“The Patient Protection and Affordable Care Act (ACA), enacted in 2010, was immediately challenged in court by states, organizations and individuals.
Background
At enactment of the ACA 45 million Americans did not have health insurance. Health care costs were outpacing the rate of general inflation. People were falling into financial ruin and/or foregoing critical medical care when faced with health care needs they could not afford to address. The problem was particularly acute among older people, who have a higher incidence of chronic health conditions and often live on fixed or limited incomes, making an unanticipated expense a significant problem.
Challenges to the ACA were filed in numerous federal courts. The U.S. Supreme Court will now review four issues: (1) whether the law’s requirement that people obtain minimum coverage either from the government or through the private market is constitutional, (2) whether the law’s expansion of the Medicaid program (in which states participate and pay part of costs) to help provide coverage for at risk populations is constitutional, (3) if either of those provisions is unconstitutional, whether the offending provisions can be severed and the remainder of the law — which includes important Medicare provisions — can stand, and (4) whether challengers to the minimum coverage provision, which does not go into effect until 2014, have standing to sue if the provision is a tax that cannot be challenged under the Anti-Injunction Act until collected. In challenges to the minimum coverage issue, AARP Foundation Litigation attorneys filed AARP’s “friend of the court” briefs in lower courts and now the U.S. Supreme Court, focusing on massive evidence showing that people ages 50-64 without employer-provided or government health insurance are systematically denied coverage or priced out of the private individual market due to their age or pre-existing health conditions.
Regarding the constitutionality of minimum coverage provisions, AARP’s brief describes the effects on the national economy as well as on public health caused by the millions of uninsured and underinsured people who cannot afford medical diagnosis and treatment, and accumulate crushing medical debt or are forced to file bankruptcy because of the debt. In addition, older Americans with employer-based insurance experience “job lock,” which means they are unable to retire or pursue self-employment as they often cannot obtain or afford health insurance on the private, individual market for them or covered family members. Moreover, the brief explains that Congress considered how uninsured and underinsured ages 50-64 suffer worse health outcomes and require more intensive and costlier care when they enter Medicare at age 65 than their insured counterparts, thereby costing the federal government millions of dollars in extra costs.
As for the legitimacy of Medicaid expansion, AARP joined with 39 organizations in filing a brief in the Supreme Court explaining how (1) state participation in Medicaid is and always has been voluntary, (2) starting in 2014, states will receive substantial federal matching funds for the expansion, and (3) the expansion in ACA is consistent with the history and structure of the Medicaid program and numerous other changes to the program since its inception.
AARP, with several other organizations that also advocate for seniors, filed a Supreme Court brief that argues that the ACA is written in such a way that if the minimum coverage provision is found to be unconstitutional, the remainder of the law that is unrelated to the minimum coverage provision can and should stand. Provisions in the ACA fixed several substantial problems with Medicare and these less controversial and widely approved measures should not fall if unrelated sections of the law are struck down. Among other things, the ACA (1) reduces cost-sharing for Medicare beneficiaries by substantially reducing the coverage gap for prescription medications (commonly known as the “donut hole”), (2) eliminates cost-sharing for preventive services such as an annual wellness visit, (3) prohibits Medicare Advantage plans from charging higher cost-sharing for chemotherapy and dialysis than permitted under traditional Medicare, (4) decreases the unnecessary institutionalization of Medicaid beneficiaries by providing financial incentives to states to shift spending away from institutional care, moving beneficiaries out of nursing homes and back into the community, (5) improves long term services and supports in the community for people with disabilities, (6) improves the coordination of care for people receiving both Medicare and Medicaid, and (7) improves quality and safety in nursing facilities, and prevents abuse and neglect of elderly and disabled individuals in nursing and other residential care facilities. Regarding the question of ripeness — one which AARP did not weigh in on — the U.S. Court of Appeals for the Fourth Circuit ruled in Liberty University v. Geithner that a challenge to the law was premature as the challenged provision has not yet taken effect and while that specific lawsuit is not at issue before the court, the court has agreed to look at that question and could base its ruling on that question alone if it determines that the fee imposed in ACA upon individuals who fail to obtain health insurance after 2014 is actually a tax.
What’s at Stake
People ages 50-64 — a population more likely to suffer from chronic health conditions than younger counterparts — who need to buy health insurance on the individual market have been especially harmed by current health insurance industry underwriting practices, which discriminate based on health status and age. This situation has led to devastating results for people in need of health care and financial harm to both individuals and government programs that step in to care for people when their conditions deteriorate. Likewise, people on Medicare were also harmed by the cost of much of their health care, putting many older people in jeopardy of not receiving preventive care and affording all of their prescription medicines. Should the ACA be struck down in whole or in part, many of the provisions of the law specifically designed to protect older people would be in jeopardy.
Case Status
The U.S. Supreme Court is hearing three days of oral arguments in Florida v. HHS, HHS v. Florida, and NFIB v. Sebelius on March 26-28, 2012.”