• The U. S. Supreme Court upheld the Affordable Care Act (ACA) in large part, including the individual mandate, by a vote of 5 to 4.

• The decision bars the Department of Health and Human Services (HHS) from denying all Medicaid funding to states that opt out of ACA’s Medicaid expansion, but it allows states to obtain additional funding in exchange for opting in and complying with ACA’s standards.

• Implementation of health insurance exchanges and other provisions will continue, but delays are very likely, because so many states have yet to reach consensus on exchange design.

• If states elect to opt out of Medicaid expansions, millions of low-income Americans who would have obtained coverage may now remain uninsured, and providers will continue to face significant uncompensated care burdens.

• Opponents of the law will continue to pursue efforts on multiple fronts – in Congress, in the states and in the courts – to defund, derail or overturn the law, in whole or in part.

• Industry-specific provisions enacted to finance the expansion of health coverage will remain in effect, but they may be challenged in Congress and in the courts based on the smaller-than-anticipated population of newly-insured individuals.

• Policy-makers remain intensely focused on deficit reduction and reducing health care spending, and Medicare and Medicaid reimbursement streams are at significant risk for additional cost-cutting.

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