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Supreme Court justices uphold Affordable Care Act

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    The U.S. Supreme Court ruled this morning that President Barack Obama's health care reform law is constitutional, and upheld the entire act, 5-4, with certain limitations to the Medicaid expansion provisions.

    The Affordable Care Act has been seen as a centerpiece of President Barack Obama's presidency, and business owners in New Jersey and beyond had been carefully watching the process since the bill was signed into law.

    For New Jersey, many of the protections and insurance coverage expansion in the Patient Protection and Affordable Care Act of 2010 already were enacted by the state Legislature, but the ruling still impacts the state's health care landscape.

    Questions that still need to be answered include the timing of implementation of the many requirements of the act. These include setting up health insurance exchanges, adjusting to reimbursement cuts and establishing what are essential medical treatments to be covered under price-conscious insurance plans.

    State Sen. Joe Vitale (D-Woodbridge) told an audience of health care stakeholders Wednesday that, if the individual mandate had been struck down, he would work with a group of interested parties that had been formed years ago to begin working on legislation to create an individual mandate at the state level.

    Individual mandate

    The individual mandate is the portion of the law that would require most Americans to purchase health insurance. It was one of the most contentious portions of the law, with opponents saying it violated the U.S. Commerce Clause. But the court's 5-4 decision held that, while Congress does not have the power to implement the individual mandate under the Commerce Clause — regulation of interstate commerce activity — it does have the power to institute the individual mandate as a tax. Despite the court labeling the mandate a tax, the opinion said it was not open to the Anti-Injunction Act, which would have prevented a lawsuit from being filed until the tax was imposed in 2014.

    There were, however, limitations placed on the expansion of the Medicaid program. The court considered whether the government could terminate Medicaid funds if states did not comply with an expansion of the program, and if the expansion would have coerced states to increase Medicaid spending.

    According to an early excerpt of the opinion posted by SCOTUSblog — a live update of the proceedings from Bloomberg — the Medicaid expansion provisions are constitutional, but taking away Medicaid funds for noncompliance would be unconstitutional. From SCOTUSblog:

    "The key comment on salvaging the Medicaid expansion is this (from Chief Justice John Roberts): 'Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding.'"

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