The recent U.S. Supreme Court ruling on the constitutionality of the Patient Protection and Affordable Care Act was interesting, to say the least. The ruling walked a fine line, but in the end the majority of the law was upheld.
The short version of the story is that the court ruled that the law's penalty for not purchasing health care is constitutional because the penalty is actually a tax. In summary, the mandate is legal because Congress can impose a tax if one does not buy insurance.
This means that "community rating" for all health insurance policies, also a mandate in the law, is feasible and will be implemented.
The ruling will have significant political ramifications for the fall election, as you have likely heard. President Obama had gone to great lengths to characterize the mandate's charge as a penalty and not a tax. The opponents of the law are going to press the message that this was a tax hike.
There was one significant strike-down by the court that may, in some states, impact the implementation of coverage for those with low income. The court ruled that the federal government cannot force the states into expanding Medicaid coverage by withholding current Medicaid funding if they do not expand as directed by the law. However, it does not prevent the feds from "enticing" states to participate in the expanded Medicaid coverage programs; they just cannot cut off other Medicaid funds if states choose not to participate. Many states will likely proceed with some form of Medicaid expansion to acquire the extra funds available.
All the other aspects of the bill are now the law with no changes. Entities such as medical homes, accountable care organizations (ACOs), and the Independent Payment Advisory Board (IPAB), among others, will remain unchanged.
What does this all mean to the practicing urologist? Here is an overview of what to expect in the months and years ahead.