March 28, 2012

This week, the U.S. Supreme Court is hearing arguments on the constitutionality of the Affordable Care Act (ACA), the health care reform law enacted in 2010. The case has engendered strong reactions among Americans, with some fervently arguing that the new law should be upheld, others arguing equally fervently that the law is unconstitutional and should be repealed. Sifting aside for the moment political arguments for and against the ACA, there are two main issues before the Court.

First, is the provision in the law requiring Americans to purchase health insurance (the “mandate”) an impermissible tax? Second, does the requirement in the law that all states participating in Medicaid must cover everyone at or below 133 percent of the federal poverty level (FPL) by 2014 exceed Congressional authority under the Constitution?

Irrespective of how you feel about the overall law, the Supreme Court’s decision in this case has significant potential implications for people living with mental illnesses and their families.

First, the expansion of Medicaid in 2014 to cover all individuals at or below 133 percent of the FPL will impact millions of Americans with mental illnesses who currently do not qualify for Medicaid for a variety of reasons, including pending SSI applications, lack of a fixed address, or those with part time employment whose income may exceed current Medicaid eligibility levels.

Second, many individuals living with mental illnesses will be included among those able to purchase federally subsidized health insurance policies in 2014 through state health insurance exchanges established by the ACA. And, these policies must cover mental health and substance abuse treatment at parity with other medical conditions.

Third, if the entire ACA were struck down this would negate important provisions in the law expanding federal mental health and substance abuse parity to millions of Americans currently not protected by the law, including those who purchase health insurance through state insurance exchanges and those who are added to Medicaid through the expansion.

Finally, if the Supreme Court were to strike down the requirement in the ACA that all uninsured Americans purchase health insurance, it is not clear at present whether the ruling would negate the entire law or just the operation of the health insurance exchanges. If the entire law were to be negated, this would eliminate other aspects of the ACA beneficial to individuals living with serious mental illnesses.

For example, the nullification of the ACA would eliminate the provision in the law establishing a Medicaid Health Home option for integrating health and specialty care for individuals with chronic disabilities. A number of states are currently moving aggressively to implement these health homes. The nullification of the entire ACA would also eliminate important insurance reforms, such as the requirement that all individuals be issued insurance regardless of pre-existing conditions.  And, it would eliminate provisions designed to fix problems in the Medicare Part D program, such as subsidies for those who reach the so-called “Donut Hole.”

Clearly, much is at stake for individuals living with serious mental illnesses and their families. The Supreme Court is expected to issue its decision in June.

For more information about the ACA and its impact on people living with serious mental illnesses, click here.

For more information about the issues currently before the Supreme Court, click here.

And, for those interested in accessing the legal transcripts of the oral arguments taking place this week before the Supreme Court, click here. The name of the case is U.S. Department of Health and Human Services v. Florida.

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