A Mandate for Health Reform

US Supreme Court Upholds the Affordable Care Act


This is archived content; for historical reference only.

The US Supreme Court today upheld the core elements of the federal Affordable Care Act (ACA), clearing a major hurdle toward implementation of the sweeping health care legislation. The act promises to extend insurance coverage to 33 million Americans, including 4 to 5 million Californians.

With the legal uncertainty surrounding the law now put to rest, the state faces an aggressive timeline to prepare for the 2014 launch of its key provisions.

The court upheld the individual mandate — requiring all Americans to either obtain health insurance or pay a tax. It did, however, limit the federal government’s ability to require states to expand their Medicaid programs, which cover low-income Americans. The decision allows the federal government to provide substantial financial support to states that choose to expand their Medicaid programs beginning in 2014, but prohibits the federal government from penalizing states that choose not to.

“The court’s decision brings clarity to what had been a very murky situation,” says Marian Mulkey, director of the California HealthCare Foundation’s Health Reform and Public Programs Initiative. “But as the saying goes, we should not confuse a clear view with a short distance. There is a lot of work to be done in California under an aggressive timeline. Luckily, our state has already taken significant steps forward.”

Officials will need to ensure that Medi-Cal, the state’s Medicaid program, offers timely access to care; create a user-friendly enrollment process; and provide effective oversight of private insurance markets, Mulkey says. This challenge is intensified, she notes, by the backdrop of California’s struggles to maintain a balanced budget.

In the wake of the court’s decision, uncertainty remains:

  • Timely federal guidance will be needed if California is to meet the 2014 implementation goal. California policymakers must decide a number of important questions, including the definition of “essential health benefits” and whether or not to pursue the ACA’s Basic Health Program option.
  • The results of the November election could cloud the future of the law if Republicans gain control of the White House and/or Congress. Many prominent Republicans have called for overturning the law.
  • Health care spending continues to rise faster than the rest of the economy, and unless that trend is addressed, any gains in coverage and access under the ACA will be short-lived.

“This is an exciting development for a problem that challenged the state and the nation for many years,” says Mark D. Smith, MD, MBA, president and CEO of CHCF. “We must continue to work on many fronts to help cure our ailing health care system. Coverage is key, but we must also focus on the underlying cost of that care. With millions more Americans on the brink of getting coverage, this is an urgent problem.”

For in-depth information on what portions of the ACA have already taken effect in California, see the March 2012 CHCF publication: The Affordable Care Act: What Californians Need to Know.


About the California Health Care Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.