June 28, 2012


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This morning, the United States Supreme Court announced its decisions on the four interrelated issues that made up the constitutional challenge to the Patient Protection and Affordable Care Act. The court has decided the individual mandate is a tax and thereby constitutional, and that the Medicaid expansion is also legal, although its provisions were limited. The entire measure stands as is except that the federal government's power to terminate states' Medicaid funds has been reduced. For purposes of implementation, virtually all of the law and all resulting regulations and deadlines proceed as scheduled. The only part of the law that will change has to do with the level of funds states may receive based on choices they make relative to their Medicaid programs. 

With regard to the constitutionality of the individual mandate, the Justices voted 5 to 4 that Congress was within its authority to require that all Americans have health insurance coverage using its power of taxation. Justices Roberts, Ginsberg, Breyer, Sotomayor and Kagan voted to uphold the mandate. Justices Kennedy, Scalia, Alito and Thomas opposed the decision. The court also ruled that PPACA may allow states to expand their Medicaid programs. However, in the majority opinion, the Justices made it clear that if states do not want to participate in the PPACA expansion of Medicaid, they can continue to receive their existing level of funding for the rest of the program.

Since the Court voted to uphold the individual mandate and Medicaid expansion provisions of the law, the question of whether or not these provisions of the law are severable is moot. The majority opinion also made it clear that the federal Anti-Injunction Act does not apply because the label "tax" is not controlling.

Copies of the majority and minority opinions issued today and related documents can be found here. NAHU's press release can be found here and an issue summary of what may happen next politically can be found here. We will also send you a more detailed legal overview of the opinions prepared by our counsel later today. 

While we know that many of you may not agree with this decision, we must respect the actions of our nation's highest court and move forward. This decision gives us a degree of closure and direction about PPACA's future and will help guide our policy focus in the years to come.

Agents and brokers can remain a constant for their individual and employer clients as we head toward full implementation of the law's insurance-market reforms and other requirements in 2014. As an association, we must work with our policymakers to ensure a better transition to preserve the integrity of the free market and ease the compliance and cost burden on health insurance consumers. Most important, we must redouble our efforts to reduce the cost of medical care, which is the true driver of health insurance premiums. Sadly, true means of cost containment were barely addressed by PPACA. 

There is no doubt that the historic ruling will have a profound impact on the upcoming presidential and congressional elections. You can help our association have a profound impact on the elections too by clicking here and making a donation, or increasing an existing donation, to our political action committee, HUPAC, today. 

NAHU will be holding a free one-hour Webinar for members about the decision and its impact on our industry and individual and employer clients moving forward on July 11 at 1:00 pm eastern. Participation is limited to the first 1,000 members who sign up, so click here to register and secure your spot today. If you can't make it, the call will be recorded and the slides and the recording will be made available to members via the NAHU website later that week. 

Thank you for your continued support of your industry through your NAHU membership. If you have any questions about our government relations efforts as they pertain to the ruling, please contact us at legislative@nahu.org.

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