Implications of the Supreme Court's ACA Medicaid Decision

2013 ◽  
Vol 41 (S1) ◽  
pp. 77-79 ◽  
Author(s):  
Jane Perkins
Keyword(s):  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
President Obama ◽  
Patient Protection ◽  
General Welfare ◽  
The Supreme Court ◽  
Medicaid Eligibility ◽  
Over Time

Congress implemented the Medicaid Act in 1965, acting pursuant to its Spending Clause authority to “provide for the…general Welfare.” Over time, the Act has been amended more than 50 times. Most recently, as part of the Patient Protection and Affordable Care Act (ACA), Congress required participating states to extend Medicaid eligibility to childless, non-disabled, and non-elderly adults with incomes below roughly 133% of the federal poverty level (referred to as childless adults).Within hours of President Obama signing the ACA into law, four lawsuits were filed challenging the con-stitutionality of the ACA, including a case in Florida that eventually made its way to the Supreme Court as National Federal of Independent Business v. Sebelius (NFIB). As part of this case, officials from 26 states argued that Congress was improperly coercing them into participating in the Medicaid expansion.

scholarly journals Constitutional Ratemaking and the Affordable Care Act: A New Source of Vulnerability

2012 ◽  
Vol 38 (2-3) ◽  
pp. 243-268
Author(s):  
Richard A. Epstein ◽  
Paula M. Stannard
Keyword(s):  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
Patient Protection ◽  
Commerce Clause ◽  
Different Types ◽  
Individual Mandate ◽  
The Government ◽  
The Individual

As this Article is being written, the Patient Protection and Affordable Care Act (ACA) is being besieged with two different types of challenges. The first is a Commerce Clause challenge to the individual mandate on the ground that, although the Commerce Clause allows the government to “regulate” the transactions into which people choose to enter, it does not allow the state to force people to enter into disadvantageous transactions against their own will. The second of these challenges deals with the imposition of the Medicaid expansion provisions requiring a state to forego all of its additional Medicaid support unless it is prepared to extend Medicaid coverage, partially at its own expense, to individuals whose income levels put them at 100% to 133% of the federal poverty level.

scholarly journals Medicaid on the Eve of Expansion: A Survey of State Medicaid Officials on the Affordable Care Act

2014 ◽  
Vol 40 (2-3) ◽  
pp. 253-279 ◽  
Author(s):  
Benjamin D. Sommers ◽  
Sarah Gordon ◽  
Stephen Somers ◽  
Carolyn Ingram ◽  
Arnold M. Epstein
Keyword(s):  
Affordable Care Act ◽  
Enrollment Management ◽  
Medicaid Expansion ◽  
Federal Poverty Level ◽  
Access To Services ◽  
Poverty Level ◽  
Implementation Challenges ◽  
Coverage Expansion ◽  
The Affordable Care Act ◽  
Care Costs

As of January 2014, 26 states had chosen to expand Medicaid under the Affordable Care Act (ACA) to cover individuals with incomes up to 138% of the federal poverty level. In these states, Medicaid agencies are facing one of the largest implementation challenges in the program’s history. We undertook a survey of high-ranking Medicaid officials in these states to assess their priorities, expectations, and programmatic decisions related to the coming expansion.The Medicaid expansion poses major challenges in the domains of enrollment, management of health care costs, and providing adequate access to services for beneficiaries. Previous research has documented that millions of individuals eligible for Medicaid are currently not enrolled and remain uninsured, suggesting that state outreach strategies may underpin the success or failure of the ACA’s coverage expansion.

Physician Reimbursement Under Medicaid

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 778-780
Author(s):  
PHILIP R. LEE ◽  
PAUL W. NEWACHECK
Keyword(s):  
Federal Poverty Level ◽  
Physician Payment ◽  
Poverty Level ◽  
Physician Reimbursement ◽  
Medicare Program ◽  
Medicaid Eligibility ◽  
Low Levels ◽  
Poor Children

Physician payment under Medicaid has been a cause of growing concern among physicians because of the low levels of reimbursement in relation to private payors and the Medicare program in many states. This is particularly important to physicians caring for children because of the growing dependence of poor children on Medicaid and the evolution of Medicaid policies since the mid 1980s. Beginning in the mid 1980s Congress began legislating a series of laws that expanded Medicaid eligibility for poor and near poor children. This series of legislation culminated with the Omnibus Budget Reconciliation Acts of 1989 and 1990. These acts required all states to establish minimum Medicaid income eligibility thresholds at 133% of the federal poverty level for children less than 6 years of age and then subsequently to phase-in coverage, 1 year at a time, for all children through 18 years of age with family incomes less than 100% of poverty level.

scholarly journals Examining Medicaid Expansion and the Treatment of Substance Use Disorders

2019 ◽  
Vol 109 ◽  
pp. 187-191 ◽  
Author(s):  
Jevay Grooms ◽  
Alberto Ortega
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Health Coverage ◽  
Federal Policies ◽  
Patient Protection

As the drug epidemic continues to cripple communities and disrupt our country, identifying and understanding state and federal policies which have helped alleviate the burden of substance use disorders (SUDs) is imperative. In 2010, the passage of the Patient Protection and Affordable Care Act (ACA) expanded health coverage and services offered to millions of Americans. Prior to the ACA, treatment for substance use disorders was not included in all medical coverage. We examine the brief literature on ACA Medicaid Expansion and SUDs and complement this literature by including the effects on measures of supply and efficacy of SUD treatment.

State strategies to address medicaid prescription spending: negotiated pricing vs price transparency

2020 ◽  
pp. 1-15
Author(s):  
Shihyun Noh ◽  
Christian L. Janousek ◽  
Ji Hyung Park
Keyword(s):  
Managed Care ◽  
Affordable Care Act ◽  
The State ◽  
Pricing Strategy ◽  
Care Organization ◽  
Price Transparency ◽  
Patient Protection ◽  
Managed Care Organization ◽  
Medicaid Prescription ◽  
Over Time

Abstract This research longitudinally examines the association between levels of state Medicaid prescription spending and the state strategies intended to constrain cost increases: the negotiated pricing strategy, as indicated by state rebate programs, and the price transparency strategy, as indicated by state operation of All-Payer Claims Databases. The findings demonstrate evidence that state Medicaid prescription spending is influenced by the negotiated pricing strategy, especially Managed Care Organization (MCO) rebates under the Patient Protection and Affordable Care Act, but not influenced by the price transparency strategy. State decisions for MCO rebates, such as carving prescription benefits into managed care benefits, were effective in containing levels of Medicaid prescription spending over time, while other single- and multi-state rebate programs were not. Based on these findings, state policymakers may consider utilizing the MCO rebate program to address increases in Medicaid prescription spending.

Changes in Reimbursement to Emergency Physicians After Medicaid Expansion Under the Patient Protection and Affordable Care Act

2019 ◽  
Vol 73 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Jesse M. Pines ◽  
Rahul Ladhania ◽  
Bernard S. Black ◽  
Christopher K. Corbit ◽  
Jestin N. Carlson ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Emergency Physicians ◽  
Patient Protection

scholarly journals Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Non–Small Cell Lung Cancer Survival

JAMA Oncology ◽  
2020 ◽  
Vol 6 (8) ◽  
pp. 1289
Author(s):  
Ying Liu ◽  
Graham A. Colditz ◽  
Benjamin D. Kozower ◽  
Aimee James ◽  
Tracy Greever-Rice ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Affordable Care Act ◽  
Cancer Survival ◽  
Small Cell ◽  
Medicaid Expansion ◽  
Small Cell Lung ◽  
Patient Protection ◽  
Lung Cancer Survival

scholarly journals Overturning the ACA’s Medicaid Expansion Would Likely Decrease Low-Income, Reproductive-Age Women’s Healthcare Spending and Utilization

2020 ◽  
Vol 57 ◽  
pp. 004695802098146
Author(s):  
Lucy Chen ◽  
Richard G. Frank ◽  
Haiden A. Huskamp
Keyword(s):  
Low Income ◽  
Medical Expenditure Panel Survey ◽  
Healthcare Spending ◽  
Reproductive Age ◽  
Medical Expenditure ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Difference In Differences ◽  
The Supreme Court ◽  
Household Incomes

In late 2020, the Supreme Court began hearing a case challenging the Affordable Care Act (ACA), which led to coverage gains for many low-income, reproductive-age women. To explore potential implications of a full ACA repeal for this population, we examined gains experienced after Medicaid expansion, assuming that such gains may be reversed. Using restricted 2013 to 2014 data from the Medical Expenditure Panel Survey for 1190 women ages 18 to 44 with household incomes below 138% of the federal poverty level, we compared the change in healthcare spending and utilization for women living in expansion states to the change in non-expansion states using a difference-in-differences design. We found that if Medicaid expansion were overturned, Medicaid coverage is likely to decrease, as well as Medicaid spending and prescription drug utilization.

scholarly journals A FEW FOR-PROFIT BUSINESSES’ BATTLE OVER THE AFFORDABLE CARE ACT’S PREVENTATIVE SERVICES MANDATE

2014 ◽  
Vol 32 (2) ◽  
pp. 381-400
Author(s):  
Leigh Argentieri Coogan
Keyword(s):  
Affordable Care Act ◽  
Cost Sharing ◽  
Religious Organizations ◽  
District Court ◽  
Health Plans ◽  
For Profit ◽  
Patient Protection ◽  
The Supreme Court ◽  
Regulation Changes ◽  
Preventative Services

Under the Patient Protection and Affordable Care Act (ACA), employers are required to provide employees with health plans, which must include FDA, approved contraceptives with no cost sharing. While Health and Humans Services (HHS) revised the regulation to allow for a compromise among religious organizations and non-profits run by religious organizations, private for profit businesses must comply with the ACA even if the business asserts to be founded on religious principles. Several for profit business have sued in district court for an injunction against the requirements. However, a circuit split exists among courts granting preliminary injunctions against the ACA pending a granting of appeal. This note will focus on whether the federal government can compel secular, for profit organizations to provide employee health plans that include contraceptives, the morning after pill and sterilization under the Religious Freedom Restoration Act. Unless the statute or regulation changes, the Supreme Court will likely need to grant certiorari to resolve the issue.

Working With Older Adults: Impact of the Affordable Care Act and Other Trends in Health Care

2011 ◽  
Vol 16 (1) ◽  
pp. 10-17
Author(s):  
Amy Hasselkus
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Affordable Care Act ◽  
Care Delivery ◽  
Speech Language Pathology ◽  
Policy Changes ◽  
Patient Protection ◽  
Language Pathology ◽  
The Impact ◽  
Over Time

Rapidly increasing numbers in our aging population coupled with anticipated changes in reimbursement and health-care delivery have led to policy changes that will be implemented over time. This article will review the Patient Protection and Affordable Care Act of 2010 (ACA) and the Health Care and Education Reconciliation Act and will discuss the impact of health care changes on speech-language pathology practice with older adults.

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