Notes On the Affordable Care Act Rulings

The supreme court has issued a fourth major ruling on the Affordable Care Act, A.K.A. Obamacare. Today I want to explain what each of those major ruling was about, where those ruling leave us today, and what action we can take in relation to those rulings.


The supreme court has issued a fourth major ruling on the Affordable Care Act, A.K.A. Obamacare. I want to explain what each of those major ruling was about, where those ruling leave us today, and what action we can take in relation to those rulings.

National Federation of Independent Business v. Sebelius was a lawsuit challenging what is called the individual mandate. The individual mandate is a part of the law that states most Americans must either have some form of health insurance or pay a fine. NFIB and others argued that the federal government had no authority to require health insurance the supreme court ruled five to four that the fine was a tax, and the federal government has a right to tax individuals.

The Affordable Care Act also required a provision referred to as Medicaid expansion. This provision changed the eligibility for Medicaid allowing for more people to qualify for the plan, especially families with a working adult.  For more information about who would qualify for Medicaid click here. Originally the ACA required the states to expand their Medicaid program to match the new eligibility requirements or lose all federal funding for existing Medicaid programs.  NFIB also challenged the constitutionality of this requirement.  On this point they won.  The federal government was told that will need to continue existing Medicaid funding to states even if they didn't expand eligibility.  So this left states with the choice of leaving their programs as they have been, or accepting additional funding and enrolling more residents in their Medicaid programs.


Burwell v. Hobby Lobby was a lawsuit challenging what is commonly called the contraception mandate. The ACA requires health insurance companies to cover preventative care. As you may have noticed you no longer need to pay copays for annual check ups. The idea being if patients don't need to pay for preventive care they are more likely to seek it, and prevention is generally much cheaper than treatment. The ACA did not define what counts as preventive care.  Which means it is up to the administration,The President and his staff, to decide. The Obama administration decided that contraceptives count as preventive treatment.  Hobby Lobby's complaint was that they were being compelled to pay for forms of birth control that the company owners considered to be abortion. The courts ruled that closely held companies(companies with a few owners) could not be compelled to violate their religious beliefs.  So certain companies are able to buy health care plans that don't cover the cost of certain forms of birth control.


King v. Burwell challenged subsidies being given to individuals using the federal exchange. The ACA provided funding for states to create online exchanges where individuals could purchase health care coverage directly from insurance companies. Recognizing that purchasing health insurance directly with out the employer subsidy most of us receive would be difficult for many, the ACA also provided federal subsidizes directly to many purchasing health care on the exchanges. After the original draft of the ACA someone pointed out that the states may not act to create the exchanges even after being provided the funds to do so.  So a provision was created for residents of states that refused to implement their own exchange would be able to use an exchange created and ran by the federal government.  How ever the wording related to the subsidies being given to individuals was never changed, and still stated that subsidies were to be given to people using the state exchanges.  The court ruled six to three that while the ACA was poorly worded congress clearly meant for individuals using the federal exchange to receive the subsidies.


So where does all this leave us today?  The individual mandate is still in place, and if you do not have health insurance you will likely be required to pay a "tax penalty" as part of your federal taxes. Medicaid is still an ongoing battle in many states including Utah.  The battle in Utah led the LDS Church to issue the following statement:

We reaffirm the importance for individuals and families to be as self-sufficient as their particular circumstances allow and recognize that the lack of access to health care can impair a person's ability to provide for self and family....

Many people are not able to work because of health issues, getting them properly treated(as opposed to stabilized, the purpose of an emergency room) can lead to these people being more self-sufficient. 

The current Medicaid system discourages many from joining the labor force.  Those who are disabled both mentally and physically find it difficult to find full time employment.  Either due to frequent needs to miss work for treatment, or because companies are unwilling to incur the cost of full time employment for the type of work these individual are able to do. Unable to find full time employment these individuals can only take part time jobs that do not offer health care. As mentioned above there is a magic number that if a family crosses they lose their Medicaid. Being disabled these individuals go to the doctor a lot and crossing that line would mean no more treatment.  Medicaid expansion raises that line to a point where hopefully families whose incomes rise above that line can afford the cost of the private medical insurance with the use of subsidies. 

Why don't we just encourage all these people to go on subsidize health insurance?   Part of it is out pocket cost for them can be higher and especially when we are talking about people with disabilities, but the main reason is it's cheaper for us.  Adding a family to the Medicaid program is cheaper than paying their cost to buy health insurance.  The people drafting the ACA created Medicaid expansion in order to keep the over all costs of the ACA down.  Concerned that simple Medicaid expansion did not meet the values of self-reliance that we as member of the LDS church believe in, Governor Herbert adapted the Medicaid Expansion program to include an employment benefit.  If you meet the requirements for Medicaid under the new rules, you can apply to the state for what is called Healthy Utah, and you will be given a job, if you don't already have one, and health insurance.  This is similar to how the state already runs the SNAP(foodstamps) program.Healthy Utah will be funded by the money that would have been used for Medicaid expansion.

There are many who oppose Healthy Utah, stating that either it's, "yet an other hand out to those who aren't willing to work hard", or that we simply can't afford it.  I don't believe either to be true.  What we can afford is all about values, and while it's true that if the federal government doesn't continue funding the program(their funding is only guaranteed for a certain number of years), and the current budget does not have the means to cover the gap, we can raise the money if we need it.  I personally support paying higher taxes if it mean covering healthcare for working Utahns. I encourage you to sign the LDS Democrats petition encourage our legislature to support Governor Herbert's Healthy Utah plan.

The Hobby Lobby ruling leaves us with no copays for contraceptives. Certain types of contraceptives may not be cover by your insurance if your company owners find them morally objectionable.  Contraceptives being considered preventive medicine is an administrative ruling, and can change based on who's president, so if this issue is important to you make sure you find out the stances of the candidates.


The King ruling has left the subsidies in place so individuals and families who's employers do not provide health care can continue to count on those.

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