On March 23, 2010, the Affordable Care Act (ACA) was signed by President Obama. What’s ACA and why it is important? Before I read the guide to the Supreme Court’s Affordable Care Act Decision, I knew nothing about it. National Federation of Independent Business v.
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Sebelius is known as a case that the Supreme Court will consider the constitutionality of two major provisions of the ACA: the individual mandate and the Medicaid expansion (Musumeci, 2012, p.1). The Individual Mandate was supported by a majority of the Court; however, “”Court found the Medicaid expansion unconstitutionally coercive of states because states didn’t have adequate notice to voluntarily consent and the Secretary could potentially withhold all of a state’s existing federal Medicaid funds for non-compliance (Musumeci, 2012, p. 1). What was the final decision of the Court on ACA? How did the Court rule? Supreme Court Obamacare The Affordable Care Act is known as Obamacare. Florida state claimed a lawsuit to question the constitutionality of individual mandate and Medicaid expansion. Florida gathered 25 other states: “” Alabama, Alaska, Arizona, Colorado, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Mississippi, Michigan, Nebraska, Nevada, North Dakota, Pennsylvania, Ohio, South Dakota, South Carolina, Utah, Washington, Wisconsin, Texas and Wyoming (Musumeci, 2012). The plaintiffs were gathered by the National Federation of Independent Businesses (NFIB) and individual plaintiffs who do not have health insurance to support ACA. Specifically, two state, Iowa and Washington, supported both sides. As we see, the key points in this case are focused on two main ideas: Individual Mandate and Medicaid expansion that is the most controversial.
Individual Mandate, also known as the individual shared responsibility provision, requires all citizen and legal immigrants of United States to have health insurance. According to Musumeci (2012), “”To increase access to affordable health insurance, the ACA provides for the creation of health insurance exchanges that will offer qualified health plans, as well as advance payment of premium tax credits to people with incomes between 100% and 400% of the federal poverty level (FPL), between $23,050 and $92,200 per year for a family of four in 2012 (p.2). Unfortunately, lots of poor families and individuals didn’t have health insurance because they cannot afford for it. For the people who do not satisfy the Individual mandate, they must pay a penalty tax called the shared responsibility payment. The controversial point is about the penalty imposed by the individual mandate. The opponents of ACA argued that government should not be permitted to penalize people who do not buy something (health insurance). Medicaid Expansion is also a way in order to increase access to affordable health insurance by expanding the medical eligibility to young individual whose annual income at or below 133 percent of federal poverty level. This program is funded by federal and state government and all states are voluntary to do this; however, there is a concern in the federal requirements about the people who is eligible to be covered by the program.
According to Musumeci (2012), “”Prior to the ACA, federal law mandated coverage for the following principal eligibility groups: pregnant women and children under age 6 with family incomes at or below 133% FPL, children ages 6 through 18 with family incomes at or below 100% FPL, parents and caretaker relatives who meet the financial eligibility requirements for the former AFDC (cash assistance) program, and elderly and disabled people who qualify for Supplemental Security Income benefits based on low income and resources (p.3). What’s more, at the beginning of 2014, the ACA requires all the states to expand the coverage groups to all people under age 65 and people with incomes at or below 133 percent of federal poverty level. But many states still didn’t cover certain group of people and the federal law initially didn’t include non-elderly or non-pregnant people without children in the range of Medicaid program; Therefore, it becomes another controversy in ACA. To promote the Medicaid program, according to Musumeci (2012), “”federal government will cover 100% of the states’ costs of the coverage expansion in 2014 through 2016, gradually decreasing to 90% in 2020 and thereafter. The ACA also provides that the benefit package for the newly eligible Medicaid population must include the ten categories of “”essential health benefits specified elsewhere in the ACA (p.3).
In this case, finally, Supreme Court agreed to grant the constitutionality to the Individual Mandate and Medial expansion. There are three aspects of important vote tallies about the decision. According to Musumeci (2012), the three aspects are “” (1) The Individual Mandate is a Constitutional Exercise of Congress’ Power to Tax; (2) Medicaid expansion violates Congress’ spending clause power as unconstitutionally coercive of states because all existing Medicaid funds at risk and states not given adequate notice to voluntarily consent; (3) Remedy is to limit HHS Secretary’s power to withhold existing federal Medicaid funds for state non-compliance with Medicaid expansion (p.4). Around the first argument, there are five votes supporting it and four votes disagreeing with it. The supporters of this points claimed that according to U.S. Constitution, “”Congress should be able to levy taxes. The lower federal courts however did not realize that the individual mandate was constitutional because of the power of taxing of Congress. The opponents claimed that the shared responsibility payment does not include people whose income is extremely low. They augured that the failure to comply with the individual mandate is an illegal act. What’s more, they considered the amount of money from tax annually collected by government from the low-income people is only about $4 billion per year. As a result, Since the Congress has the power to tax its citizens, the Supreme Court decided the individual mandate was constitutional.
Around the second and the third arguments, the main controversy is whether the Medicaid expansion is a constitutional exercise of Congress’ Spending Clause power. The Roberts plurality, the supporters of this program, claimed that restricting the Services Secretary’s enforcement power is the way to remedy the violation. According to Musumeci (2012) “”The Court ultimately held that the Medicaid expansion is unconstitutionally coercive of states because states did not have adequate notice to voluntarily consent, and the Secretary could withhold all existing Medicaid funds for state non-compliance (p.5), the opponents thought that Medicaid expansion is illegally coercive of the states.
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