The Supreme Court decided today, in a 5-4
decision, that the vast majority of the provisions with the Act, dubbed
“Obamacare” by most opponents, are in-fact constitutional. Chief Justice John
Roberts cast the deciding vote and penned the majority opinion for the court in
SCOTUS Docket
11-393, National Federation of Independent
Business v. Sebelius.
Most significant among the
resulting questions is the decision’s impact on Medicaid – specifically what
the decision means in barring the Act’s penalization of any state that does not
expand Medicaid coverage to individuals earning as much as 133-percent of the federal
poverty line.
Additionally in the air for
Michigan is pending action on legislation authorizing a state health exchange.
The Senate passed Senate
Bill 693 last November; however, despite urging by Governor Snyder, the
House decided to await the Supreme Court’s decision. Proponents of the measure
argued that it is better to pass a version with input from Michigan policy
makers than be required to implement what is delivered to them by the Federal
government. Now with the Supreme Court upholding the law, some policy makers,
including Michigan Attorney General Bill Schuette and House Health Policy
Committee Chair Representative Gail Haines (R-Lake Angelus) believe the House
should wait until after the November Presidential Election.
Also affected is the State’s
largest insurer, Blue Cross Blue Shield of Michigan. By current statute, the
Blues are Michigan’s insurer of last resort – required to insure those with
preexisting conditions or who were otherwise denied coverage by other insurers.
The individual market reforms included in the Act require all insurers to do as
much after 2014, requiring associated changes in the enabling laws in Michigan.
Finally, and likely most
significantly, is the political fall-out of the decision during an election
year. Members of both parties, from party leaders to office-holders to
grassroots members reacted with loud voices Thursday over social media outlets,
radio, press conferences – to anyone that would listen. Based on the buzz,
there is little doubt that the decision will have an immediate energizing
effect on those opposed to the Act – generally Republicans and other
conservative interests. What remains to be seen is whether this issue may serve
to unite GOP factions prior to the August party primary election and if the
energy will be sustained through the first Tuesday of November. It will also be
interesting to see how the decision will work to energize the Democratic base,
the immediate winners Thursday.