July 16, 2012
The Supreme Court ruling upholding the Affordable Care Act (ACA) on June 28 answered many questions that the healthcare industry has been debating for two years. While a majority of justices voted to strike the individual mandate under the Commerce Clause, a majority also voted to uphold it under the premise that Congress does have the power to levy taxes. For more information on when specific provisions of the ACA go into effect, see the Affordable Care Act Timeline.
States have option to expand Medicaid rolls
The ruling on the healthcare reform law from the Supreme Court says individual states do not have to expand their rolls in 2014 as the ACA originally stated. Those opting to expand their Medicaid rolls to 133 percent of the federal poverty level would receive the added bonus of a substantially increased federal match for this new subset of their Medicaid populations. Those choosing not to expand their programs would not forfeit their current federal portion of Medicaid funds but they would also not receive additional funds for the expansion.
In Alabama, many questions must be answered before reaching a decision to expand the program.
“If anything, the issue is certainly unresolved,” said Don Williamson, MD, the state public health officer and chairman of a committee studying the Medicaid agency. “There are still as many, if not more questions.”
The Medicaid expansion would make the program available for people making 133 percent of the poverty level, equivalent to $14,856 a year for individuals and $30,657 for a family of four.
The expansion could enroll up to 455,000 individuals in Medicaid by 2019, with up to 335,000 being previously uninsured, according to the Henry J. Kaiser Family Foundation. In 2010 the foundation estimated 744,100 Alabamians were without insurance.
“The problem is if you’re expanding by 40 percent the Medicaid population, you are not expanding by 40 percent the provider population,” Dr. Williamson said. “I don’t think you can say giving 400,000 people a Medicaid card is going to be equivalent of giving them access.”
Regarding cost of expanding eligibility, the federal government will cover 100 percent of the states’ cost of covering newly eligible Medicaid beneficiaries from 2014 to 2016 and will then phase down its federal contribution to 90 percent by 2020. Coverage for previously eligible Medicaid beneficiaries will continue to be financed through a matching system between the states and the federal government.