We learned this week that the U.S. Supreme Court will hear a case challenging the constitutionality of the Affordable Care Act (or Obamacare if you prefer). The Court announced that it will hear an almost unprecedented five-and-half hours of oral argument on the case in March 2012, with a decision likely in late June 2012. Some of the key questions to be decided by the Court include:
- The constitutionality of the individual mandate that American citizens carry health insurance or pay a penalty.
- Whether the rest of the law may move forward if the individual mandate is not upheld.
- Whether Congress can expand Medicaid to cover more people and require states to pay for their portion of Medicaid. (In New Jersey, we have a 50-50 match, so if the feds spend a dollar, the state must match that dollar. Under healthcare reform, the feds pay 100 percent until 2016 and then the state governments would have to pick up its fair share of the cost of the expansion.)
- Whether the case is even ripe for Supreme Court review. Some say that the penalty provision of the law must go into effect first in 2015 before the Court can decide the case. On this last point, the Court did leave itself some wiggle room for a deferral of a decision if it agrees that the penalty provision must go into effect first.
I’m a healthcare professional first and foremost, but I’m also an attorney. And for the healthcare community, the individual mandate is key. If the rest of the law moves forward without the individual mandate, we will be left with many positive aspects of the law, but the largest one – providing care for insured Americans in exchange for $155 billion in cuts to our reimbursement over at 10-year period – will be stripped away. The cuts will stay, but hospitals and other healthcare providers will still be required to care for people who cannot pay.
The arguments in this case will be fascinating (if they sold tickets for this on Stubhub I’d buy one) and the subsequent decision even more so. Hopefully, we will have some clarity in just seven months. In the meantime, N.J. hospitals will continue to do what they’ve always done – provide care to all despite great challenges and uncertainty.
