Today, in a surprise 5-4 decision, with the traditionally conservative Chief Justice Roberts writing the opinion for the majority, the Supreme Court upheld the main provisions of the Affordable Care Act (ACA). The bottom line of the over-200 page decision is that the challenge to the ACA, brought by over 25 states, was denied and the Act upheld as constitutional. Chief Justice Roberts joined Justices Breyer, Ginsburg, Kagan, and Sotomayor in the majority. The link to the full opinion is here: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.
The cases brought by the group of states challenged two provisions of the law: the individual mandate and the Medicaid expansion.
The individual mandate is the backbone of the Affordable Care Act: it provides that every American must be insured by 2014 and that Americans without insurance must pay a penalty when they pay their federal taxes. The Court’s approval of the mandate was vital: without the mandate (and the income gained through the premiums and penalties) it would be difficult for insurance companies and states to afford the cost of insuring all of the people who only bought insurance when they needed it (when they were sick or injured). The Court did uphold the individual mandate, but not as originally written.
Instead, the Court found that it is unconstitutional for Congress to penalize citizens for not having insurance, but constitutional for Congress to tax citizens for not having insurance. And that is likely how the mandate will be read in the future: if a person does not have health insurance, he or she must pay a tax (identical to the penalty, but framed differently for constitutionality). The tax levied against an uninsured person will be equal the amount it would cost to insure that person in the newly created affordable markets. Thus, the financial incentive is to be insured. In order to protect low-income individuals and families, the Act provides substantial subsidies for families and individuals who cannot afford insurance.
The Medicaid expansion, the second main provision of the law litigated in the Court this session, would expand Medicaid to cover adults under 65 who make less than $15,000 per year. The Court found it to be “coercive” to force states to make this expansion or else lose all of their Medicaid funding. But went on, however, to say that it would be constitutional for the law to withdraw new Medicaid funding from states if they refuse to offer the new coverage. Ultimately, this decision will likely result in a number of states declining to expand Medicaid coverage, leaving millions of Americans, especially LGBT families and families of color, without the benefit of comprehensive Medicaid coverage.
Now that the Affordable Care Act will move forward with implementation, here are some of the ways in which the ACA will benefit LGBT people and LGBT families:
Affordable Care: Under the ACA, states will now offer affordable health insurance to millions of individuals and families who couldn’t previously afford care. LGBT families, badly under- and un-insured, will finally be able to afford quality care. For families who cannot afford insurance under the “exchanges,” the state markets, there will be tax credits to cover the premiums.
Non-Discrimination: The “exchanges,” the state markets for health insurance, cannot discriminate on the basis of sexual orientation or gender identity in any of their activities, and discrimination on the basis of “sex,” which has been interpreted to include sex stereotypes and gender identity, is prohibited throughout the ACA.
Expansion of coverage to young people up to age 26: This portion of the law was already implemented and wholly preserved by the court. Young people up to age 26 must now be covered under their parents’ insurance. We know that over 80,000 young adults raised by LGBT parents have been able to access care under this provision. Check out our infographic HERE and share it widely!
Over the next few years, as the Affordable Care Act is implemented across the country, our families and millions of families like ours will be able to access affordable, comprehensive care (many for the first time). Today’s decision, highly politicized as it is, will be remembered as one of the most important advances for the health and well-being of all American families, including families headed by parents who are lesbian, gay, bisexual, and transgender.