In a groundbreaking decision announced on June 28, 2012, the Supreme Court upheld the constitutionality of most of the Affordable Care Act. At the same time, it declared the law’s Medicaid expansion unconstitutional because the law threatened states that did not expand Medicaid with a loss of all their Medicaid funding. The court’s remedy was to block the potential cutoff of all Medicaid funding, in effect making the expansion of Medicaid optional for states. The court’s Medicaid decision dealt a blow to a major element of the government’s strategy to expand health insurance coverage to millions of uninsured Americans. It is unclear how many states will now move forward with the expansion, or what options they have to undertake partial expansions.
This Health Policy Brief reviews the Supreme Court’s decision and its implications, particularly for federal-state programs going forward, and was published online on September 27, 2012 in Health Affairs.