The long awaited U.S. Supreme Court decision on the constitutionality of the federal health care reform law (the Affordable Care Act) was issued this morning, and the law has been upheld. Although it is a complicated decision that will provide fodder for analysis for months and years to come, the upshot is that Congress has the power to impose a tax on people who decline to buy health insurance. This means that the “individual mandate” stands. While Congress cannot compel people to buy health insurance, it has the power to impose consequences in the form of a tax if people refuse to do so.
The decision also confirmed the constitutionality of using the Medicaid program as the vehicle in the states to expand the insured population. But the ACA sought to cut off all Medicaid funding to states that refuse to expand the program, and the Court struck down that provision as unconstitutional because Congress does not have authority to force states to regulate. Instead, states that refuse to expand their Medicaid program will lose only the new funding that would have come along with the expansion.
In a nutshell, today’s decision upholding the federal law means that Vermont’s plans remain intact: for using the funds it anticipates receiving under the Affordable Care Act for its health insurance exchange (estimated to be $300,000,000 to $ 400,000,000) as a springboard to a single payer system. Vermont will implement the exchange in 2014, at which time individuals and employers of 50 or fewer people will buy insurance through the exchange. By 2017, most employers in Vermont will be required to buy health insurance through the exchange, and at that point, Vermont will apply for federal waivers of the exchange requirements so it may use the exchange money for a single payer system.
Although there are many unanswered questions, the big question of what happens immediately to Vermont’s reform efforts has been answered today. We move forward, as planned.
Tomorrow on VPR’s Vermont Edition, Bob Kinsel will interview Anya Rader Wallack, Chair of the Green Mountain Care Board, and Robin Lunge, Director of Health Care Reform, about Vermont’s next steps in light of today’s decision.
Please read the decision here: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf