After months of deliberation, the Supreme Court announced this morning that the Affordable Care Act will remain intact and upheld completely. In a 5-4 decision, Chief Justice John Roberts authored an opinion, which was joined by Justices Breyer, Kagan, Sotomayor and Ginsburg, that upheld the constitutionality of the individual mandate because it is a tax. The Court further decided that the Medicaid expansion is constitutional, but that the federal government cannot withhold existing Medicaid funding for states as punishment for states that do not comply with the expansion requirement.
During the two-year debate on healthcare reform, the IMF fought hard on behalf of myeloma patients for specific reforms which were critical to accessing quality care for ALL cancer patients, including:
- The elimination of discrimination based on pre –existing conditions
- The elimination of annual and lifetime insurance caps
- Closing of the Medicare doughnut hole
- Access to affordable health insurance
These key issues were all addressed in the Affordable Care Act. At this time, the IMF will remain focused on the implementation of these reforms to ensure access to care for patients facing a cancer diagnosis.
Read More: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.
What this Means for Patients:
The ACA requires that all citizens have health insurance coverage after 2014 or pay a fine, referred to as the "individual mandate." Several individuals sued the government, arguing that it is unconstitutional for Congress to pass a law requiring individuals to purchase something that they don’t want to purchase. The Supreme Court ruled that the individual mandate is indeed constitutional, meaning that the government can require people purchase health insurance. In essence, this means that the entire law is upheld and all of the provisions will remain intact and go into effect as outlined in the law.
IMF supports the provision prohibiting insurance companies from denying coverage or raising premiums because of pre-existing conditions. A diagnosis of cancer, including myeloma, is considered a pre-existing condition and without this protection in ACA, many patients and their families would have difficulty obtaining health insurance. These protections go into effect in 2014.
IMF also supported the provision that removes annual limits and lifetime caps on benefits. Today patients who reach this limit, have to pay out of pocket for any additional costs. After 2014, myeloma patients will not have to worry about reaching limits on their benefits annually or over the course of their lifetime.
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again. In 2010, Medicare provided seniors with a one-time rebate of $250 to help cover their prescriptions when they reach the donut hole. You also get a 50% discount on expensive brand name drugs in the donut hole and in 2020, the entire donut hole will be closed and you will no longer have this coverage gap.
Additionally, the Supreme Court decision means that the insurance exchanges will also remain intact and continue to be implemented over the next 1-2 years. Plans offered through the exchanges must include a minimum set of benefits called essential health benefits (EHB) and it’s up to the states to decide what is the benchmark plan that describes those benefits. IMF is advocating on the state level to include oral cancer drugs as part of the benchmark plan’s prescription drug benefit and now after the Supreme Court decision, they will continue these efforts.