The U.S. Supreme Court
Decision on the Affordable
Care Act
June 28, 2012
Four Questions Reviewed
1
• Is the individual mandate to have health insurance
constitutional?
• Is the mandated expansion of Medicaid constitutional?
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• Can any part of the ACA survive if the individual mandate
is unconstitutional? (not relevant to the decision)
• Does the Anti-Injunction Act preclude a decision at this
point in time?
2
Is the individual mandate constitutional?
Individual Mandate Findings
ACA requires individuals to have health
insurance coverage beginning in 2014
Q. Does Congress have authority to mandate purchase
of insurance?
–
–
–
Commerce Clause
Authority to lay and collect taxes
Necessary and Proper Clause
DECISION:
The individual mandate is valid under
Congress’s power to tax.
4
Is the mandated expansion of
Medicaid constitutional?
Medicaid Expansion Findings
Largest expansion of public health insurance coverage
since 1965
ACA requires participating states to cover nearly all
people under age 65 at or below 133% FPL
Q. Valid exercise of Congress’s spending power or
coercion of states?
DECISION:
Federal government cannot terminate all funding
for Medicaid if states don’t comply. Only new
funding for expansion affected.
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Does the Anti-Injunction Act
preclude a decision?
Anti-Injunction Act (AIA) Findings
Q. Is the individual mandate’s monetary sanction a
tax or a penalty?
–
–
If a tax, the Court must wait until someone is penalized
for not purchasing insurance and not paying the tax
If a penalty, the AIA does not apply and the Court is
free to decide now.
DECISION:
The AIA does not apply because the sanction for
not complying is labeled a penalty under the ACA,
and not a tax.
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Implications for Illinois and
Next Steps for Illinois
Hospitals
Questions that will Frame Next
Discussions at the State Level
 Efforts to repeal the ACA
 Status of Illinois insurance exchange
 Status of Medicaid expansion
Next Steps for Illinois Hospitals
Driving forces of reform remain
• Continuing public and private fiscal pressure on
providers to:
 Improve quality
 Improve population health
 Improve efficiency
 Lower cost
IHA will continue to help members improve operations
and transform their systems to provide Illinois
residents with the right care, at the right time, in the
right place, and at the right cost.
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