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Supreme Court upholds Affordable Care Act in landmark decision

July 19, 2012

Ruling has major implications for Oklahoma

OKLAHOMA- The Supreme Court Thursday in a landmark 5-4 vote upheld provisions of the Affordable Care Act, including the individual mandate. The decision means that the bulk of the act will go into effect in 2014 unless Congress acts to repeal all or portions of the act before then.

“This is one of the most important rulings involving health care in the past 10 years,” said Karen Rieger, chair of the health care practice group at Oklahoma-based Crowe & Dunlevy law firm. "Now that we have the decision, it will be important for health care providers, employers and regulators to move forward quickly to assure timely implementation of the law.”

The majority opinion of the court, delivered by Chief Justice John Roberts, upheld the individual mandate requiring nearly all Americans to carry health insurance or pay a penalty. In particular, the decision found that this provision is constitutional under Congress' power to tax, although the court also held that it was not within Congress' power under the commerce clause.

The court limited the act's provision expanding Medicaid eligibility, essentially making such expansion optional for states. Chief Justice Roberts noted that Congress may create state-federal spending programs, but the programs must be voluntarily and knowingly accepted by the states. Threatening states with the loss of their existing Medicaid funding if they decline to comply with the expansion, Roberts stated, violates the Constitution.

The act is anticipated to extend health insurance to approximately 30 million Americans who currently lack coverage. It also will guarantee the availability of insurance for those with pre-existing conditions and ensure those people do not pay more than healthy people.

Oklahoma Republicans have generally opposed the provisions of the act. The Oklahoma Legislature formed a Joint Committee on Federal Health Care Law to investigate the health care needs of Oklahomans. The committee formed a plan that was similar to the federal law, but was not aligned within. In 2012, Senate Bill 1629 was sent to the Senate committee but was tabled until the Supreme Court's ruling on the constitutionality of the act.

Now that the act has been upheld, Oklahoma will need to take steps to implement an Oklahoma Health Insurance Exchange before the commencement of the February regular legislative session in order to comply with the federal law. If the state is not able to comply with the federal law by Jan. 1, 2013, the federal government will impose its health insurance exchange on Oklahoma. Health insurance exchanges will provide internet-based "markets," where initially individuals and small employers can research health insurance options and purchase insurance coverage.

"Many in the industry have been in a holding pattern, waiting for the Supreme Court decision," Rieger said. "It is now time for all affected businesses and individuals to determine what steps they need to take to assure smooth implementation of the act."

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