As most of you know (probably ad nauseam at this point), the Supreme Court of the United States delivered their ruling today on the constitutionality of the Affordable Care Act (ACA).
Q. So what happened this morning?
A. Ultimately, the ACA was upheld. Likely the most controversial component, the requirement that every American buy insurance, was upheld. But there was a twist; the Supreme Court said it does not violate the commerce clause because the mandate doesn’t regulate existing commercial activity. Instead, it compels individuals to become active in commerce by purchasing a product. Therefore, Americans can choose not to buy health insurance, but will instead pay a tax. The expansion of the Medicaid program up to 133% of the Federal Poverty Level (FPL) was also among the top controversies in the law. The Supreme Court ruled that states will have a choice about whether or not to participate in the expansion. So if states choose not to participate, they will not be penalized by losing their current Medicaid dollars (as written in the ACA). If states opt for the expansion, they will get money to participate, but they must comply with the conditions attached to the new expansion funds.
Q. What position did CRHC take on the ACA?
A. The Colorado Rural Health Center did not take a position on the Affordable Care Act. Our policy agenda is directed by our membership, and the membership did not come to consensus on all provisions of the ACA. However, membership supported the rural provisions which contribute to CRHC’s vision to ensure that all rural Coloradans have access to comprehensive, affordable, high quality healthcare.
Q. What happens with the rural provisions in the law?
A. Given the decisions made this morning, it means that all rural provisions included in the ACA were upheld in entirety. As a reminder, some of the rural provisions included additional funding for the National Health Service Corps program, residency allocation, and creation of Rural Physician Training grants, as well as establishment and funding for the Centers for Medicare and Medicaid Services (CMS) Innovation Center, Primary Care Incentive payments, “Extenders,” and modification of the low volume hospital adjustment. So the workforce modifications, innovation dollars and payment modifications will be administered as outlined in the law.
Q. Does this mean it’s all over?
A. Not at all. There will be additional legal challenges concerning implementation and regarding Medicaid participation, and the political mudslinging has already begun!
CRHC will continue providing training and technical assistance to Critical Access Hospitals and Rural Health Clinics, offering workshops and conferences, administering grant programs, offering the Colorado Provider Recruitment Program and advocating on behalf of rural facilities and communities. We will be in Washington, D.C. at the end of July to fight against the cuts that will disproportionality impact rural and to provide Congress with a real picture of rural health in Colorado.
And we will work with rural communities and facilities on creative solutions that will continue to improve patient health, improve community health, and contain cost, all the while ensuring hospitals and clinics in rural areas remain viable practices that ensure access to their communities.
