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Affordable Care Act Ruled Constitutional

Today the Supreme Court ratified 100 years of efforts to assure that every American has access to medical care. These are efforts from Democratic and Republican Presidents, Governors and legislative leaders from Presidents Theodore and Franklin Roosevelt through Presidents Truman, Nixon and Clinton, from California Governors Earl Warren and Arnold Schwarzenegger, from Senators Ted Kennedy and Bob Dole finally culminating in the passage of the Affordable Care Act under President Obama. Now the US joins every other developed country, in coverage for all its citizens.

Its decision will be vital to the 7 million California men, women and children who are uninsured and unable to access medical care except in emergencies. The decision is vital for their health, for their productivity at work, for their economic and personal security. Its decision will help the two million Californians with private individual insurance with the costs of their coverage and provide important legal protections against insurance carriers’ exclusions and rescissions of their coverage. Its decision will be help the doctors, nurses and hospitals who provide care to the uninsured that ends up as billions in bad debt and charity care. Its decision will help reduce medical bankruptcies that continue to be the leading cause of individual bankruptcy. The Court’s decision will assist the state of California and its county governments, which have been the payors and providers of last resort for the very large and ever growing number of uninsured Californians. And it will help to modestly slow the rise in health spending on unnecessary and inappropriate care that burdens employers and employees, the federal and state governments.

The decision by Chief Justice Roberts held that the small penalty for those who choose not to be uninsured is constitutional when construed as a “tax”, whereas it would be and is unconstitutional as an individual mandate. The Court also held that states, which choose not to accept the 100% federal funding to expand their Medicaid programs, would lose only the new Medicaid funds, not their existing Medicaid funds if they decide not to expand their Medicaid programs for the newly eligible parents, children and adults.

Where does California go from here? It will need to continue to effectively implement the important aspects of the ACA that remain – the expansion of Medicaid for the low income uninsured, the refundable tax credits for moderate and middle income Californians and the Exchange to offer more affordable and reliable coverage for many small businesses and individuals, the ACOs that have shown promise to improve health outcomes and reduce costs for those with chronic illnesses and the expanded coverage of preventive services to every Californian with coverage.


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