1. AAMC Contacts: Lori K. Mihalich-Levin, J.D. Director, AAMC Health Care Affairs Telephone: 202-828-0599 E-mail: lmlevin@aamc.orglmlevin@aamc.org Scott Wetzel Program Specialist, Health Care Affairs Telephone: 202-828-0495 E-mail: Swetzel@aamc.org The Supreme Courts Decision on the Affordable Care Act July 6, 2012

2. Chief Justice John Roberts wrote the 5-4 majority decision (joined by Justices Ginsburg, Breyer, Sotomayor, and Kagan) upholding the ACA, with changes to the Medicaid expansion. The Courts opinion can be found here: http://www.supremecourt.gov/opinions/11pdf/11- 393c3a2.pdf http://www.supremecourt.gov/opinions/11pdf/11- 393c3a2.pdf Justices Scalia, Kennedy, Thomas, and Alito wrote a joint dissenting opinion arguing that the entire ACA was unconstitutional 2 The Courts Decision

3. The individual mandate is Constitutional: Permissible use of Congresss taxing power Not permissible under the Commerce Clause 3 Key Ruling: Individual Mandate

4. States will not lose current Medicaid funding should they chose not to expand their Medicaid programs ACA said that if states did not expand coverage to individuals under the age of 65 with incomes below 133% of the federal poverty level, they would lose all Federal funding for their Medicaid programs The Federal Government initially pays full cost of expansion; offers substantial subsidies for states to expand coverage to Medicaid eligible individuals It is unclear at this time which states will choose to expand their Medicaid programs 4 Key Ruling: Medicaid Expansion

5. Under the Anti-Injunction Act, the Supreme Court is prohibited from considering the implementation of a Federal tax before the tax is enforced. Under the ACA, the tax penalties for not purchasing individual health insurance will go into effect in 2014 The Court ruled that since Congress did not use the word tax in the statute, the Anti- Injunction Act does not apply 5 Anti-Injunction Act

6. With the exception of the Medicaid expansion, all other provisions of the ACA remain in place This includes: VBP, PCORI, CMMI, demonstrations, resident slot redistribution, DSH cuts, changes to physician and hospital quality reporting, etc 6 Important Takeaways from the ACA Ruling

7. Congressional Republicans have pledged to repeal all or parts of the ACA. Repeal is unlikely as long as Democrats control the Senate and the White House Some states may choose not to expand their Medicaid programs The AAMC is working with its member institutions to better understand the implications of the Courts ruling on Medicaid and how it relates to other ACA provisions 7 Next Steps