Supreme Court Upholds the Affordable Care Act: What the Experts Are Saying

June 28, 2012

Today's Supreme Court decision to uphold most of the Patient Protection and Affordable Care Act (ACA)—and most notably, the individual mandate that all Americans purchase health insurance or pay a financial penalty—is likely the most significant health care-related ruling in U.S. history.

When President Barack Obama signed the bill into law in March 2010, the American health care system seemed destined for sweeping reform. Yet constitutional challenges soon surfaced, with two such cases climbing the judicial hierarchy and landing in the Supreme Court, threatening the President's signature legislative achievement.

Now that key provisions of the president's reform have survived the process and a mixed ruling on Medicaid expansion has prevailed, what lies ahead for health care in America? RAND experts sound off in the wake of the Court's momentous decision.

Future of Medicaid Still Uncertain

Christine Eibner

With most of the key provisions of the Affordable Care Act upheld, we expect close to 30 million Americans to gain health insurance coverage. Yet the part of the ruling dealing with Medicaid is significant. We don't know how many states will respond, and it will take thoughtful, quantitative analysis to gain insight into this. Our next challenge will be to analyze the effects of states opting out of Medicaid expansion, and how this might influence insurance coverage, exchange enrollment, and federal spending on subsidies.

Christine Eibner, economist

Learn More

Program Design Key to Achieving ACA's Goals

Cheryl Damberg

As federal and state policymakers move to implement the ACA, there are a plethora of decisions that must be made about how to structure the program elements. These decisions and the evolution of health care reform can be improved by the independent, objective analyses that RAND can provide. We can help identify best approaches to program design and implementation, and how to assess the impact of the ACA in achieving better quality, lower costs, and improved health. RAND's work in the area of pay-for-performance and value-based purchasing is one example of how RAND is helping policymakers design incentive programs to improve quality and lower costs.

Cheryl L. Damberg, senior policy researcher

Learn More

With Ruling Settled, Reform Can Begin

Peter Hussey

The ACA contains a myriad of provisions to reduce health care costs and improve quality independent of the mandate. For example, reforms have advanced primary care in ‘patient-centered medical homes’ and ‘bundled payments’ for common episodes of care have been taking root, but could potentially accelerate in the private sector with federal funding confirmed. Now that the uncertainty of the Supreme Court decision has been lifted, transformation of health care delivery can move rapidly ahead.

Peter Hussey, policy researcher

Learn More

Supreme Court Not the Only Group Whose Decisions Matter

The passage of the law and this ruling are the start of health care reform, not the end. There are now many decisions to be made. State governments need to make preparations for the insurance exchanges and the expansion of Medicaid. Health insurance companies must ensure their offerings are in compliance with the law. Businesses should assess the impact of the new options on their employees to determine if they should continue to offer health insurance. Health care providers need to assess whether they have the capacity to provide care to as many as 30 million newly insured Americans. Finally, individuals should look at the new options that will be open to them in 2014.

— Carter C. Price, mathematician

Learn More

  • Commentary

    What Happens If the ACA's Tax Credits Are Replaced with Premium Support?

    Nov 24, 2015

    As policymakers consider alternatives to reduce the federal government's financial burden from providing subsidies under the ACA, they should consider the consequences for enrollees. Existing premium-support models yield considerable savings for the federal government but could create age and income disparities in coverage.

  • Commentary

    Insurance Enrollment Holds Steady in Advance of the 2016 Open Enrollment Period

    Nov 12, 2015

    Since September 2013, the number of people with health insurance coverage has increased by 16.6 million. But since the second ACA open enrollment period in February 2015, the number of people with coverage has remained relatively flat. The third open enrollment period began on November 1. Whether the number of uninsured will continue to decline remains an open question.

  • Commentary

    A Tale of Two Deliveries, or an Out-of-Network Problem

    Nov 4, 2015

    Two mothers gave birth within weeks of each other, at the same hospital, using the same employer-sponsored insurance. Both had an epidural. But one received a surprise physician bill for anesthesiology, while the other didn't have to pay a dime. Why?

  • Report

    Can the Cadillac Tax Be Made Less Regressive by Replacing It with an Exclusion Cap?

    Oct 8, 2015

    The ACA’s Cadillac tax or a revenue-equivalent exclusion cap have very similar effects on families in different income ranges.

  • Report

    Alternatives to the ACA's Affordability Firewall

    Oct 5, 2015

    RAND examined the policy impacts of the Affordable Care Act's "affordability firewall," which limits subsidies to individuals lacking access to alternative sources of coverage that are "affordable," and investigated two potential modifications.