For three days this week, the Supreme Court heard arguments regarding the Affordable Care Act, which was signed into law by President Barack Obama in 2010.
The first day of arguments dealt with the timing of the case, since provisions of the ACA that would trigger penalties have not yet gone into effect. The second day of arguments centered on the individual mandate of the act, which would require persons not covered through employer-based programs, Medicaid or Medicare or other public insurance programs to purchase health insurance. The first part of the final day of arguments focused on whether remainder of the act could survive, if the individual mandate was struck down as unconstitutional. The second part of the third day was devoted to arguments regarding the act's Medicaid expansion.
Beginning in 2014, the ACA expands Medicaid eligibility to include everyone under age 65 with incomes up to 133% of the federal poverty level. Through 2016, the federal government will pay 100% of the cost of providing medical care for the recipients who are added to the program under the expanded eligibility requirements. The federal contribution will gradually be reduced to 90% in 2020, leaving the states to pick up the additional 10%.
Twenty-six states joined together to argue that the additional costs they will need to pay out under the expanded program are a burden that the federal government is prohibited from placing on them. The United States' argument in support of the funding structure is that since Medicaid is a voluntary program opted into by the states, the government is able to expand the program's eligibility guidelines and funding, as it has done numerous times over the life of the program.
Decisions on the issues are expected to be handed down by the court in June. Transcripts of the oral arguments are available on the Supreme Court's website.