1. What Now? Health Reform in the Aftermath of the S. Ct. Decision Jaime S. King, JD, PhD UCSF/UC Hastings Consortium on Law, Science and Health Policy June 29, 2012

2. Two Major Holdings  Individual Mandate upheld  4 Justices upheld it via the Commerce Clause (Ginsburg, Sotomayor, Kagan, and Breyer)  Chief Justice Roberts upheld it as a tax.  Medicaid Expansion  Federal government may incentivize the expansion  Roberts, Kagan, Breyer, Ginsburg, Sotomayor  But, the Federal Government cannot withdraw all Medicaid funds for failure to expand  Roberts, Kagan, Breyer, Scalia, Alito, Kennedy, Thomas

3. Major Elements of the ACA Upheld  Individual Mandate  Employer Mandate/Play or Pay  Premium and Cost Sharing Subsidies  Medicaid Expansion (limited)  Health Insurance Exchanges  No Preexisting Condition Exclusion  Community Rating  Dependents can stay on insurance until age 26  Payment Changes in Medicare

4. Health Law and Policy Initial Implications  2014 – Nearly all individuals will have to purchase health insurance or pay a tax.  Medicaid Expansion – Opt In  State Exchanges – Back on Track  Future Litigation/Repeal Efforts

5. No “Broccoli Horrible”

6. Mandate vs. Tax

7. Medicaid Expansion – Opt In Prior Medicaid Eligibility  Disabled  Blind  Families with Children  Elderly ACA  All individuals with incomes under 133% of the Federal Poverty Level  ACA Following S. Ct. Ruling  133% only if state decides to expand

8. What will the States do?

9. Medicaid/Tax Credit Ineligible?  $15,000 Total Income for 2  $90,000 Total Income for 4

10. Exempt from the Individual Mandate, but No Subsidy? 100% FPL

12. Strategies to Undermine the Health Law  Repeal and Replace Entire Bill  Repeal Portions of the Bill  Litigate HHS Regulations  Limit Appropriations

13. Difficult to Repeal and Replace All of it….

14. Strategies to Undermine the Health Law  Repeal and Replace Entire Bill  Repeal Portions of the Bill  Litigate HHS Regulations  Limit Appropriations

15. Intersection of Law, Science and Health Policy