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Yesterday, the U.S. Supreme Court rendered a 5 to 4 decision to uphold the Patient Protection and Affordable Care Act (aka Obamacare). The much awaited decision on National Federation of Independent Business v. Sebelius that challenged the constitutionality of Obamacare has a significant impact in Illinois which must integrate Obamacare with recently enacted state Medicaid reforms.
Traditionally liberal leaning Supreme Court Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Ellen Kagan were led by the normally conservative Chief Justice John Roberts in upholding the constitutionality of the individual health insurance mandate which was the core issue of the case and the decision. It was opposed by the court’s typically conservative bloc of Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito. In the controlling opinion, Justice Roberts clarified that the mandate was upheld under Congress’ constitutional power to “lay and collect taxes”, instead of under Congress’ commerce clause power. In essence, by calling it a tax, the court said it was legal but not as interstate commerce that should be federally regulated.
Fo For Illinois residents, the decision means that::
- · 102,659 young adults under the age of 26 can remain on their parents’ health insurance policies;
- · 1,962 Illinois residents with pre-existing conditions will keep their health insurance policies that were previously denied by their providers;
- · 144,226 Medicare recipients will continue to save, on average, $667 a year on their covered prescription drugs;
- 1,353 million Medicare recipients will remain eligible for free preventive services, such as colonoscopies and mammograms;
- Of the 1.9 million residents without health insurance, 776,040 of them will be eligible to purchase subsidized health insurance; and
- Chronic disease sufferers will not be limited by lifetime and annual financial caps on their health insurance benefits.
Although Illinois Governor Pat Quinn was enthusiastic about the Supreme Court decision, stating, "this is a great day for health care in America, and a great day for health care in Illinois," there may be some issues in implementing it in President Obama’s home state. State government analysts will have to determine how much impact the decision will have on the recently enacted Illinois Medicaid reform law which reduced the state Medicaid budget by $2.7 billion. The reform package’s highlights included:
- Removing approximately 300,000 Illinoisans from Medicaid eligibility through tighter screening;
- Reductions in dental, optometrist, chiropractic and podiatric services;
- Reducing the Medicaid rates paid to nursing homes and hospitals; and
- Eliminating some pharmaceutical subsidies for low-income seniors and people with disabilities.
Determining how to integrate the Medicaid program growth of Obamacare and the program constriction by the reforms is actually an option for the state. A major part of the ruling was that the federal government could not threaten to withhold a state’s entire Medicaid allotment if it doesn’t participate in the program’s expansion. It will apparently be a non-issue in Illinois.
Although Obamacare is estimated to allow 500,000 more Illinois residents to qualify for Medicaid coverage, Governor Quinn plans to fully embrace the provision. Per his office, the logic behind Illinois compliance is rooted in the new Medicaid recipients being totally covered by federal funds until 2019, with only a 10 percent pay-in by the state starting in 2020. Then it is projected that the 10 percent pay-in portion will be covered by higher federal reimbursement rates being paid to the state. But that math is questioned by some, such as Illinois Comptroller Judy Baar Topinka, who warns that the Medicaid expansion could cost the state $2.4 billion over the next six years.
The Illinois Statehouse may also jump-start the health insurance exchange component, which officials estimate will allow 1 million Illinois residents to purchase health insurance. Prior to the fall “lame duck” veto session, Governor Quinn could start the process as early as this summer by issuing an executive order.
Time will be the judge as to which side in the Obamacare debates was the more accurate prognosticator. The one thing that can be guaranteed is that the nation and Illinois are venturing into unchartered, yet historic, territory.