Now that we can all stop guessing how the U.S. Supreme court will rule on the Patient Protection and Affordable Care Act –- it upheld the individual mandate, but limited the Medicaid expansion — we can now all start speculating about how it will actually work, right?
Well, the answers might be closer than you think.
As we reported earlier this month, Massachusetts passed its own individual mandate and Medicaid expansion in 2006, part of a health insurance overhaul law that was signed by then-governor Mitt Romney and served as a template for the federal law.
But the vast majority of the state’s 439,000 newly insured were the poor and low-income workers, who gained insurance through the expanded Medicaid program and other new subsidized options.
The Supreme Court ruled the federal Medicaid expansion constitutional, but limited the government’s ability to enforce it. The government can offer money as an incentive, but it can’t deny funds as a punishment.
As we saw in Massachusetts, the Medicaid expansion played a large role in getting everyone covered in that state, and it was expected to play a large role in expanding coverage under the federal law, too. As it rolls out in the 49 other states, a big question will be how many opt for the Medicaid expansion, and how those that don’t will cover their poor.