no matter which way the Court rules.
The Supreme Court's decision this month on President Obama's health care law is likely to take one of four basic forms. No matter what the court rules, however, it won't be the last word.
The court can uphold the entire law, strike down the "individual mandate" requiring most Americans to buy insurance, strike down the mandate and related health insurance changes, or kill the entire law.
Still to come: State actions. More lawsuits. The verdict from voters on Nov. 6. And more battles in Congress next year.
The four outcomes that USA Today sees:
Option 1: Law upheld - A decision upholding the law would unleash a series of political, legislative and legal forces.
Option 2: No mandate - The verdict that would present the biggest complications is also one of the most likely, if the justices' questions in March prove prophetic: striking down the individual mandate requiring most Americans to buy health insurance.
Option 3: More provisions invalidated - Lawmakers would be under far less pressure to fix what the court hands them if insurance protections for people with pre-existing conditions and related changes are eliminated along with the mandate.
Option 4: Law killed - The justices may decide to strike down all the taxes, subsidies, mandates, coverage expansions, insurance market changes and other provisions in the law. But some may find their way back.
The NYT takes on the effect on Medicaid, the state-run medical program for the poor.
The expansion of Medicaid — if it is upheld by the Supreme Court — is among the most significant parts of the law, as it will provide coverage to people with the greatest financial needs. Many health care advocates support the expansion, saying it will allow poor people to receive needed care, while many state officials, especially Republicans, worry that it will bring budget-breaking new costs.
The expansion may also strain the health care system, given the shortage in some places of primary care doctors, who will be vital to expanded coverage.
The Supreme Court, which is expected to rule on the health care law this month, devoted more than an hour of argument to the Medicaid provision.
Medicaid is jointly financed by the federal government and the states, with Washington paying 50 percent of the costs in higher-income states and about 70 percent in lower-income states like Arkansas. States have historically had leeway to define eligibility and benefits within guidelines set by federal law.
Under the new law, the federal government will pay the full cost of covering those newly eligible for Medicaid for three years, from 2014 to 2016, and the federal share will then gradually decline to 90 percent in 2020 and later years. Administration officials say this is a good deal for states, but it may ultimately create new costs for states. Many state officials also worry that Congress will reduce the federal share and shift more costs to the states.
In challenging the constitutionality of the new health care law, 26 states have asserted that Congress cannot force them to make such a large expansion of Medicaid. The case raises profound questions about Congress’s ability to attach conditions to money that it distributes to states not only for health care but also for education, transportation and myriad other purposes. At some point, the states argue, financial inducement turns into coercion.
The expansion of Medicaid would have a large impact in relatively poor states like Arkansas, where current eligibility criteria for adults are strict and chronic conditions like diabetes and obesity are widespread. (Arkansas is less healthy than all but three other states, according to annual rankings by the United Health Foundation.)
Other states that expect large increases in Medicaid enrollment, like Louisiana and Texas, are among the plaintiffs in the federal lawsuit. In Arkansas, by contrast, state officials accept the expansion of Medicaid.
The new health care law will simplify eligibility, sweeping away many of those categories in favor of a single standard. People under 65 will generally qualify for Medicaid if their income is less than or equal to 133 percent of the federal poverty level (up to $25,390 for a family of three).
In addition to the costs, state officials here are not sure how they will cope with the expected surge in people eligible for Medicaid, given that doctors and nurses are scarce in some counties.
From the Cornfield, for now, it is a guessing game of "what ifs". A decision is expected no later than June 29.