SCOTUS has Decided, Let’s Move Forward
The Supreme Court upholding the Affordable Care Act (ACA) marks a huge victory not only for Minnesotans, but for all Americans. On a 5-4 decision, with Bush appointee Chief Justice John Robert siding with the liberals, the Court ruled that the “mandate” was a constitutional as a tax, and that states have the option to decline Medicaid expansion funds. But, the decision has a couple nuances.
Regarding the individual mandate, the Court ruled it was constitutional as a tax. That’s true. If you don’t check the box on your tax forms saying “I have insurance,” a small penalty gets added to your taxes. But, if you want, you can decide to go without insurance and pay the tax.
Chief Justice Roberts argued that the mandate was not constitutional under the Commerce Clause. So if the mandate, had just said “buy insurance,” that would be unconstitutional. Essentially, the Court ruled that Congress cannot make citizens engage in certain behaviors, but it can use the tax code to incentivise behavior.
The more interesting decision is regarding Medicaid. The Court ruled Congress could place conditions on states taking federal funds for health care, but could not institute penalties for states that refuse health care funding. Think of it like this: It’s legal for your employer to offer you a raise, but to require you take on additional responsibilities. It’s illegal for your employer to offer you a raise, and if you refuse, to take away your entire wage.
Without the ability to establish penalties for refusing to expand Medicaid, conservative-led states will be able to decline federal funds and not expand their Medicaid programs. As a result, low-income Americans in these states will be unable to get health care.
Minnesota was an early adopter of this expansion, and now nearly 100,000 more people have insurance.
By 2014, the federal government will offer all states money to expand the number of people under Medicaid, and to pay for all of the cost of the expansion for the first 3 years (after that states will pick up 10% of the tab). In fact, the federal government already pays 50% to 75% of each state’s Medicaid program.
Conservatives hoped the Supreme Court would derail the ACA. But it didn't, so it’s time to stop being petty and follow through on implementing the ACA. The next step for Minnesota is to move forward with establishing its health exchange.
Conservatives state lawmakers have refused to be part of Governor Dayton's exchange process, and have worked to stymie its efforts. What they don't realize is the freedom that they have with the exchange. By being involved, they can shape the exchange to best meet their constituents' needs, which may vary depending on where in this diverse state one lives. It is time to stop playing politics with other people’s health and start working to move Minnesota health care policy forward.