Cath Lab Digest

The Supreme Court this morning upheld the majority of the Patient Protection and Affordable Care Act (ACA), a major victory for President Barack Obama as he seeks re-election in November.

By a 5 to 4 vote, the Court ruled the individual mandate requiring most people to buy insurance was constitutional. Chief Justice John Roberts, who was nominated by former President George W. Bush, wrote the majority opinion and cast the deciding vote. People can refuse to purchase insurance, but they will be taxed for doing so.

President Obama signed the ACA into law in March 2010. By 2014, an estimated additional 32 million people will gain access to health insurance thanks to the ACA, according to the Obama administration. Approximately half of those people will enroll in Medicaid.

However, today's ruling noted that the federal government cannot penalize states that refuse to expand Medicaid.

Other aspects of the law include the creation of state-based health insurance exchanges in which individuals and small businesses will purchase insurance; a provision that health insurers spend a minimum amount (80-85%) of their premiums on patient care; a mandate that insurers cannot deny coverage to anyone based on pre-existing conditions; and a provision that allows children to remain on their parents' health insurance coverage until they are 26 years of age.

Since the ACA's enactment, numerous lawsuits have been filed against the law. Among the plaintiffs' most persistent arguments was that it was unconstitutional to force people to buy insurance. Opinion polls have also been split on the ACA's popularity, with Democrats typically in favor of the law and Republicans opposed to it.

The 193-page ruling is available at http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

More details to follow in the July issue of First Report Managed Care.