Supreme Court Upholds Health Reform Law, But Medicaid Coverage Left in Doubt

The U. S. Supreme Court recently upheld the majority of the Affordable Care Act, also known as universal health care or Obamacare, but the court's decision leaves the future of Medicaid coverage for the very poor in doubt.

In the most controversial portion of the opinion, Chief Justice John Roberts, writing for a divided court, determined that Congress, using its taxation power, has the right to penalize people who choose not to obtain health insurance through work, from the government, or by purchasing it directly. Because this key provision of the law was upheld, other segments of the Act that directly affect people with disabilities, like the ban on denials of coverage for people with pre-existing medical conditions and the requirement that insurance companies allow children to remain on their parents' health insurance plans until they are 26, will remain in effect.

However, the court's ruling is not all good news for people with disabilities. Although the court upheld most of the Act, it struck down the portion of the law that forced states to significantly expand Medicaid coverage for people with incomes up to 133 percent of the federal poverty line. According to the court's decision, each state will have the option to either expand its Medicaid program to cover these low-income beneficiaries or leave its program as it currently stands. (Under the law, the federal government will completely fund the expansion until 2017, but by 2019 states will have to pick up 10 percent of the cost of covering the new beneficiaries.) Several Republican governors, including those in Florida, Kansas, Nebraska, and South Carolina, have already indicated that they will not expand Medicaid in their states.

Unfortunately, under the Act, people who need to purchase health insurance on their own will qualify for government-subsidized insurance plans only if they make more than 133 percent of the federal poverty limit. This means that in states that forgo Medicaid expansion, there may be a class of very poor people who will not qualify for Medicaid and will also be unable to qualify for subsidized insurance. This group of people, which includes many people with disabilities with limited incomes, will in all likelihood remain uninsured.

To read the Supreme Court's lengthy decision, click here.

To read about the Medicaid expansion quandary in the Washington Post and the New York Times, click here and here.