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Supreme Court Upholds Health Care Reform Bill

At 10 a.m. today, in a 5-4 decision, the U.S. Supreme Court upheld the Affordable Care Act (ACA) in its entirety (with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read).  The Court could have struck down all or part of the bill as unconstitutional, but instead, upheld each of four distinct legal challenges. What does the Court’s decision mean to rural America? Whether you support of oppose the health care bill, it is important to know that many provisions were included in the bill that benefit both the rural provider and patient.  During the health reform debate, NRHA’s message was clear: Improve rural America’s access to health care providers by resolving the workforce shortage crisis in rural areas, and eliminate long-standing payment inequities for rural providers.  NRHA fought for and won key rural workforce and payment improvements in the bill.  Each of these decisions will remain intact in light of today’s decision.  However, complete funding for several of the provisions will likely continue to remain challenging.  (Many programs “authorized” in the ACA, must actually be funded through a separate act of Congress.) A list of rural relevant provisions in the Affordable Care Act can be found here. The Supreme Court reviewed four separate legal issues based upon the four previous federal appellate court challenges.  The four issues on which the court granted review and subsequently upheld today are:
  • Whether the Anti-Injunction Act prevents challenges to the Affordable Care Act at this time (that is, is there legal “standing” to challenge a tax that hasn’t gone into effect yet);
  • The constitutionality of the individual mandate, requiring most Americans to purchase health insurance by 2014;
  • Whether the individual mandate is severable if it is found to be unconstitutional, or whether the entire Act would have to fail; and
  • Whether the Affordable Care Act's expansion of the Medicaid program is constitutional.
The issues of the constitutionality and severability of the individual mandate attracted the most attention in the federal courts and among the public. Though three of the four federal appellate decisions upheld the mandate, many legal scholars are still surprised at today’s decision. Implementation of health reform is already underway, especially through the regulatory process.  Today’s decision will mean that rural providers must continue to be vigilant as preparations continue for the major provisions to go into effect in 2014.  Expect continued push-back from Congress to repeal all or part of the bill, as well as efforts to defund key provisions.  Stay tuned…

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