Informational Conference Call Today for Members
2 p.m. EDT / 1 p.m. CDT / Noon MDT / 11 a.m. PDT
All legislators and staff are invited to participate. NCSL Executive Director William Pound will lead the discussion, along with NCSL's federal health reform expert Joy Wilson, and Brian Webb of the National Association of Insurance Commissioners, expert on state health insurance issues. All legislators and legislative staff have been sent an email with call-in details and instructions on how to pose questions.
Supreme Court Rules on the PPACA
The much-anticipated Supreme Court decision came down on June 28, 2012, upholding the Patient Protection and Affordable Care Act, with a change to the Medicaid expansion. The ruling limits the ability of the federal government to penalize states that choose not to expand their Medicaid programs to cover people with incomes up to 138 percent of the poverty level, as originally allowed by the law. Below is a brief summary of the issues and what the U.S. Supreme Court held.
First was a procedural question over whether, under the federal Anti-Injunction Act, the law could be challenged before the penalty for not purchasing insurance was imposed. The court decided the Anti-Injunction Act does not apply in this case.
A core provision of the law, the individual mandate, was challenged on the basis that Congress exceeded its authority under the Commerce Clause by compelling people to buy health insurance. The court held that Congress did not have authority under the Commerce Clause to compel individuals to purchase health insurance coverage, but Congress did have authority under its taxing powers to impose a penalty or tax on individuals who fail to purchase such coverage. As a result the individual mandate was upheld.
The third challenge—that the entire law or other parts of it should be struck down if the individual mandate was found unconstitutional—was moot because the mandate was upheld.
Finally, the court considered whether the threat of losing all federal Medicaid funds for not complying with the new Medicaid requirements was too coercive. The Affordable Care Act effectively requires states to expand Medicaid eligibility to most people with incomes at or below 138 percent of the federal poverty level, with the threat of losing all federal Medicaid if they don’t. The court held that the Act’s Medicaid expansion is constitutional as long as it is considered a state option. The court also held that a state could not be penalized for choosing to continue its existing Medicaid program.
The ruling leaves plenty of work for state policymakers. States still face the challenges and opportunities of implementing such a wide-sweeping law, including the upcoming deadlines for health insurance exchanges. States will continue to grapple with some questions that remain under the ruling. For example, how much flexibility will states really have under the Medicaid changes? How will this new twist affect providers? Will the ruling have implications for health insurance exchanges? If a state chooses not to expand Medicaid eligibility, will people with incomes below 138 percent of poverty qualify for the federal subsidy to purchase insurance in the exchange? How will the Court’s ruling affect the fall elections?
Check NCSL website’s for ongoing updates about the ruling and its effect on states.
Grants for Community Health Centers Awarded to 41 States
Health and Human Services (HHS) Secretary Kathleen Sebelius announced grants to 219 Federally Qualified Health Centers (FQHCs) in 41 states, the District of Columbia, Puerto Rico and the Northern Mariana Islands this month. Totaling $128.6 million, these Patient Protection and Affordable Care Act authorized grants will allow health centers to serve 1.25 million additional patients.
FQHCsare community-based, nonprofit or public organizations that provide services to people who lack access to other health care, including those without insurance, residents of rural and underserved areas, and some Medicaid patients.
 These health care services are available to all people, regardless of their ability to pay. FQHCs include community health centers, migrant health centers, homeless health centers and public housing primary care centers. To qualify as an FQHC, a center must provide comprehensive primary health care services to all, be located in or serve a high-need community and be governed by a board with a majority of community members. Centers also offer support services such as health education, translation and transportation.
Building on the momentum of the George W. Bush administration— which expanded health center sites by about 1,200—the Obama administration has demonstrated support of health centers through both economic stimulus dollars and health reform implementation. Since the beginning of 2009, health centers have added more than 25,300 new full-time positions, including physicians, nurse practitioners, dental staff and behavioral health providers. According to Mary K. Wakefield, administrator of the Health Resources and Services Administration (HRSA), “These awards demonstrate our [the Obama administration’s] commitment to increasing access to quality health care through the creation of new health center sites.”
The PPACA designated $11 billion over a five-year period to fund the operation, expansion and construction of health centers throughout the country.
New Hampshire Will Not Create a State Exchange
New Hampshire’s legislature recently passed legislation addressing the state’s role in a federally facilitated exchange while prohibiting the state or anyone in it from creating a state exchange. Under provisions in HB 1297, signed into law on June 18, 2012, state agencies’ activities with the federal exchange must support the following objectives:
- Promote the preservation of the private, commercial market;
- Minimize administrative costs;
- Promote consumer choice (support an open market model in which all insurers can participate);
- Preserve the state insurance regulatory authority and Medicaid flexibility.
The law also creates a 12-member exchange advisory board whose primary responsibility will be to ensure the state’s best interest in a federal exchange. The law also offers clarification on the role of the commissioner and navigators if a federal exchange is built in the state.
Last year, similar bills to prohibit the creation of a state-based exchange in Minnesota and Montana failed. Montana’s governor vetoed a bill that would have prohibited a state exchange. Missouri’s SB 464 was sent to the governor for his signature in May 2012. The bill would prohibit the establishment and operation of health insurance exchanges in Missouri unless the exchange is created by a legislative act, an initiative petition, or referendum, requiring voter approval. This bill would prohibit any state agency from accepting federal funds without prior legislative or voter approval.
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