Updated 5:20 p.m. EDT
In today's 5-4 Supreme Court decision to uphold the Accountable Care Act (ACA), Chief Justice John Roberts, typically a conservative voter who was nominated by President George W. Bush in 2005, voted alongside Justices Elena Kagan, Sonia Sotomayor, Ruth Bader Ginsburg, and Stephen Breyer. Justice Anthony Kennedy wrote the dissenting opinion, and he was joined by Justices Clarence Thomas, Samuel Alito, and Antonin Scalia.
As per the Supreme Court, the individual mandate for the purchase of health insurance was affirmed not under the Commerce Clause of the U.S. Constitution, but in the form of a tax. With regard to the individual mandate, the court ruled that the federal government cannot use the Commerce Clause to justify the individual mandate, as the government cannot force people to purchase services. However, it sustained the mandate under the concept of its being a tax, as there is no criminal or civil penalty for not purchasing health insurance under the ACA.
Ruling on another significant element of the ACA, the nation's high court ruled that the Medicaid expansion provided for in the act is constitutional, but that it would be unconstitutional for the federal government to withhold Medicaid funding for non-compliance with the expansion provisions.
Within minutes of this morning's verdict, reactions began to pour in from organizations and agencies that serve long-term care and post-acute care. Here are immediate comments from some of the industry's key leaders:
American Health Care Association and the National Center for Assisted Living (AHCA/NCAL): “Skilled nursing centers across the country have been implementing the law and preparing for the provisions yet to come,” AHCA/NCAL President and CEO Mark Parkinson said in a press statement. “With the constitutional issues surrounding health reform now answered, we hope Congress will shift its attention to tackling the difficult challenge of how to care for a growing elderly population in an era of declining resources.”
LeadingAge: “Reforms in the health and long-term care delivery systems [will] better integrate services and promote value over volume,” the nonprofit organization stated in a release. LeadingAge played an active role in developing the Community Living Assistance Services and Supports (CLASS) program, a part of the ACA that LeadingAge calls “a better means of financing long-term services and supports than our present patchwork and unsustainable system, which gives people limited choice of services.”
Direct Care Alliance (DCA): Access to affordable healthcare to attract and retain direct care workers is a key concern of the DCA, which applauded today’s SCOTUS decision in a press statement. “Due to punishingly low wages (median annual earnings were just $16,800 in 2009), nearly one in five direct care workers depend on Medicaid for insurance coverage. Approximately 900,000 more have no insurance at all, earning too much to qualify for Medicaid but too little to afford the premiums for private insurance,” the national advocacy group said. “These improvements will make it possible for more people to commit to this important work as a career, removing the barriers that now force many to choose between caring for others and providing health care for themselves and their families.”
Paraprofessional Healthcare Institute (PHI): “In light of today’s affirmation of the Affordable Care Act, 900,000 direct-care workers will have access to affordable coverage,” PHI President Steven Dawson noted in a statement. “Workers who live in households with incomes below 133 percent of poverty level, will be eligible for Medicaid and workers who cannot afford employer coverage will be able to buy state insurance with more affordable premiums because of the link to government subsidies.”
Health Information Management Systems Society (HIMSS): “HIMSS, like the rest of the country, is relieved that questions about the healthcare reform law have now been settled and the nation can move forward with the essential work of transforming healthcare in America,” said HIMSS President and CEO H. Stephen Lieber, CAE, in a statement. “Health information technology is critical to the ongoing transformation in our nation.”
American Medical Association (AMA): “This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance,” AMA President Jeremy Lazarus, MD, commented in a release. “The decision upholds funding for important research on the effectiveness of drugs and treatments.” Lazarus added that the decision also protects patients in the Medicare “doughnut hole,” the gap in the prescription drug coverage, retaining the discounts on needed prescriptions that are not covered by insurance.