Supreme Court Upholds Health Care Mandate

Affordable Care Act.

Regardless of which side of the fence you stand on, yesterday was a historic day in US History and the Supreme Court’s ruling will have a long lasting impact on all Americans.

The ruling leaves in place the requirement of Americans to have or buy health insurance either through their employers or a state-sponsored exchange beginning in 2014 or face a penalty, with some individuals being exempt. Examples of those who would be exempt are: people with very low incomes who are members of certain religious groups, or who face insurance premiums that would exceed 8% of family income even after including employer contributions and federal subsidies.

For those who are not exempt, in 2014 the penalty would be:

  • $95 per individual or 1% of his or her income (the higher of the two values).
  • $285 per family or 1% of income (the higher of the two values).

Each year the penalty/fine would rise. The supreme court ruled that this individual mandate is valid as a tax, even though it is impermissible under the Constitution’s commerce clause. In the majority opinion, Chief Justice John Roberts wrote, “The federal government does not have the power to order people to buy health insurance. … The federal government does have the power to impose a tax on those without health insurance.”

In addition to the individual insurance mandate, the expansion of Medicaid coverage was also upheld, but the federal government’s ability to penalize states that don’t participate will be limited.

Most industry experts feel this year’s election may be the platform for additional changes to be made whether that be through improving the current legislation or by initiating a repeal of the Affordable Care Act itself if new leadership is elected.

You can read the full Supreme Court ruling here.

HEALTHCAREfirst will send out additional details and information as it is made available and will post information regarding the proposed Home Health Prospective Payment System (HH PPS) payment rates for CY2013 shortly.

What do you think of the Supreme Court’s ruling?  How do you feel this will affect Home Health and Hospice Care?