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.

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 The Taxing Power Of The Federal Government And The General Welfare: What Are The Limits In The Wake Of NFIB V. Sebelius?

2015 ◽  
Vol 76 (3) ◽  
Author(s):  
Mark Klock
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Funds ◽  
Chief Justice ◽  
Commerce Clause ◽  
General Welfare ◽  
Individual Mandate ◽  
Constitutional Constraints ◽  
The Individual

The Affordable Care Act seeks to remedy the problem of information asymmetry in the health insurance market by mandating that everyone obtain health insurance or pay a penalty, and by requiring the States to expand Medicaid or lose existing federal funds. In NFIB v. Sebelius, Chief Justice Roberts held that Congress’ power to regulate under the Commerce Clause could not justify the Individual Mandate to purchase insurance, but that the penalty could be construed as a tax and upheld under the taxing power. Chief Justice Roberts also held the Medicaid Expansion to be an unconstitutional use of spending power, but determined that the Medicaid Expansion could remain with the States having the option to keep existing funding and not expand or expand and take the incremental funding. Eight Justices disagreed with the Chief Justice on the Individual Mandate, and six Justices disagreed with the Chief Justice on the Medicaid Expansion. This creates a paradox in that a supermajority of the Court believes the case was wrongly decided on both main questions. More distressing is the scant analysis given in all of the opinions to the constitutional constraints on taxes.

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.

scholarly journals The Affordable Care Act’s Coverage Impacts in the Trump Era

2021 ◽  
Vol 58 ◽  
pp. 004695802110429
Author(s):  
Charles Courtemanche ◽  
Ishtiaque Fazlul ◽  
James Marton ◽  
Benjamin Ukert ◽  
Aaron Yelowitz ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
Community Survey ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
Individual Mandate ◽  
Us Presidential Election ◽  
Causal Impact ◽  
The Individual ◽  
Trump Administration

The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion increased in 2017 (7.0 percentage points) before returning to the 2016 level of coverage gains in 2019 (5.9 percentage points). The net effect of the ACA in expansion states is a combination of these trends, with coverage gains falling from 10.8 percentage points in 2016 to 9.6 percentage points in 2019.

The Individual Mandate: Implications for Public Health Law

2011 ◽  
Vol 39 (3) ◽  
pp. 401-413 ◽  
Author(s):  
Wendy E. Parmet
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Universal Coverage ◽  
Health Law ◽  
Healthy Individuals ◽  
Sick People ◽  
Patient Protection ◽  
Death Spiral ◽  
Individual Mandate ◽  
The Individual

No provision of the Patient Protection and Affordable Care Act (PPACA) has proven to be more contentious than the so-called “individual mandate.” Starting in 2014, the mandate will impose a penalty on non-exempt individuals who lack health insurance. According to Congress, the mandate is essential to ensuring near universal coverage. Without it, PPACA’s insurance reforms will lead healthy individuals to delay purchasing health insurance until they require medical care, resulting in risk pools with a disproportionate share of high-risk people. The price of insurance will then climb, causing more and more not-so-sick people to forego health insurance. The resulting “death spiral” will make insurance unaffordable to many more Americans.

scholarly journals What is the Meaning of Health? Constitutional Implications of Defining “Medical Necessity” and “Essential Health Benefits” under the Affordable Care Act

2012 ◽  
Vol 38 (2-3) ◽  
pp. 445-470 ◽  
Author(s):  
B. Jessie Hill
Keyword(s):  
Affordable Care Act ◽  
Human Services ◽  
Health Benefits ◽  
Medical Necessity ◽  
Health And Human Services ◽  
Patient Protection ◽  
The Affordable Care Act ◽  
The Government ◽  
The Individual ◽  
Essential Health Benefits

When the government decides to assume a major role in providing and paying for healthcare, the government also has to decide exactly what constitutes appropriate, reasonable, or essential healthcare under its program. Congress, of course, recognized this necessity when it passed the Patient Protection and Affordable Care Act (ACA), and the statute itself provides authority to the Secretary of Health and Human Services (HHS) to determine the “essential health benefits” that must be covered under the ACA beginning in 2014, both by insurers offering plans within governmentally sponsored exchanges and on the individual and smallemployer markets outside the exchanges. In a decision that was hailed as both “politically astute” and problematic for the goals that the ACA itself was supposed to accomplish, HHS shunted off the task of defining the term “essential health benefits” to the individual states.

Religious Exemptions to the PPACA's Health Insurance Mandate

2011 ◽  
Vol 37 (4) ◽  
pp. 624-651 ◽  
Author(s):  
Samuel T. Grover
Keyword(s):  
Health Insurance ◽  
Focal Point ◽  
Circuit Court ◽  
Patient Protection ◽  
Commerce Clause ◽  
Legal Challenges ◽  
Individual Mandate ◽  
Insurance Mandate ◽  
The Individual ◽  
Circuit Courts

Arguably the most controversial change to the U.S. healthcare system written into the Patient Protection and Affordable Care Act (“PPACA” or the “Act”) is what has been colorfully termed the Act’s “individual mandate,” the provision that establishes tax penalties for those who do not maintain health insurance in 2014 and beyond. Though the health insurance mandate does not go into effect until 2014, it has already faced numerous constitutional challenges in district and circuit courts, with entirely inconsistent results. Conflicting decisions regarding the Act’s constitutionality at the circuit court level cry out for Supreme Court review. But while the individual mandate’s validity under either the Commerce Clause or Congress’s taxing power has been the focal point of litigation thus far, another aspect of the individual mandate may undermine the goal of establishing universal, affordable healthcare coverage for all Americans. As currently written, the religious conscience exemption from the PPACA’s individual mandate threatens the efficacy of the Act and potentially exposes it to legal challenges under the Constitution’s Religion Clauses.

Affordable Care Act

2014 ◽  
Author(s):  
Stephen H. Gorin ◽  
Julie S. Darnell ◽  
Heidi L. Allen
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Health Care Quality ◽  
Care Quality ◽  
Health Coverage ◽  
Poverty Level ◽  
Deep Roots ◽  
Patient Protection ◽  
Individual Mandate ◽  
Improve Health Care Quality

This entry describes the development and key provisions of the Patient Protection and Affordable Care Act (ACA), which instituted a major overhaul of the U.S. health system, much of which took effect in 2014. The key provisions of the ACA included an individual mandate to purchase insurance, an employer mandate to offer coverage to most workers, an expansion of Medicaid to all persons below 138 percent of the federal poverty level (FPL), minimum benefit standards, elimination of preexisting condition exclusions, and reforms to improve health-care quality and lower costs. This historic legislation has deep roots in U.S. history and represents the culmination of a century-long effort to expand health care and mental health coverage to all citizens.

State-Run Insurance Exchanges in Federal Healthcare Reform: A Case Study in Dysfunctional Federalism

2012 ◽  
Vol 38 (2-3) ◽  
pp. 548-569
Author(s):  
Kyle Thomson
Keyword(s):  
Health Insurance ◽  
Small Business ◽  
Affordable Care Act ◽  
Bargaining Power ◽  
Healthcare Reform ◽  
Patient Protection ◽  
Individual Mandate ◽  
The Individual ◽  
Insurance Exchanges

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law, resulting in the most sweeping reform of the healthcare marketplace and one of the largest expansions in access to healthcare in American history. A key component to both restructuring the healthcare marketplace and improving access are the health insurance exchanges contained in the ACA. Today, individual and small group purchasers have difficulty finding affordable health insurance in the marketplace because they lack the tools to gather information about plans and because they lack the bargaining power to negotiate for affordable rates the way large purchasers can. In conjunction with the individual mandate, the health insurance exchanges aim to solve inefficiencies in the current marketplace by creating a centralized venue to connect insurers with individual and small business purchasers. Thus it both creates a place for insurers to readily find customers, who are now guaranteed to be there because of the individual mandate, and provides a place for customers to shop for insurance.

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.

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