(Message from PICO National Network members and allies after the health care decisions yesterday.)
Dear PICO members and allies -
Yesterday’s Supreme Court decision was an important milestone toward making affordable health coverage available to all people in the United States. It came as a blessing to families who worry about becoming sick and not being able to afford the care they need. But the decision also opened the door to the possibility that some hard-hearted states might decide to exclude their poorest citizens from coverage under the law.
We wanted to share an analysis of the decision and what it means for our families and our work.
The good news is that Chief Justice John Roberts joined with the four liberal members of the Court to uphold the law. They declared that while the Federal Government did not have the power to make people buy health insurance, the requirement to purchase coverage or pay a fine could be understood as a tax that fell within the taxing power in the Constitution. The practical effect of this part of the decision was to uphold the individual mandate to purchase health insurance, along with the new requirements on insurance companies to stop denying people coverage for pre-existing conditions.
The Supreme Court also upheld the part of the Affordable Care Act that provides states with funds to expand their Medicaid programs to cover all people in families earning less than 133 percent of the poverty line. However, the Court said that the Federal Government could not require states to accept this funding. As written, the ACA required states that want to continue to participate in the Medicaid program to participate in the expansion of coverage. The Supreme Court said that this part of the law is unconstitutional, and essentially rewrote this section of the law to remove the stick that it gave the federal government to get states to comply.
This sets up big fights in many of our states. Under the ACA, the federal government provides states with the full cost of expanding their Medicaid programs during the first three years, and then 90 percent of the cost after that. The law provides a huge carrot to states to expand their Medicaid programs. Federal Medicaid funds to states not only provide valuable health coverage to uninsured families, but they also create millions of jobs and billions of dollars in tax revenues. States come out way ahead in this arrangement because of the economic activity generated by federal funding. Nonetheless, there are states that have threatened to turn down Medicaid funds on ideological grounds.
The big risk created by the Supreme Court decision is that governors who oppose the law on ideological grounds may decide to keep their Medicaid programs as is, claiming that they do not want to take on the additional costs of a new federal program. That would mean that millions of poor people earning less than the poverty line could be left out of the benefits of the ACA. Under the law these people are not eligible for subsidies to purchase health coverage in the new health care exchanges. It would be a cruel irony if the poorest Americans were excluded from health coverage by their states. If all of the states that sued to declare the health care law unconstitutional decided to opt-out of the Medicaid expansion, that could leave as many as 8.5 million poor people uninsured.
Although the expansion of Medicaid did not receive much attention in the debate over health reform, it was an important focus of PICO’s organizing on health care reform. As many as perhaps 20 million people stand to benefit from the decision to make Medicaid universally available to the lowest income families in the country. PICO worked to increase Medicaid reimbursement rates for primary care in the ACA to increase the availability of health care providers. And delivering better care at a lower cost in Medicaid is an important focus of our ACA implementation work.
Now that the Supreme Court has spoken, organizations in states that have opposed the ACA (including Florida, Louisiana, Kansas, Ohio, New Mexico and Alabama) need to make sure that their states do not abandon their poorest citizens. We must demand that all of our states move forward with Medicaid expansions. As people of faith we have a moral obligation to protect the poor and vulnerable and make sure that those who are sick, regardless of their income, do not have to rely solely on emergency rooms for their care.
As you talk to people about the decision, we encourage you to lift up the significance of the victory, and highlight the importance of pressing our states to include everyone in the benefits and protections of the Affordable Care Act.
In the coming months it will be important to set up meetings with your state governor, and his or her health care advisors, and with the heads of health-care committees in your state legislature. PICO will be working with our partners at Community Catalyst to provide more information and guidance in the coming weeks.
Many thanks for all of your powerful work to make the vision of a just and humane health care system a reality.
Director of Policy, PICO
Lead Health Care Organizer, PICO