What Now? Health Reform in the Aftermath of the S. Ct. DecisionJaime S. King, JD, PhDUCSF/UC Hastings Consortium on Law, Science and Health PolicyJune 29, 2012

Two Major Holdings Individual Mandate upheld

4 Justices upheld it via the Commerce Clause (Ginsburg, Sotomayor, Kagan, and Breyer)

Chief Justice Roberts upheld it as a tax.

Medicaid Expansion Federal government may incentivize the expansion

Roberts, Kagan, Breyer, Ginsburg, Sotomayor But, the Federal Government cannot withdraw all

Medicaid funds for failure to expand Roberts, Kagan, Breyer, Scalia, Alito, Kennedy,

Thomas

Major Elements of the ACA Upheld

Individual Mandate

Employer Mandate/Play or Pay

Premium and Cost Sharing Subsidies

Medicaid Expansion (limited)

Health Insurance Exchanges

No Preexisting Condition Exclusion

Community Rating

Dependents can stay on insurance until age 26

Payment Changes in Medicare

Health Law and Policy Initial Implications2014 – Nearly all individuals will have to

purchase health insurance or pay a tax.

Medicaid Expansion – Opt In

State Exchanges – Back on Track

Future Litigation/Repeal Efforts

No “Broccoli Horrible”

Mandate vs. Tax

Medicaid Expansion – Opt InPrior Medicaid

Eligibility Disabled

Blind

Families with Children

Elderly

ACA All individuals with

incomes under 133% of the Federal Poverty Level

ACA Following S. Ct. Ruling 133% only if state

decides to expand

What will the States do?

Medicaid/Tax Credit Ineligible? $15,000 Total Income for 2 $90,000 Total Income for 4

Exempt from the Individual Mandate, but No Subsidy?

100% FPL

Strategies to Undermine the Health Law

Repeal and Replace Entire Bill

Repeal Portions of the Bill

Litigate HHS Regulations

Limit Appropriations

Difficult to Repeal and Replace All of it….

Is This the End of the Fight?Repeal and Replace Entire Bill

Repeal Portions of the Bill

Litigate HHS Regulations

Limit Appropriations

Intersection of Law, Science and Health Policy