Waiting for the U.S. Supreme Court Decision on Outcomes of the Patient Protection and Affordable Care Act (PPACA)

In March 2012, the U.S. Supreme Court heard oral arguments on what has become the most controversial piece of legislation in recent history, the Patient Protection and Affordable Care Act (PPACA). These oral arguments included:

  • Do the states have the ability to challenge PPACA now based upon a technical interpretation of the Anti-Injunction Act?
  • Does the Commerce Clause give the federal government the right to mandate each individual to purchase insurance or pay a fine?
  • Should the entire Act be over-turned due to the missing Severability Clause?
  • Can the federal government expand Medicaid?

A final decision is expected to be published in June. Meanwhile, below are some possible outcomes of the case:

  • Delay hearing the legal issues associated with case for several years due to the Tax Issue.
  • Invalidate the Individual Mandate.
  • Invalidate all or part of the Medicaid Expansion requirements.
  • Uphold PPACA as is.
  • Declare the entire Act unconstitutional due to the lack of a Severability Clause if any of the key provisions such as the Individual Mandate are overturned.
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Did You Know?

  • Health benefit exchange acts as a marketplace for purchasers of health benefits in a platform that will provide information about health insurance plans at various levels of pricing and offerings.
  • The Colorado Health Benefits Exchange (COHBE) Act was passed in 2011. However, the current status of the COHBE is that the decisions regarding the operations, administration, and benefits that will be offered in the plans available in the Exchange have not yet been determined. The process to determine these important policies is ongoing and must be in place before the end of 2013.
  • Although the details have not been finalized, currently individuals through one marketplace and small employers through the Small Business Health Options Program (SHOP) marketplace can participate. Currently, small employers are defined in Colorado law as having less than 50 employees.
  • For the most up-to-date information about COHBE, visit their website at: www.getcoveredco.org.
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U. S. Department of Health and Human Services (HHS) to give states more flexibility to implement health reform

In mid-December HHS released a bulletin outlining proposed policies that will give states more flexibility and freedom to implement the Affordable Care Act. Under these policies, states would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the essential health benefits package.

What does this mean to Americans? Sherry Glied, Ph.D., assistant secretary for planning and evaluation explains, “In addition to assuring comprehensive coverage for the newly insured, many millions of Americans buying their own insurance today will gain valuable new coverage, including more than 8 million Americans who currently do not have maternity coverage, and more than 1 million who will gain prescription drug coverage.” . …Read More

Colorado Lawmakers Move Forward With Grant Application To Set Up Exchange

On December 15, in a 9-to-1 vote, Colorado lawmakers moved forward with an $18 million federal grant application that will set up an insurance marketplace required under the new health care law. The recently submitted application (due to HHS on Dec. 30) is very similar to the first submission however includes some different timelines and clarifying language on infrastructure technology planning .…Read More






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State Exchanges Remain Unclear: A Dozen States Move Forward to Set Up PPACA Exchange Infrastructure

Colorado is among one of 10 states that are taking legislative steps to create our own state health insurance exchange that will meet the Patient Protection and Affordable Care Act (PPACA) guidelines. There are still many issues that face the future state-based health insurance exchanges under PPACA and this will become more transparent after the 2012 election.  …Read more

Additional useful links:

National Conference of State Legislatures: State Actions to Implement Health Insurance Exchanges (http://www.ncsl.org/?TabId=21388#CO) updated November 2011

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