ACA, including its individual mandate, is upheld by U.S. Supreme Court

June 28, 2012

Today, the U.S. Supreme Court upheld the Affordable Care Act as constitutional, including its individual mandate requiring all Americans to purchase health insurance.

Today, the U.S. Supreme Court upheld the Affordable Care Act (ACA) as constitutional, including its individual mandate requiring all Americans to purchase health insurance. In a 5-4 vote, the justices ruled that Congress has the right to impose the individual mandate under the taxing clause of the U.S. Constitution.

By 2014, individuals who are not exempt and do not receive health insurance through their employer or a government program will need to pay for private insurance. If they don’t, they will be subject to a “penalty” and must pay it when they file their yearly tax returns.

Chief Justice John Roberts delivered the opinion of the Court that the individual mandate could be upheld under Congress’s power to tax.

The Supreme Court also upheld the authority of the Congress to expand Medicaid to millions of Americans. However, the court ruled that the federal government cannot terminate funds to state Medicaid programs if they do not follow the Medicaid expansion provision. States that do not expand Medicaid program eligibility under the ACA will lose only additional federal funds for their existing Medicaid programs.

Various pharmacy groups responded to the Supreme Court’s ruling.

The American Society of Health-System Pharmacists (ASHP) was satisfied with the ruling on the ACA, which will help more patients receive pharmacists’ medication therapy management (MTM) services and promote integrated care around hospitalization, according to a statement emailed to Drug Topics.

“The American Society of Health-System Pharmacists is pleased that today’s Supreme Court ruling on the ACA preserves the law’s healthcare delivery and payment reforms, which will provide an enhanced role for health-system pharmacists on inter-professional teams,” said Paul W. Abramowitz, PharmD, FASHP, ASHP’s CEO.

The ACA also created the Centers for Medicare and Medicaid Services Innovation Center, which will test payment and service delivery models that reduce expenditures and preserve or improve quality of care. These new mechanisms include accountable care organizations, the medical home model, and quality-based financing mechanisms, according to ASHP’s statement.

The National Association of Chain Drug Stores (NACDS) will remain focused on emphasizing community pharmacy’s ability to save lives, enhance patient care, and reduce healthcare costs.

“NACDS and the pharmacy industry we represent have the power and potential to help achieve these goals,” said NACDS President and CEO Steven C. Anderson, IOM, CAE, in a prepared statement. “NACDS also remains committed to ensuring that Medicaid’s prescription drug program reflects a pro-patient and pro-pharmacy approach that ultimately is effective in maximizing health and reducing healthcare costs across the board.”

The National Community Pharmacists Association (NCPA) emphasized its role in offering recommendations for provisions to the ACA that could improve the care that independent community pharmacists offer, including maintaining access.

“We strived for more coordination with healthcare providers across the spectrum; reforms that embrace the free market ethos of fairness and transparency; reimbursement levels that take into account budget constraints for payors and are financially sustainable for providers; and ensuring that successful programs are embraced further,” said NCPA CEO B. Douglas Hoey, RPh, MBA, in a prepared statement.

In its statement NCPA said it supports the following healthcare reform law provisions, including reasonable reimbursement for Medicaid generic prescription drugs, transparency requirements for pharmacy benefit managers in the healthcare exchanges that are set to launch in 2014, expansion of MTM for Medicare beneficiaries, inclusion of pharmacies in accountable care organizations and medical homes, and the pharmacies’ exemption from the duplicative accreditation requirement for selling Medicare Part B durable medical equipment.

Drug Topics editorial advisor Philip Burgess, RPh, DPh, MBA, was surprised by Chief Justice Roberts support of the individual mandate.

“It gives me a strong sense that [Chief Justice Roberts] will lead efforts in the future to make the Supreme Court decisions to be viewed by the American public as less politically driven in the future,” Burgess explained in an email to Drug Topics.

The healthcare reform law offers pharmacists from all practice settings the opportunity to become involved and shape the implementation of the ACA, he said.

“There are numerous states that have been dragging their feet in establishing health exchanges and other aspects of the Affordable Care Act that now will need to significantly ratchet up their efforts to be prepared for 2014,” said Burgess, chairman of the Community Pharmacy Foundation and member of the Illinois Board of Pharmacy, Chicago. He is also principal of Philip Burgess Consulting, LLC.

In as much as this issue was political as well as Constitutional, many people were caught by surprise that Chief Justice Roberts affirmedfor the majority, said Ned Milenkovich, PharmD, JD, Drug Topics' regulatory and legal columnist, in an email. "The biggest surprise was probably that the Justices concluded the individual mandate was not a valid exercise of Congress' commerce clause power, but was a proper use of Congress' tax authority."

He also said, "Any efforts undertaken by hospital pharmacists to comply with the ACA must stay the course. Those provisions that are legally in effect must continue to be complied with by all pharmacists, including hospital pharmacists. Had the law been struck down, the provisions could still be complied by within the healthcare infrastructure, but there would have been no legal obligation to do so."

More on the Supreme Court ruling on healthcare reform

Supreme Court ruling impact: More patients, little help with costs(Medical Economics)

Health reform survives(Formulary)

Affordable Care Act upheld; urologists concerned about 'key aspects' of law(Urology Times)

Supreme Court upholds healthcare reform law: Dermatologists react(Dermatology Times)

Court rules for ACA; traveling industry should benefit(Healthcare Traveler)

Medicaid expansion will stand with revision(Managed Healthcare Executive)