One Year Later: SCOTUS, the Affordable Care Act, and Unfinished Business

Today marks the one-year anniversary of the Supreme Court's historic ruling that upheld the constitutionality of the Affordable Care Act (ACA). In National Federation of Independent Business v. Sebelius,  the Court upheld the constitutionality of two major provisions of the ACA: the individual mandate and the Medicaid eligibility expansion. However, the Court made one very significant change to the terms of the Medicaid provision: It held that the federal government could not condition a state's current federal Medicaid funding on participation in the coverage expansion, thereby giving states the choice to opt-out of covering more people through Medicaid. 

Today, Medicaid programs in all states cover low-income individuals with disabilities, seniors, children, pregnant women, and parents. But federal money provided through the ACA will enable states to reach people younger than 65 whose income is below 138 percent of the federal poverty guideline ($15,856 annually for an individual; $26, 951 for a family of three in 2012). 

For the first time, low-income childless adults will have access to Medicaid coverage in many states. 

If all states take this federal money, approximately 15.1 million currently uninsured adults [PDF] would newly qualify for Medicaid coverage. Covering more people through the Medicaid program is especially important for low-income women who make up over 60 percent of uninsured women in the U.S. and are four times more likely than higher income women to report fair or poor health. 

Not only is this option the right thing to do because it ensures coverage for the poorest and most vulnerable Americans, it is also a great deal for states. The federal government covers 100 percent of the costs for the first three years, phasing down to no less than 90 percent in subsequent years. 

So, where are we one year after the Supreme Court's landmark ruling? The good news is that nearly half of the states have decided to move forward and accept the federal dollars to cover more people in the Medicaid program, starting in 2014. As of this posting, another six are still undecided. But twenty-one have decided to forgo the additional federal dollars. This means that millions of the poorest residents in these states will continue to be left without an affordable coverage option. 

This need only be a temporary setback. States that have declined the additional Medicaid funding can sign up at a later date and still receive generous federal subsidies. It is therefore as important as ever that we continue our advocacy efforts to show state governments how access to health coverage will benefit the health and wellbeing of millions of women and families. The ACA's promise of affordable health coverage may have been delayed, but it does not need to be denied. 

To find out more about the Medicaid eligibility expansion and why it is a good deal for women's health, a good deal for states, and a good deal for healthcare consumers, take a look at our issue brief.