The US Supreme Court Rules on the Constitutionality of the Affordable Care Act—What was at Stake?
This historic decision means that people with disabilities will continue to benefit from the profound impact of the landmark law. By affirming the individual mandate, the Court ensured that private insurers will have access to the largest possible pool of enrollees, thus holding costs down. In combination with market reforms prohibiting discrimination against people with pre-existing conditions, this affirmation will make it possible for everyone, including an estimated 3.5 million uninsured people with disabilities, to benefit from more affordable insurance prices.
A majority of the Court did strike down the provision in the law that would allow the federal government to penalize any state that does not expand their Medicaid program by withholding all of that state’s existing Medicaid funding. However, as the Court’s minority decision pointed out, the majority struck down the authority to withhold, not the authority to grant. While the full impact of this part of the holding remains to be seen, it is likely that some states may choose to expand Medicaid in exchange for additional federal funding, which will benefit millions more low-income adults with disabilities.
Key Provisions of the Law for People with Disabilities
Individual Mandate
The ACA requires most U.S. citizens and legal residents to have health insurance and includes penalties for those who do not. It also provides for cost sharing and premium credits for low-income families and establishes Health Benefit Exchanges through which individuals can purchase coverage.
Low-Income Medicaid Expansion
States have the option to open Medicaid eligibility to all individuals and families with income up to 133 percent of the federal poverty level. In 2010, as many as 3.5 million adults with disabilities living in the community have household incomes between 100 and 133% of poverty and therefore may qualify for Medicaid under the expansion.
Insurance Market Reform
- An estimated 3.5 million people between the ages of 16 and 65 with pre-existing medical conditions or disabilities who are currently uninsured will no longer be shut out of the private insurance market as of 2014.
- Temporary coverage is available for people with pre-existing medical conditions or disabilities until 2014 through state-run high-risk pools.
- Dependent children under the age of 26, including those with disabilities, can remain on their family’s health policy. An estimated 4.1 million young people aged 15 to 24 have disabilities. An additional 500,000 reach adulthood each year and face loosing health coverage.
- Insurers may no longer cancel a health policy because the policyholder develops a serious medical condition.
- Discrimination on the basis of health status is prohibited.
Improvements to Public Programs
Long Term Services and Supports
The ACA created new and extended existing programs to help people with disabilities avoid institutionalization and remain in their homes and in the community:
- States may now cover comprehensive community attendant care services under their optional Medicaid service plan.
- Home and community based services (HCBS) are strengthened.
- States can receive a Medicaid incentive payment if they increase spending on community-based long term services and supports and reduce support for institutions.
- A demonstration program (“Money Follows the Person”) that helps people move from institutional settings to the community is extended.
Healthcare Provider Training and Research
- Increases opportunities for training of health care providers (including dentists) on the needs of people with developmental and other disabilities.
- Authorizes new training programs for direct support workers who provide long term services and supports.
- Comparative effectiveness research, which will eventually influence the treatments insurers will cover, will take into account potential differences in the effectiveness of healthcare treatments and services for people with various disabilities, their quality of life preferences, and also include representatives from these groups in research.
Data Collection
- Requires collection of data on where people with disabilities access health services and where accessible facilities can be found.
- Adds disability status as a bona fide health disparities in population and health care quality reporting surveys.
Accessible Diagnostic Equipment
Requires that access standards be established for medical diagnostic equipment such as exam tables and weigh scales and mammography equipment