Emily Martin, Vice President and General Counsel

Yesterday was a very good day for women at the Supreme Court. The constitutionality of the Affordable Care Act, was upheld, and its implementation will now continue. As a result, women will no longer be charged more than men for the same insurance; mammograms, Pap smears, contraception, and a host of other preventive services will be covered by insurance with no co-pay; women will no longer be denied insurance coverage because they are pregnant or have had a cesarean section or survived domestic violence; and millions more women will be covered by Medicaid. There is much to celebrate. But the Court's decision reveals that there are also important tasks ahead.

First, the Court held that states need not participate in the expansion of Medicaid as a condition of continuing to receive their current Medicaid funding. The ACA expanded Medicaid's coverage to reach all adults under 133 percent of the poverty level beginning in 2014. (Today the federal government only requires states to cover the disabled, the elderly, children, pregnant women, and parents.) Under the Court's ruling, states will have the option whether or not to provide that additional coverage. But there is much reason to be optimistic that all or nearly all states will do so. The federal government covers 100 percent of the costs of the Medicaid expansion for the first three years; it is in essence offering the states free money during that time. After that, the federal government's support will phase down — to only 90 percent of the costs of the expansion. By spending very little of their own money, states can ensure that those uninsured who are the poorest and most vulnerable — those least able to get insurance any other way — will receive health coverage. This should be an easy choice, but there is nevertheless work to be done to ensure that all states do the right thing and fulfill the promise of the ACA.

Second, while the result today was almost wholly good, the Court's opinion raised questions about how the Constitution will be interpreted in future cases.