Analysis of the Ruling to Uphold the ACA

The U.S. Supreme Court’s ruling to uphold the individual mandate and the entire Patient Protection and Affordable Care Act (ACA) continues to reverberate across the political and health care landscape. In a 5-4 ruling, the high court said that Congress had the power to tax those who do not buy health insurance but not mandate the purchase of insurance. This ruling, though, effectively upheld the individual mandate in the ACA.

The court did rule that the federal government could not require states to expand Medicaid eligibility up to 133 percent of the federal poverty level, or about $30,000 for a family of four, as required by the law. It is estimated that this expansion would mean at least an additional 500,000 more Ohioans would be covered by Medicaid. The federal government set aside funding in the ACA for states to make this expansion. However, the court’s ruling allows states to turn down that funding and not expand Medicaid. The OSMA opposed the expansion of Medicaid as a vehicle to provide access to coverage under the ACA.

“In the wake of this ruling by the high court, the Ohio State Medical Association (OSMA) calls on Congress to improve upon several deficiencies in this legislation by eliminating the flawed Medicare Sustainable Growth Rate (SGR) formula, implementing cost-saving measures, like comprehensive medical liability reform, and finding alternative ways to achieve access to medical care other than already underfunded and overstressed public programs, such as Medicaid,” said Deepak Kumar, MD, president of the OSMA in statement on the ruling.

The American Medical Association (AMA) praised the court’s decision.

"[The AMA] has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy,” AMA President Jeremy A. Lazarus, MD, said in a statement.

The website SCOTUSblog has an excellent summary of the ruling on the individual mandate and the Medicaid expansion. A full breakdown of the high court’s ruling, including numerous sources of analysis, is also available here from Kaiser Health News. Finally, interactive text of the ruling is available here from NPR.

We will keep you updated as further information becomes available as to the short and long-term ramifications on this ruling.

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