Challenging the Affordable Care Act – Florida v. HHS
(Written for Contemporary Social Policy, University of Pennsylvania School of Social Policy and Practice)
The history of the Affordable Care Act (commonly referred to as “ObamaCare”) has been riddled with controversy, and not surprisingly, legal conflict. Originally passed as the Patient Protection and Affordable Care Act in March of 2010, the legislation is considered one of the highlights of the presidential legacy of Barack Obama. However, as is the case with many high profile legislative actions, the bill would quickly be brought into the legal system.
Things such as a single-payer system, and reductions in prescription drug costs for Medicaid/Medicare were not included in the final legislation, however the mandate that every person must attain insurance or be faced with penalties was.
Ultimately, in 2012, the Supreme Court would rule in favor of the Affordable Care Act – for the most part. In a 5-4 decision, the Justices found the legislation to be within the power of congress save one mandate – the forced expansion of Medicaid, under duress of losing previously funded dollars if a state should elect not to. The Justices argued that while the Medicaid mandate was within the fiduciary powers of congress, it lacked the ability to enact the individual mandate – a technicality that only the Supreme Court could uphold. For 27 states this came as a huge win; for objecting politicos it was a crushing blow as the ACA would remain to stay, forever changing the public health landscape in the country.
While not a complete victory for President Obama and ranking democrats, the upholding decision from the Supreme Court for the ACA would ensure that incremental change would be available to provide quality healthcare to citizens (and non-documented individuals) within the United States. Things such as a single-payer system, and reductions in prescription drug costs for Medicaid/Medicare were not included in the final legislation, however the mandate that every person must attain insurance or be faced with penalties was. Through these mandates, we have seen public health perspectives in the United States begin to change. For instance, with the inability to now block previously diagnosed medical problems or the requirements for behavioral health parity, many previous stigmatized medical concerns would know be covered under federal policy. It could be argued that these mandates enacted under the ACA, now held constitutional by the Supreme Court, were the biggest fundamental policy shift in the United States since the New Deal.
The decision has also lead to an increase in legislative activity at the federal and state level. With the ACA decision came the need to pass parity enforcement laws not only in D.C., but also in individual states – a process which is still being undertaken in many, including Pennsylvania, today in 2016. We have also seen additional states advocate and pass the expansion of Medicaid, even states which were part of the ACA court case arguing validity of the mandate. While the states did not agree with the provision which would take away funding if they elected not to expand Medicaid, it would appear that their constituents ultimately valued the benefits it would bring.
While the decision paved the way for healthcare reform in the United States, it does little to speak towards an issue of mandating a single payer system. It is believed that this system would be the next incremental progression from the ACA, but we are likely to face the same opposition in the legal system once that occurs.