All across the country, experts are going to be analyzing and commenting on today’s Supreme Court decision on the Affordable Care Act (ACA). For now, though, it seems clear that the vast majority of the law remains in place which is certainly something to celebrate for persons living in poverty in the District of Columbia. We are concerned about the Court’s limitation on the ACA’s Medicaid expansion and the implications of that part of the decision for many vulnerable families and individuals. However, we are pleased that coverage for Medicaid beneficiaries in the District does not appear to be jeopardized by today’s decision.
Let’s start with the good news. Lost in the discussion of mandates, taxes, and federal expenditures are the many great things contained in this law for our client community and all District residents, including:
- Protections against discrimination on the basis of pre-existing conditions for adults and children (which, in some states, could include being a survivor of domestic violence);
- Requirements that new insurance plans cover preventive health care services (including mammograms, HIV testing and contraceptive methods and counseling) at no cost to the consumer;
- Requirement that maternity care be covered under new individual, small business and Health Insurance Exchange plans;
- Closing of the Medicare Part D “doughnut hole;” and
- Requirement that insurance companies allow people under the age of 26 to stay on their parents’ insurance policies.
These are only a few of the improvements in the insurance market which will improve access to health insurance and health care for millions of families and individuals.
Now for the less than great news. Although we are awaiting the complete analysis by Medicaid experts, it appears that states may not have to expand their Medicaid programs (as required by the ACA) if they choose not to do so. There are, however, strong financial incentives for these states to provide coverage to these vulnerable populations, and we hope these incentives will be sufficient to ensure that these individuals are not left behind.
That said, our concerns about Medicaid should not extend to the District, which was one of the few jurisdictions who expanded its Medicaid program even before the requirement to do so kicked in. Again, much will be written on this in the upcoming days and weeks, but it would appear that the District can continue its expanded Medicaid program, which has contributed to the District having one of the lowest rates of uninsured individuals (6 percent) in the country. (The percentage of uninsured children is even lower at about 3.5 percent).
We applaud the District’s long term, sustained commitment to providing access to health insurance for so many low and moderate income families and individuals. Legal Aid and many other organizations have long worked with the District government to ensure that our Medicaid program delivers promised benefits to our client community. These efforts have continued through our collaboration with the many District agencies’ implementing the ACA. We look forward to continuing to work with the District government and our coalition partners to improve access to health insurance and quality health care services as we move towards full implementation of the ACA in Fiscal Year 2014.