Final Ruling on PPACA July 2, 2012

Last Thursday was a historic moment for our nation. The Supreme Court of the United States (SCOTUS) released its long awaited decision on the constitutionality of the Patient Protections and Affordable Care Act (PPACA), the healthcare reform law. The decision was not what anyone would have speculated; there were many unusual turns and twists. But, ultimately, the healthcare law was upheld, less one significant aspect of the Medicaid expansion provision.

In my earlier post on this subject, I described some questions before the court. With respect to the Anti-Injunction Act (AIA) (that is, whether the court could even hear the case), SCOTUS determined that the individual mandate, as described in the health reform law, is not a “tax” within the meaning of the law. Despite the fact that the SCOTUS upheld the individual mandate as a “tax”, because the meaning within the law was that of a penalty, the court determined the AIA did not apply.

With respect to the constitutionality of the individual mandate, as noted above, the high court decided it was constitutional under Congress’ taxing powers. Specifically, Chief Justice Roberts said “…the individual mandate must be construed as imposing a tax on those who do not have health insurance…”

Regarding the Medicaid expansion, the court ruled that the Congress could offer states funding to expand Medicaid coverage and that the states could expand coverage and accept the funding. However, the Congress held unconstitutional the withholding of all Medicaid funds if they did not expand. Instead, the SCOTUS ruled that a state can refuse to expand Medicaid, and continue to receive funding for its existing Medicaid program.

So, what does all of this mean to you? Well, it means that many more people will have access to insurance, although not as much as if the Medicaid provisions had been upheld. The prohibition on denial of coverage based on pre-existing conditions should help people with established heart disease. Young adults may stay on their parents’ insurance up to age 26. However, the Independent Payment Advisory Board (IPAB) stands, although it has not yet been established and there is some question about whether Congress will appropriate the funds it needs to get started. Value-Based Payment Modifier (VBPM) implementation will move forward. HRS is working to develop performance measures so EPs are prepared. Accountable Care Organizations (ACOs) will move forward, although long term outcomes on care and cost remain to be seen. The Centers for Medicare and Medicaid Innovation (CMMI) will continue to fund pilots and demonstrations, such as the dual-eligible’s demonstration program.

Your professional organization, its leaders and staff, will continue to work with Congress and the Administration to ensure the voices of our patients and of electrophysiologists are heard as the law continues to be implemented by the federal agencies. To that end, we’d love to hear your thoughts about the SCOTUS ruling, what you perceive to be the challenges moving forward, and how we can better support you and your patients in the weeks, months, and years ahead.

Kathleen Blake, MD, MPH, FHRS