The Affordable Care Act Survives – Again
On November 10, 2020 I wrote a column “The Affordable Care Act Is On the Line – Again” referencing a case before the United States Supreme Court. This past week on June 17, the U.S. Supreme Court in the same case, Texas v. California, as I predicted, upheld the Act – again. This was the third and, hopefully, the final attack before the Supreme Court on a law that has weaved its way into the fabric of our overly complex and confusing series of health care laws, regulations and practices over the years. While it is far from perfect, average citizens have begun to appreciate some of the ACA provisions, like being able to keep children up to the age of 26 on their parents’ health insurance, elimination of denial of coverage due to preexisting conditions and Medicaid expansion.
Here are some reasons why this most recent decision is important to average Americans.
- The Affordable Care Act has passed the test of time. When a law, especially one that rewires a system as complicated as American health insurance, lasts as long as this Act has done, that is 10 years, any attempt at this point to eliminate it would be extremely difficult. This fact was likely taken into consideration by Supreme Court justices, including two appointed by Trump, in arriving at their decision. Health insurers and policy holders have adjusted to the new rules and an attempt to eliminate the law altogether, which is what the plaintiffs in this recent case have requested, would likely result in chaos. Now would be the time to try to improve it rather than to kill it. Imagine, by comparison, if a lawsuit were instituted now to eliminate Medicare based on a technicality. Medicare went into effect in 1965, a time not that long ago and within the lifetime of many of us. The thought would be almost inconceivable. Medicare became accepted over time and it appears the same will be and has been happening with the ACA.
- The Supreme Court decision crossed party lines and was practical and realistic. Even with a majority of the Supreme Court having been appointed as conservative Justices, seven of the nine Supreme Court Justices upheld the law. Although their decision was limited to a relatively minor technical issue, the question of standing, the Court demonstrated its reluctance to overturn the law and a system that has been in effect since 2010. This result might evidence a practical bent in the Court looking beyond the case at hand to what is the effect of their decisions. Similar to the decision made regarding “Dreamers” on the DACA (Deferred Action for Childhood Arrivals) case, Department of Homeland Security v. Regents of the University of California, which could have resulted in deportation of tens of thousands of individuals or more brought to this country while children, if the Obama executive order had been overturned, the Texas v. California case seems to imply the Court might also look to the long term effect of its decisions. This might be helpful in understanding that some future decisions could also have a practical bent.
- Medicaid expansion provided under the Affordable Care Act makes health insurance available to millions of Americans who would otherwise remain uninsured. The Health Insurance Marketplace is now a matter of common understanding. Beginning about two years ago I started to meet with clients under age 65 who were receiving health insurance through Medicaid and asked how they qualified since they had assets above the expected cutoff figure for Medicaid. In some cases they had been employed and were laid off from their jobs. In other cases the individual might have been partially disabled but not enough to claim Social Security Disability or SSI or they might not yet have had their case resolved. They still had assets above the extremely low figures usually referenced for Medicaid qualification. Finally the answer came to me – Medicaid expansion or what is referred to now as MAGI (Modified Adjusted Gross Income) Medicaid. It depends on low or no income and not necessarily on low assets. It opens an entire new world of planning and we are ready for it.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.