Overview of the ACA legislation recently ruled on by the UC Supreme Court. By Jaime S. King, JD UCSF / UC Hastings Consortium on Law, Science and Health Policy. http://www.uchastings.edu

1. What Now? Health Reform in the
Aftermath of the S. Ct. Decision
Jaime S. King, JD, PhD
UCSF/UC Hastings Consortium on Law, Science and
Health Policy
June 29, 2012

2. Two Major Holdings
 Individual Mandate upheld
 4 Justices upheld it via the Commerce Clause
(Ginsburg, Sotomayor, Kagan, and Breyer)
 Chief Justice Roberts upheld it as a tax.
 Medicaid Expansion
 Federal government may incentivize the expansion
 Roberts, Kagan, Breyer, Ginsburg, Sotomayor
 But, the Federal Government cannot withdraw all
Medicaid funds for failure to expand
 Roberts, Kagan, Breyer, Scalia, Alito, Kennedy,
Thomas

3. Major Elements of the ACA
Upheld
 Individual Mandate
 Employer Mandate/Play or Pay
 Premium and Cost Sharing Subsidies
 Medicaid Expansion (limited)
 Health Insurance Exchanges
 No Preexisting Condition Exclusion
 Community Rating
 Dependents can stay on insurance until age 26
 Payment Changes in Medicare

4. Health Law and Policy Initial
Implications
 2014 – Nearly all individuals will have to purchase
health insurance or pay a tax.
 Medicaid Expansion – Opt In
 State Exchanges – Back on Track
 Future Litigation/Repeal Efforts

5. No “Broccoli Horrible”

6. Mandate vs. Tax

7. Medicaid Expansion – Opt In
Prior Medicaid Eligibility ACA
 Disabled  All individuals with incomes
under 133% of the Federal
 Blind Poverty Level
 Families with Children
 Elderly  ACA Following S. Ct. Ruling
 133% only if state decides
to expand

8. What will the States do?

9. Medicaid/Tax Credit Ineligible?
 $15,000 Total Income for 2  $90,000 Total Income for 4

10. Exempt from the Individual
Mandate, but No Subsidy?
100% FPL

12. Strategies to Undermine the
Health Law
 Repeal and Replace Entire Bill
 Repeal Portions of the Bill
 Litigate HHS Regulations
 Limit Appropriations

13. Difficult to Repeal and
Replace All of it….

14. Is This the End of the Fight?
 Repeal and Replace Entire Bill
 Repeal Portions of the Bill
 Litigate HHS Regulations
 Limit Appropriations

15. Intersection of Law, Science
and Health Policy