Supreme Court Upholds Affordable Care Act
On June 28, 2012, the Supreme Court issued its long-awaited decision on the health care reform law known as the Affordable Care Act (ACA). Simply put, the law has been upheld.
Chief Justice John Roberts wrote the majority opinion. Highlights of the surprising, 193-page ruling in National Federation of Independent Business v. Sebelius are as follows:
- The individual insurance mandate, which takes effect in 2014, is Constitutional as a tax. The individual mandate would not otherwise be valid under Congress’s power to regulate commerce.
- For purposes of the Anti-Injunction Act, which would have delayed the lawsuit until 2015, the individual mandate is a penalty, not a tax. Thus, that law does not apply to this case, and a final decision was rendered.
The federal government has the right to expand Medicaid coverage but is not permitted to withdraw all Medicaid funding to a state that refuses or fails to comply with the expansion.
The individual mandate requires most Americans to have adequate health coverage starting in 2014 or pay a penalty. Also in 2014 employers that fail to offer full time employees and their dependents affordable coverage with a minimum value likewise will face penalties. By 2014 health insurance exchanges will be operating in every state, offering community rated insurance to certain small employers and individuals, with federal premium tax credits available to help some people buy that coverage.
What does this mean for health care, insurance and HR professionals?
There will be no impact on implementation of PPACA for employers and plan sponsors, which will need to continue the process of activating the various provisions, including the employer mandate, which will go into effect in 2014.
In addition, there will be no impact on existing PPACA compliance and implementation efforts – all of which will continue to be in effect.
Provisions that have already been implemented will continue:
- Over-the-counter drug restrictions for flexible benefits
- Coverage of dependents up to age 26
- Elimination of preexisting condition exclusions
Efforts to comply with upcoming provisions will continue as well. This includes:
- The Summary of Benefits and Coverage, which takes effect for open enrollment periods starting on or after September 23, 2012
- The $2,500 Health FSA salary reduction contribution limit, which takes effect for plan years starting on or after January 1, 2013
- W-2 health care coverage reporting, which took effect on January 1, 2012, and will affect W-2s issued in January 2013
· Patient-Centered Outcomes Research fees, which take effect for plan years ending on or after October 1, 2012, and are due no later than July 31, 2013
- The additional Medicare tax, which takes effect on January 1, 2013
- State health exchanges, which take effect on January 1, 2014