The U.S. Health Care System in Transition

  1. Choose a major reform under the Affordable Care Act that you wish to explore in greater depth from one of the following classes: Classes 12 – 17, 19. The reform should be of sufficient scope to allow you to answer the questions posed below in #3.
    Major reform under the ACA  ACA Medicaid Expansion
  2. Write a paper that addresses Question A and the appropriate questions under B:
    A. What was the aim of the ACA reform and what has been its effect(s) to date? Describe the reform and the aspect of the health care system it was intended to change (e.g., insurance market, payment methods, delivery system, long-term care, etc.). What (if anything) has it accomplished? Which stakeholder groups have benefited? Have any been harmed?
    Insurance reform  Medicaid Expansion under the ACA
    • When signed into law in 2010, the ACA required each state to expand Medicaid eligibility to 138 percent of the FPL
    • To finance coverage for the newly eligible, states were to receive 100% federal funding for 2014 through 2016, 95% for 2017 through 2019, and 90% for 2020 and beyond
    • According to the CBO, the original Medicaid expansion provision was expected to account for roughly half of all new coverage of uninsured citizens
    B. Note whether the reform: (a) remains in effect; (b) has been repealed; or (c) has been modified by the Trump administration.
    1) If still in effect: How does it currently operate, and what challenges or threats, if any, is it likely to face in the future? How could it be improved or strengthened?

The reform remains in effect today however; it was slightly modified after the NFIB v. Sebelius Trial
Case Summary:
National Federation of Independent Business v. Kathleen Sebilius (Secretary of Health & Human Services)
• 26 states, 2 individuals, and an independent organization called NFIB
• Brought this case only two months after the ACA was enacted into law
• Challenging the constitutionality of Medicaid Expansion
Medicaid Expansion  required states to expand their Medicaid program to cover those with incomes up to 133% of the federal poverty level, which the federal government would provide funds for, and gave HHS the power to revoke this and all Medicaid funding if states chose not to do so
• QUESTION: Court must address whether the federal government/HHS has the power to revoke funding from the Medicaid program if states refuse to expand, since Medicaid was an established contract and the expansion was not a part of this original agreement
• States argue that this was not part of the original Medicaid agreement, and that it was unconstitutionally coercive to revoke funding if states choose not to expand
• Sebelius argues that expanding Medicaid coverage is crucial to containing costs that arise when the low-income uninsured require medical attention that they are unable to pay for

DECISION: Supreme Court rules that this new condition for Medicaid funding goes beyond the original Medicaid program, and therefore is not a valid exercise of Congress’s spending power
• Finds that it would be ‘unduly coercive’ to either accept expansion or risk losing all Medicaid funding, but allowed the government to refuse to give federal funding for the expansion if states did not want to expand their Medicaid programs

Discuss changes in law, policy and/or management strategy that you would recommend to improve the current situation. Justify your recommendations by explaining why you think they are worthy of consideration.

Sample Solution