Upheld: The Patient Protection and Affordable Care Act

by Miller & Martin PLLC

On June 28, 2012, the United States Supreme Court handed down a decision on the Patient Protection and Affordable Care Act of 2010.  The Supreme Court’s decision is based upon the review of two provisions of the Act: (1) the individual mandate requiring all Americans, with a few exceptions, to maintain health insurance or pay a penalty, and (2) the expansion of Medicaid by which States would receive federal funds provided that certain health care would be afforded to citizens whose income falls below a certain level.  The Court upheld the individual mandate, while it limited the Medicaid expansion.
Individual Mandate  
The individual mandate requires all Americans to maintain “minimum essential” health insurance coverage beginning in 2014.  Excluded from this mandate are those incarcerated and undocumented aliens.  Individuals who choose not to comply with the individual mandate must make what is termed a “shared responsibility payment” to the federal government.   For example, in 2014, the shared responsibility payment will be the greater of $285 per family or one percent of an individual’s household income.  In 2016, the shared responsibility will increase to the greater of $2,085 per family or 2.5 percent of an individual’s household income.  This payment, or tax, as described by the Supreme Court, would be paid to the Internal Revenue Service and collected in a way similar to its current method for collecting tax penalties.  The IRS, however, is prohibited from using a number of its enforcement methods, such as criminal prosecution and levies to collect the shared responsibility payment.  Exempt from payment of the shared responsibility payment are those with an income falling below a certain level, members of Native American tribes, and certain other individuals.
Medicaid Expansion
Currently, Medicaid requires States to cover certain categories of persons, including pregnant women, children, needy families, the elderly, the blind, and disabled persons.  The Affordable Care Act allows States to choose whether or not to participate in the Medicaid expansion pursuant to the Act.  If a State chooses to participate, it is required to expand its Medicaid programs to cover all individuals under the age of 65 with income levels below 133 percent of the federal poverty line.  Additionally, the State would be required to implement an “essential health benefits” package for all new Medicaid recipients.  Under the Act, the federal government would pay 100 percent of the costs to cover the new Medicaid recipients through 2016.  In the subsequent years, the federal payment level would decrease to a minimum of 90 percent.  The Supreme Court did not reject the offering of funds by the federal government for the expansion of Medicaid, but did reject the penalizing of a State for failure to participate in the expansion by withdrawing that State’s Medicaid funds.  Accordingly, the Supreme Court held that States can choose to participate in the expansion in exchange for the new funds provided through the Act.  If a State so chooses, then it must comply with the Act and expand its coverage.  Further, if a State that has chosen to participate fails to comply with the requirements of the Act, then the federal government may withdraw funds provided through the Act.  On the other hand, a State can opt out of the expansion program and not be penalized for continuing its Medicaid program as is without the expanded coverage. 
Impact of the Supreme Court’s Decision
Aside from the decisions on the aforementioned provisions of the Patient Protection and Affordable Care Act, the Supreme Court preserved the remainder of the Act.  Thus, beginning in 2014, employers with fifty or more employees must provide minimum essential coverage to their full-time employees or face penalties.  Insurance companies will not be able to exclude, limit or set unreasonably high rates for coverage for those with pre-existing conditions, and young adults up to the age of twenty-six will remain eligible to stay on their parents’ health insurance.
For additional information or if you have questions pertaining to health care reform, please contact Chris Crevasse, Christie Burbank, Jade Dodds or any member of Miller & Martin's Health Care Reform Task Force.  Be on the lookout for our next alert, which will cover a timeline of health care reform compliance deadlines.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Miller & Martin PLLC | Attorney Advertising

Written by:

Miller & Martin PLLC

Miller & Martin PLLC on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.