On the Hill: Supreme Court Upholds Affordable Care Act

Supreme Court Upholds Affordable Care Act!

In a spectacular victory for public health, the Supreme Court upheld the majority of the Patient Protection and Affordable Care Act (ACA) this morning. Writing for the majority, Chief Justice John Roberts determined that, while Congress does not have the power to compel individuals to purchase health insurance, its authority to levy taxes allows it to penalize those who chose not to, effectively upholding the individual mandate. The Court also upheld the ACA’s Medicaid expansion, which would extend eligibility to all individuals making up to 133 percent of the federal poverty level, regardless of disability status. Its decision however, limits the federal government’s ability to penalize states who chose not to participate in the expansion, ruling that the entirety of a state’s Medicaid funding cannot be contingent upon its decision to expand eligibility.

As NMAC pointed out in its amicus brief, the ACA does more to improve America’s response to the HIV/AIDS epidemic than any piece of legislation since the Ryan White CARE Act. Whether banning the practice of denying coverage to Americans with pre-existing conditions like HIV infection, or caps on life-time expenditures, this law will improve access to care for hundreds of thousands of people living with HIV. The Court’s decision today affirms the vast majority of these critical reforms and will go far in furthering our efforts to end the domestic HIV/AIDS epidemic.

But while today’s decision is largely positive, significant challenges remain. Congress must reevaluate mechanisms to encourage states to participate in the Medicaid expansion, while also ensuring that sufficient subsidies are available to provide coverage to low-income individuals living in states that choose not to. NMAC remains committed to the principle of universal access to quality health care and will continue to work with Congress, the administration and state governments to ensure that the ACA is implemented in a way that is responsive to the needs of those living with and vulnerable to HIV.

Supreme Court Overturns Part of Controversial Arizona Immigration Law

On Monday, the Supreme Court over turned part of Arizona’s extremely controversial immigration law,which the state claimed was necessary to protect it from a flood of undocumented immigrants. Stating that the federal government’s authority to set immigration policy preempts the power of states to do the same, the Court overturned three provisions, two that would have made it a crime for undocumented immigrants to live and seek employment in the state and another that would have allowed law enforcement to arrest or detain anyone that they had probable cause to believe had committed a deportable offense.

Unfortunately, the Court stopped short of declaring the law’s so-called “show your papers” provision unconstitutional. The most controversial aspect of the law, this provision would require state law enforcement to demand immigration papers from anyone stopped, detained or arrested whom officers “reasonably suspect” is in the country without authorization. While the majority wrote that its decision “does not foreclose other preemption and constitutional challenges to the law as interpreted and applied after it goes into effect,” it held that it is unclear whether the provision would supplant or support current federal law, and as such, should stand.

While there are a number of significant concerns about the application of the “show your papers” provision, one particularly troubling consequence could be its impact on the provision of HIV/AIDS services to Arizona’s Latino population, both documented and undocumented. The constant threat of harassment, detention and potential deportation would undoubtedly make Latinos in the state less willing to engage the health care system or seek support services. What’s more, it’s entirely plausible that because Ryan White funds can be used to provide testing and care services to undocumented immigrants, overly zealous law enforcement officials could stake out Ryan White clinics, harassing clients and disrupting their ability to serve the community.

While the law has yet to be fully implemented, NMAC will continue to track its application as well as efforts to pass similar laws across the country.