The Affordable Care Act Remains the Law of the Land

On June 17th, the U.S. Supreme Court handed down its long-awaited decision in California v. Texas, a case challenging the constitutionality of the Affordable Care Act. By a 7-2 vote, the Supreme Court held that the parties objecting to the ACA (18 state attorneys general and two individuals) lacked standing to sue. The Court鈥檚 decision leaves the ACA intact and keeps the law鈥檚 benefits in place, including:

  • Protections for people with pre-existing conditions;
  • Expanded Medicaid coverage for low-income adults;
  • ACA Marketplaces, and tax credits to help people buy individual coverage in those Marketplaces;
  • Required coverage for essential health benefits, including prescription drugs, in ACA health plans;
  • Prohibitions against annual and lifetime dollar limits on coverage;
  • Coverage for young adults up to age 26 on parents鈥 health plans;
  • And much more.

HFA, which participated in California v. Texas via an amicus brief defending the ACA, welcomed the Court鈥檚 ruling as a victory for people with bleeding disorders and other serious health conditions. At the same time, HFA and other patient advocates recognize that there still remains much work to be done to improve coverage and care. HFA reaffirms continuing commitment to our core project of defending and promoting access to safe and effective care and treatments, and access to the quality, affordable coverage that pays for such care.

Quick hits:

  • Louisiana becomes the 11th state to adopt protections against copay accumulator adjusters! Gov. Bel Edwards signed SB 94 into law on June 21st. Congratulations to the Louisiana Hemophilia Foundation and all the grassroots advocates who worked for enactment of the bill.
  • The U.S. Centers for Medicare and Medicaid Services (CMS) released a proposed rule 鈥 the third and final installment in the Notice of Benefit and Payment Parameters for the 2022 plan year 鈥 that seeks to expand access to coverage by lengthening the open enrollment period for ACA marketplace plans; creating a new special enrollment period for some lower-income consumers; and reversing Trump Administration policies with respect to state 鈥渇lexibilities鈥 to exit or modify the healthcare exchanges.
  • CMS revoked approval for Medicaid work reporting requirements in Indiana and Arizona. Nebraska dropped its proposal to provide 鈥渆nhanced鈥 Medicaid benefits only to those complying with work reporting requirements. And Georgia delayed the planned July 1 start of its controversial plan to implement a limited and partial expansion of Medicaid, subject (again) to compliance with work reporting requirements. The postponement buys more time for Georgia to negotiate with CMS over the terms of the waiver, which was approved in the final weeks of the Trump Administration.
  • A state judge ruled that the Missouri鈥檚 voter-approved Medicaid expansion is unconstitutional, and the legislature therefore didn鈥檛 violate the law when it failed to provide funding for the expanded program (which was supposed to begin enrolling beneficiaries on July 1st). The lower court鈥檚 decision is on expedited appeal to the Missouri Supreme Court.
  • S. Reps. DeGette and Upton released a new draft of their legislation, Cures 2.0, on June 22nd. 鈥淲hile the 21st Century Cures Act sought to improve how new drugs and treatments are researched and developed in the U.S., Cures 2.0 seeks to improve how those new treatments and therapies are delivered to patients,鈥 Rep. DeGette said. The draft includes provisions to: improve clinical trial design, as well as collection and use of real world evidence; create a new government research agency charged with accelerating health R&D into areas of unmet need; and improve preparedness for future pandemics.
  • Senate Finance Committee Chair Ron Wyden released an outline of principles that will inform the committee鈥檚 work on drug pricing. The paper calls for: Medicare price negotiation; reducing Medicare beneficiaries鈥 pharmacy out-of-pocket costs; extending Medicare-negotiated drug prices to commercial insurers; and tailoring policies to reward innovation and protect small biotechnology companies.
  • Medicaid enrollment has risen by approximately 10 million across the U.S. since the start of the pandemic. While some of that increase is due to new sign-ups, much is apparently attributable to the pause on state disenrollment of beneficiaries (mandated under the 2020 Families First Coronavirus Relief Act for the duration of the public health emergency). When states resume eligibility redeterminations and disenrollments (likely in 2022), it will be important to ensure that beneficiaries do not lose coverage due to administrative error or red tape.



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