Joel Ferber, Legal Services of Eastern Missouri
On June 28, 2012, the Supreme Court upheld the controversial ?individual mandate? and the constitutionality of the Affordable Care Act (ACA).1 The Court, however, did what no district or appellate court had done – finding that the ACA?s provision allowing the federal government to remove all federal Medicaid funding for states that do not expand coverage to 133% of the federal poverty level was unconstitutional, even though the expansion itself is constitutional.2 The Court treated the ACA?s expansion of the Medicaid program as if it were a new program and decided the federal government could not condition funds for the existing Medicaid program on participation in the ?new program? created by the ACA. This ruling did not actually make the Medicaid expansion an ?optional? program for states, but will likely have the same effect by stripping the Secretary of HHS of meaningful enforcement authority to require states to implement the ACA?s mandatory expansion. This decision means that many states, including Missouri, are going to treat the expansion as if it were a state option. Such action is very significant since more than half of the uninsured individuals projected to receive coverage under the ACA would receive such coverage pursuant to the Medicaid expansion. The remaining uninsured would largely be covered through the premium tax credits available to individuals purchasing coverage through the newly created health insurance exchange (?Exchange?).
If states do not choose to adopt the expansion to cover these individuals under Medicaid, the ACA?s impact on covering the uninsured will be substantially reduced. This reduction is especially important for Missouri which has 780,000 uninsured individuals according to recent estimates3 and provides very low levels of coverage in its current MO HealthNet program.
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