The United States Supreme Court this morning, in a 5-4 ruling written by Chief Justice Roberts and supported by the four liberal members of the Court, upheld the constitutionality of the Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance. The five Justices agreed that the penalty that someone must pay if he or she refuses to buy insurance is a kind of tax that Congress has the constitutional authority to impose using its taxing power. Once it was decided that the mandate was constitutional, the Court did not need to address most other provisions of the law. The one exception relates to the provision that requires states to comply with new eligibility requirements for Medicaid or risk losing their funding. The Court ruled that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding. To take all of their funding would be coercive.
Based on this decision, the Court has put to rest the legal questions for the time being. However, it is important to note that the political issues have not been resolved. We fully expect the current activity in the House, in particular, of trying to repeal individual provisions and to defund other provisions to continue. Among the likely targets are things like the Patient Centered Outcomes Research Institute (PCORI), which funds comparative clinical effectiveness research; the Centers for Medicare and Medicaid Innovation (CMMI), which funds health systems research; possibly some of the primary care payments that are increased in the law; and possibly others. In addition, the decision assures that the health care law will be a major consideration in the fall presidential and congressional elections.
SGIM, through its membership, leadership, and the Health Policy Committee will continue to advocate aggressively for health policy that supports our collective mission to lead excellence, change and innovation in clinical care, education and research. As the hard work of implementing the provisions of the ACA continues, we will be at the table representing generalist values.
Here is the opinion: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.