Policy Resource

Supreme Court Says Affordable Care Act Constitutional: We Say “Yippee!”

Mar 18, 2012

In a long-awaited decision on the fate of the Patient Protection and Affordable Care Act (ACA)—otherwise known as Obamacare—the Supreme Court today upheld the law.

Parents of young children can breathe a sigh of relief that the promise of health care for all, so important to babies and toddlers just starting life, is finally the law of the land. Chief Justice John Roberts, who provided the key vote to uphold the law, announced the historic, but close 5-4 decision. The Court ruled that the individual mandate to purchase health insurance is constitutional. It also ruled permissible the law’s requirement that states expand Medicaid to cover adults with household incomes up to 133% of the federal poverty level, but did limit the federal government’s ability to take away all Medicaid funding if states do not adopt the new expansion. States could lose new funding for the expansion, however.

What does this mean for children? The Supreme Court’s decision today means that the provisions of the Affordable Care Act that are already in place, and those scheduled to go into effect in 2014, can proceed on track. Here are some of the provisions that benefit babies, toddlers, and older children now and in the future.

Young Children Already Benefit from Health Care Reform:

  • No exclusions for preexisting conditions: This provision is already in effect for children and will be in effect for everyone else in 2014. It means an insurance company can’t deny coverage because of a health condition that exists when the family applies for coverage.
  • No lifetime limits or being dropped from coverage: Insurance companies can’t set limits on the total amount they will pay over a lifetime or drop someone from coverage if they get sick. There are restrictions on annual limits for some plans now. These restrictions will apply to all plans in 2014.
  • No copays for prevention and wellness benefits: Well-child health visits and other preventive care now are not subject to copays or deductibles. No out-of-pocket expenses for parents means more children will get those all-important routine checkups.
  • Children’s Health Insurance Program (CHIP) funded through September 30, 2015: ACA extended CHIP funding and placed conditions around its coverage being absorbed into the state Exchanges after that. It also gave states more resources for outreach and enrollment grants to reach more children.
  • Access to affordable, child-only policies: Parents can provide health coverage to their children, regardless of their own job situation.
  • More home visits to support healthy development: ACA established the Maternal, Infant, and Early Childhood Home Visiting Program to help improve early childhood development. The program is underway in states, so that babies, young children, and their moms are getting comprehensive support to help their development start out on the right track.

More Benefits Take Place in 2014:

  • Coverage of basic pediatric services, including oral and vision care: ACA will require that all new health plans cover basic pediatric services, including and oral and vision needs. Many health plans don’t cover these important services that help ensure babies, toddlers, and older children grow up healthy.
  • More parents will have access to Medicaid coverage: States will be required to cover most adults up to 133% of the Federal Poverty Line (FPL. Currently the median threshold for parents is 63% of FPL. The Georgetown Center for Children and Families estimates that 4.9 million uninsured parents will now qualify for Medicaid. Improving parents’ health can promote better health for their children. Problems such as maternal depression may be identified and treated, with positive impacts on babies’ development. Insured parents also are more likely to make sure that their children are enrolled in coverage as well. (Read the full analysis here.) NOTE: This was the section limited by the Court’s decision: states can choose not to expand coverage and be penalized by the federal government, but today’s decision limited that penalty to new money. The federal government can no longer use loss of a state’s entire Medicaid allocation as leverage to get states to participate in this expansion. This decision creates worries about whether low-income adults, including many parents, will not gain access to health care.
  • More access to health insurance for families and greater affordability when Exchanges go into effect: When the core of health care reform kicks in, families who don’t have insurance through their jobs will have more affordable health insurance choices through the state health insurance Exchanges. They’ll be able to receive tax credits if they can’t afford policies. They will have better and more understandable information on which to base their choices. The linchpin of ACA—the feature that makes access to coverage for those who can’t afford it or are too risky in the eyes of insurance companies—is the individual mandate to purchase coverage or pay a penalty. The pool of people purchasing insurance needs to be as big as possible and include healthy people who currently may not have coverage. Without a big pool, the needs of children, families, and others with significant health care needs make a bigger splash in terms of cost, so their policies become prohibitively expensive. The individual mandate creates that big pool and helps keep coverage within reach for many families.

Health care is a basic need for young children and all of us. For babies, regular visits to the pediatrician can start them on the road to positive development in all domains—physical, cognitive, social, and emotional. One in every 12 children and one in 5 parents have no health insurance. ACA gives a path to remedy that condition and improve the quality of the care to which they have access. That is what was at stake today—and why we’re smiling at the Supreme Court’s action.

  • Author

    Patricia A. Cole

    Senior Director of Federal Policy


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