As you likely have heard by now, yesterday the Supreme Court upheld the Affordable Care Act (ACA) as constitutional. Please click here to view NCSD’s overview of the ruling which went out to members a few hours after the announcement was made public.
Below are three points regarding how this ruling will affect the fight to prevent and treat sexually transmitted diseases, which NCSD sent out to news media yesterday after the ruling.
• Young people will continue to have expanded coverage under their parent’s insurance. Young people bear a disproportionate burden of STDs—those aged 15-25 make up half of the STDs contracted annually, but make up only one-fourth of the sexually active population.
• Private insurance will continue to have to cover prevention services with no cost out-of pocket costs to patients. While there is still work to be done for certain at-risk populations, such as men who have sex with men, expanded STD testing and STD counseling will be covered by insurance under this expansion of preventative care in the law and it is a great start.
• The continued need for safety-net service providers is underscored. With the narrowing of the Medicaid expansion provisions, the very real possibility exists that many low-income individuals will not have access to affordable health care coverage. Patients at STD clinics are young, minority, and poor—populations that are bear a much higher burden of STD disease—and may be left without coverage in a state that may choose not to expand their Medicaid coverage.
We wanted to give you all a little more analysis on the Court’s ruling on the Medicaid expansion, as that is likely to have an impact on your work. As the law was originally written, states were required to increase their Medicaid coverage to 133% of the federal poverty level (FPL) or lose all Medicaid funding from the federal government. The Supreme Court, however, found this cutting off of funds for non-compliance with the expansion to be coercive. In narrowing the Medicaid expansion, the court stated that states will have the option of continue their current, unexpanded plans— essentially making the Medicaid expansion contained in the ACA optional for states.
States will still have a “carrot” to expand their Medicaid programs—the federal government is to shoulder most (93 percent over the next nine years) of the finical burden of this expansion— but the “stick” of retracting all federal Medicaid funds no longer exists.
The Medicaid coverage expansion has significant potential to reduce the number of uninsured and reduce disparities in coverage across states. Yesterday’s ruling, however, sets up an inequity for those who uninsured and living below the poverty line in a state that chooses to not expand their Medicaid program. The law set up a series of subsidies for lower and middle-income earners to help purchase insurance in the new health insurance exchanges. These subsides in the law, however, begin at 133% of FPL, because the ACA assumes that those below 133% of FPL will be covered through the Medicaid program. This means that those who have incomes below 133% of FPL but above the current Medicaid coverage level in a state that chooses not to expand their Medicaid program will, as the law currently stands, likely not have access to health insurance coverage. As said above, this underscores the continued need for safety net services, including sexual health services, even after 2014.
In addition, here is a piece done by the Associated Press that looks at where states are in implementing the Affordable Care Act.
As always, if you have questions or concerns, please contact Stephanie Arnold Pang, NCSD’s Manager, Policy and Communications at firstname.lastname@example.org or 202-715-3865.