GM 12-084

Supreme Court Upholds Affordable Care Act Including Tribal Provisions

On June 28, 2012, the U.S. Supreme Court, in a 5-4 opinion, upheld nearly every aspect of PL 111-148, the Affordable Care Act (ACA), including the Indian Health Care Improvement Act (IHCIA) and other Indian-specific provisions included in the ACA. The opinion was eagerly awaited by Indian tribes and organizations, many of whom joined forces in an amicus brief arguing that the IHCIA should stand even if the ACA or portions of it were ruled unconstitutional.

Justice Roberts, who authored the opinion, was the swing vote in the decision, voting with the four more liberal members of the Court.

Nationally most of the focus was on the ACA’s provision requiring individuals to purchase health insurance or be subject to a tax penalty (the “individual mandate”). The Court held that this requirement is constitutional under Congress’ power to impose taxes. Because the individual mandate was upheld, the Court did not need to decide what other parts of the statute were constitutional, and upheld the remainder of the Act, including the Indian Health Care Improvement Act.

The Court did, however, strike down the provision that would have allowed the Secretary of Health and Human Services to take away all Medicaid funding to states that chose not to participate in the new Medicaid Expansion provisions of the law. The fallout of this portion of the opinion is not yet clear, and states will likely make differing decisions on whether to participate in the Medicaid Expansion. Tribes may be directly affected by this ruling and will need to follow state actions closely on this matter.

Many Republicans in Congress are calling for repeal of the ACA and/or the use of appropriations bills to thwart implementation of the law – a House floor vote on repeal is tentatively set for July 11. The ACA will continue to be hotly debated.

Please let us know if we may provide additional information regarding the ACA or the Supreme Court’s decision.