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Health Insurance & Affordable Care Act

Supreme Court Upholds Health Reform Law

What will the states do? Are many of them likely to refuse the money to expand Medicaid coverage? continued...

Robert Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va., says the Medicaid ruling is "a really, really important decision because you've got a lot of conservative governors saying you can't force us to expand Medicaid this way, we can't afford it."

"The political consequences of that are to say to these conservatives, 'Put up or shut up.' If you don’t want to expand Medicaid in your states, you don't have to. Take the political consequences for that. I think that is a really huge thing to be saying to these conservatives who don't want anything to do with the ACA. 'Put up or shut up.' This is a big deal. You don't want the money, you don't have to have the money, but then you go face your constituents and tell them why you didn't expand Medicaid like the other states," Laszewski says.

Will costs go up?

The answer is yes, they might.  

Karen Ignagni, president and CEO of America's Health Insurance Plans, says that parts of the law "will have the unintended consequences of raising costs and disrupting coverage unless they are addressed." 

An analysis from the group found that premiums may increase on average by 1.9% to 2.3% in 2014 and by 2023 from 2.8% to 3.7%.

But written into the law are a number of things intended to lower medical costs over time, which would potentially lower costs for consumers. 

In the near term, people who qualify for subsidies from the federal government to help pay for insurance may see their premiums go down. Exactly how this will affect premiums in the long-term, however, remains to be seen.

How is the Medicaid expansion supposed to work?

Medicaid is a program jointly funded by state and federal governments. The program is voluntary for states, but they all currently participate. Although states have some flexibility in how they operate their program, they are still required to follow certain rules in exchange for the money they receive from the federal government.

The health reform law was intended to expand coverage via Medicaid to an additional 16 million people who were never before eligible for the program, such as childless men with low incomes. The $931 billion expansion will be paid for in full by the federal government between 2014 (when this provision takes effect) and 2016. After that, federal funds will gradually be reduced to 90% by the year 2020. That will ultimately leave states to pick up 10% of the expansion's cost if they choose to opt in. However, the ruling today permits the state to refuse these funds, which could leave millions of people uncovered.

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