Supreme Court Upholds Health Care Reform Law: AOTA Analysis
By Jennifer Hitchon
June 28, 2012: In a 5-4 decision released today, the U.S. Supreme Court upheld the minimum coverage provision—more widely known as the “individual mandate”—that is the centerpiece of the Patient Protection and Affordable Care Act (ACA). Chief Justice John G. Roberts, Jr. wrote the majority opinion in Nat’l Fed. of Ind. Businesses v. Sebelius, U.S., No. 11-393 (6/28/12) with Justices Ruth Bader Ginsburg, Stephen G. Breyer, Sonia M. Sotomayor, and Elena Kagan joining in part. Justices Anthony M. Kennedy, Antonin Scalia, Clarence Thomas, and Samuel A. Alito Jr. dissented.
Four legal issues were before the Supreme Court: (1) the applicability of the Anti-Injunction Act (AIA), which could lead the Court to rule that a decision is premature since no penalties related to the individual mandate have yet been imposed; (2) the constitutionality of the individual mandate itself; (3) the severability of the individual mandate and whether the entire act must be invalidated if the mandate falls; and (4) whether the Medicaid expansion provisions are unlawfully coercive.
The justices did not apply the AIA and moved forward with a decision, finding the individual mandate to be an exercise of Congress’ tax authority rather than an exercise of its power to regulate commerce. “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” wrote Chief Justice Roberts. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” Thus the individual mandate remains, along with the rest of the law, which includes provisions on guaranteed issue, rescission, family coverage for children up to age 26, payment for quality over quantity, and other provisions that directly and positively impact the practice of occupational therapy, such as:
The inclusion of “rehabilitation and habilitation services” as required essential health benefits offered by plans operating in state-based purchasing exchanges. Once the law is fully implemented, practitioners should see a reduced number of coverage denials for occupational therapy simply because an insurance company deems the service “habilitative.”
Opportunities for occupational therapy in Medicare and other payment systems, including pilots and explorations of chronic care management, accountable care organizations, patient-centered medical homes, coordinated care, medication management, and wellness and prevention programs. (Originally posted in Occupational Therapy: Part of the Health Care Solution, March 2009).
The Court also ruled on the constitutionality of the ACA requirement that states expand Medicaid coverage and increase program spending or lose federal Medicaid funding. The Court’s decision on Medicaid expansion is divided and complicated: in essence, the majority found that a state may continue to operate its current plan and refuse to participate in ACA expansions without losing existing federal funding. State governors may now make their own decisions about whether to maintain their state Medicaid program as is and receive federal funds at the same rate, or expand eligibility and coverage requirements pursuant to the ACA and receive additional federal funds.
Health care reform efforts in the states and the federal government are already underway and will no doubt continue, although the fate of government regulation of health care will turn in large part on the outcome of elections in November. AOTA is continuing to analyze the Supreme Court’s decision and report on its implications for occupational therapy. E-mail your thoughts and questions to the AOTA Reimbursement and Regulatory Policy Department at firstname.lastname@example.org.
Jennifer Hitchon, JD, MHA, is AOTA’s regulatory counsel. She can be reached at email@example.com.
Supreme Court Opinion, Concurrence, and Dissent
Orders and case filings in the ACA cases
Previous AOTA Analysis of the ACA arguments before the Supreme Court
Analysis from the Henry J. Kaiser Family Foundation
Analysis from the Wall Street Journal
Analysis from the Washington Post
Analysis from the New York Times
AOTA Health Care Reform Implementation Page