The Supreme Court Upholds the Affordable Care Act

The Friends of AIDS Foundation welcomes the recent Supreme Court decision upholding the Affordable Care Act (ACA) as a victory for People Living with HIV/AIDS (PLWHA).

Below is a summary of the key elements of the Court’s ruling as they affect people living with HIV and hepatitis C. We will continue our advocacy for full implementation of this important legislation based upon this historic decision. Further information about the ACA is available at: http://www.hivhealthreform.org

1. The Affordable Care Act has been largely upheld by the Supreme Court, ending legal challenges to the law and clearing the way for implementation. Unless the ACA is repealed by Congress, current protections and coverage expansions will continue and large coverage expansions and additional important protections, such as a ban on insurance discrimination against adults with pre-existing conditions including HIV and hepatitis C, will begin in 2014. This is a major victory for people with HIV/AIDS and hepatitis C, who need an assured source of affordable, quality health care and treatment in order to live healthy and productive lives and reduce new infections. It is of particular importance to uninsured people living with hepatitis C who currently do not have a safety net like the Ryan White Program. The Supreme Court decision allows the ACA to clear a major hurdle and advocates can now focus on successful implementation and removing any barriers that would cause health disparities.

2. The individual mandate was upheld by the Supreme Court, although it is to be enacted as a tax for not purchasing insurance. This is the provision in the law that was considered most vulnerable. The individual mandate, which requires all American citizens to purchase health insurance or face a tax penalty, is an important element of health care reform. Without it, there would be little reason for healthy people to purchase insurance until they needed it. Meanwhile, sicker people who do need insurance would purchase it in larger numbers, potentially driving insurance premiums higher and making insurance less affordable. The decision to uphold the penalty for those who do not purchase insurance will bring more people into coverage and prevent the public from having to pay for care that is otherwise uncompensated.

3. Changes to the Medicaid expansion provision are problematic. The Supreme Court has ruled that while the federal government can offer funding (the federal contribution to states would be approximately 93% between 2014 – 2022, and ultimately maintained at 90%) to states to expand Medicaid coverage to low-income and poor adults, it can’t withhold a state’s traditional Medicaid funding as a penalty if it refuses to expand its Medicaid to all people living at 138% of Federal Poverty Level (FPL) or less. The majority opinion, written by Chief Justice Roberts, explicitly says that states may reject Medicaid expansion without penalty. This decision raises the real possibility that some states with poor health care coverage could choose not to expand their Medicaid programs.

However, although 26 states entered the law suit to challenge the constitutionality of the penalty, there are also many pressures that could make it hard for those states to refuse the expansion. The amount that the federal government is contributing is much higher than what states currently receive in Medicaid contributions and, in fact, the federal government covers 100% for the first two years of the program. Sick and poor people are already in the health care system in states, usually using costly and uncompensated emergency and acute care. Refusing federal money to serve those same individuals might not be fiscally prudent for many states. Additionally, since states will have Health Benefit Exchanges where individuals at higher incomes can purchase insurance with financial help from the federal government in order to afford coverage, states might have difficulty explaining why they won’t take federal money to provide health care to their most vulnerable residents.

Health lawyers are also analyzing the Court’s decision and state Medicaid statutes to see if the decision could allow people under 138% FPL to purchase insurance through the Exchange using federal financial help if their state did not expand Medicaid, or if state Medicaid law might make the expansion mandatory with the newly established federal expansion category.

4. Impact on California: California is one of the states that stands to benefit most from full implementation of the ACA. People in California are more likely to be uninsured and working in jobs that do not offer insurance. Already California has expanded its Medicaid program (Medi-Cal in California) to serve almost 500,000 uninsured Californians, including people with HIV and hepatitis C. In addition, 11,000 people including people with HIV and hepatitis C have benefited from the Pre-Existing Condition Insurance Program (PCIP) established under the ACA. California has established its Health Benefit Exchange Board and is planning a full Medi-Cal expansion in 2014. The state can now move with confidence to fully enact health care reform and provide insurance coverage and access to millions of Californians in great need, including people with HIV and hepatitis C.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.

TOGETHER WE REMAIN STRONG!