For the past four years, the focus of progressive state lawmakers has largely been on shaping, passing, implementing, and securing the very survival of the Affordable Care Act. But following last year’s historic U.S. Supreme Court decision upholding the law, that focus shifted in legislative sessions this year to preparing to implement the law fully and effectively before critical elements of the legislation take effect in 2014 — a focus made more urgent by the Court’s decision to leave the question of Medicaid expansion up to the states. At the same time, and despite the political consequences, conservatives continued to ramp up their War on Women in statehouses across the nation, attacking abortion rights and making it more difficult for women to receive much needed care.
The pressure to fully implement the Affordable Care Act continued to build in state capitals this week as new reports showed the extent of the financial pain that both business and hospitals will feel if their states refuse to participate in the expansion of Medicaid (since the pain felt by the millions of people who would find themselves uninsured in those states was clearly not enough to win conservative support). In some states where previously opposed governors have already agreed to support expansion, conservative legislators are putting up a fight.
The initial news last week was that the Supreme Court upheld the Affordable Care Act (ACA). And though that remains true, discussion has increasingly focused on the one limitation the Court put on the law. While the ACA required all states to expand Medicaid eligibility to 133% of the federal poverty level (FPL) – about $30,000 for a family of four – in order to receive any federal Medicaid funds, the Court ruled that only funds for the expansion itself could be withheld. The practical effect of the limitation was to make it optional for states to expand Medicaid to all Americans at or below 133% FPL.
State governments are facing mounting budgetary pressures to cut Medicaid costs. Reducing eligibility or cutting covered services is the obvious, but short-sighted, cost-cutting strategy. Such cuts will leave already ill people more ill, shift treatment costs to other payers (including small businesses, individual insurance policyholders, and medical providers), and forego significant federal funding that frequently exceeds any state budget savings.
Hundreds of state legislators from every state in the nation continue to send a clear message to the Supreme Court: state Attorneys General seeking to overturn the Affordable Care Act through the courts are not the only ones who speak for the states.
In this week’s Research Roundup: Recent reports from NAACP Legal Defense and Education Fund, Centers for Medicare and Medicaid Services, Political Economy Research Institute, Center for Economic and Policy Research, US Action Education Fund, Center for Rural Strategies, Pew Center on the States, Good Jobs First, Commonwealth Fund, Economic Opportunity Institute, and more.