Every day our patients continue to express their concern over the lack of affordable care being without insurance, and how Faith Family Clinic has made a huge difference in their lives. As we considered the results of the Supreme Court decision we knew there would continue to be a need for the kind of medical care that we provide to the uninsured and under insured who cannot afford the high costs of medical insurance.
On Thursday, June 28, 2012, the Supreme Court issued a ruling on the constitutionality of the Affordable Care Act (ACA). There is no question that this has been one of, if not the, most anticipated rulings in the history of the Court. The follow is a rough overview of the action.
Today the Supreme Court ruled the following:
The ACA, including its individual "mandate" that American's buy health insurance, is constitutional. While there was much discussion in the Court as to whether or not Congress could use its power to regulate commerce between states to impose this mandate, or whether it is a tax in the end, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power.
With the survival of the "mandate", the Court did not need to decide what other parts of the statue were constitutional with the exception of a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding.
To understand what this means it can be best explained by SCOTUSBlog.com
The Court's decision on the constitutionality of the Medicaid expansion is divided and complicated. The bottom line is that:
(1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals;
(2) States can agree to expand coverage in exchange for those new funds;
(3) If a state accepts the expansion funds, it must obey by the new rules and expand coverage;
(4) A state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option to continue its current, unexpanded plan as is.
This could mean that some states may decide that they do not want to expand their Medicaid program to 133% of the poverty level, but rather continue with the levels that are currently in place.
While some states have started the Medicaid expansion process internally and the process to establish exchanges, there are some states that have not started any parts of this process.
It will be interesting to see how the 26 states that brought this case before the Supreme Court respond to the ruling and the expansion of Medicaid. These states are Alabama, Alaska, Arizona, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.
Texas has about 6.2 million uninsured or about 25% of the population and has not implemented a health care exchange. Texas has joined with other states in challenging the law in court. Gov. Rick Perry, who is vocally opposed to the law, says the state can "deliver health care more efficiently, more effectively and cheaper than the federal government can."
Basic Information on the ACA
Signs indicate that some 23 million Americans will still lack insurance in 2019, after key provisions of the law have been in effect for as long as five or six years, according to a Congressional Budget Office (CBO) estimate.
Where will individuals purchase health insurance? Individuals can purchase insurance through state established exchanges. According to Kaiser Health Reform:
Exchanges are new organizations that will be set up to create a more organized and competitive market for buying health insurance. They will offer a choice of different health plans; certifying plans that participate and provide information to help consumers better understand their options.
Beginning in 2014, Exchanges will primarily serve individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future. States are expected to establish Exchanges--which can be a government agency or a non-profit organization--with the federal government stepping in if a state does not set them up.
States can create multiple Exchanges, so long as only one serves each geographic area, and can work together to form regional Exchanges. The federal government will offer technical assistance to help states set up Exchanges.
These individuals are not required to purchase health care under the ACA:
- Those who are part of a religion opposed to acceptance of benefits from a health insurance policy.
- Those who are an undocumented immigrant.
- Those who are incarcerated.
- Those who are a member of an Indian tribe.
- Those whose family income is below the threshold requiring you to file a tax return ($9,350 for an individual, $18,700 for a family in 2010).
- Those who have to pay more than 8% of their income for health insurance, after taking into account any employer contributions or tax credits.
Those individuals who were insured, a combination of any of the following sources will not receive a fine for not having health care·
- Medicaid or the Children's Health Insurance Program (CHIP).
- TRICARE (for service members, retirees, and their families)
- The veteran's health program.
- A plan offered by an employer.
- Insurance bought on your own that is at least at the Bronze level.
- A grandfathered health plan in existence before the health reform law was enacted.
The penalty for not purchasing health insurance will be phased-in according to the following schedule: $95 in 2014, $495 in 2015, and $750 in 2016 for the flat fee or .05% of taxable income in 2014, 1.0% of taxable income in 2015, and 2% of taxable income in 2016.
As Texas moves forward with the development of an Exchange we have positioned ourselves to provide a resource to small businesses through our Business MemberCare program. This is NOT insurance but direct medical care via a membership plan. Much like a gym membership, you pay one price for unlimited access to the services provided. Employers can not provide quality medical care at an affordable fee.
While the politicians and pundits continue their pontification, Faith Family Clinic will continue to serve the physical, spiritual, emotional and social needs of our community.
Thanks to the National Association of Free and Charitable Clinics for their assistance in compiling this information.