On March 23, 2010, President Barack Obama signed into law the Affordable Care Act (ACA). Bringing to an end more than 15 months of intense legislative activity, the new law marks the first time in our nation's history that all Americans are guaranteed access to health care coverage. Following suits challenging aspects of the law ranging from the individual mandate to the proposed Medicaid expansion, the U.S. Supreme Court issued a final ruling on the constitutionality of the ACA by a vote of 5 to 4.
Chief Justice John Roberts created the majority by concluding that the individual mandate is constitutional under the taxation clause. The only provision of the ACA that was struck down, albeit only partially, was in reference to Medicaid expansion.The ACA would have required states to expand eligibility for Medicaid to cover individuals with incomes up to 133% of the federal poverty level or face losing all federal Medicaid monies. Justice Roberts wrote that while the Medicaid expansion was constitutional, the proposed penalty for states that choose not to participate was not. Any states choosing to expand Medicaid under the provisions of the ACA will now be eligible for additional federal funding to support the expansion.
Several provisions of the ACA took effect on Jan. 1, 2011. Among the most notable are the new medical loss ratio requiring health insurance plans to demonstrate that, at minimum, 80% of all premium dollars are devoted to health care delivery (85% for large group markets), and the primary care bonus, which provides a 10% bonus on Medicare allowable charges for qualifying primary care physicians. With the Supreme Court ruling now in place, the implementation of the law will continue as planned.