National Comprehensive Cancer Network

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Supreme Court Upholds Affordable Care Act

Jonathan Larsen, MPP, Program Coordinator

On Thursday, June 28, 2012, in a much anticipated ruling, the United States Supreme Court upheld the major elements of the Patient Protection and Affordable Care Act (PPACA) in a 5-4 vote. The PPACA had been subject to several legal challenges rising to the Supreme Court, most notably to its individual mandate requiring those who can afford to purchase basic minimum health care insurance to purchase it or pay a fine. This provision along with the PPACA's Medicaid expansion were upheld, though the ruling may permit states to opt out of the Medicaid expansion without existing federal Medicaid funding being withheld by the federal government, a mechanism in the law meant to encourage states to comply with the law's expanded Medicaid eligibility criteria. The law mandates, effective January 1, 2014, that people earning less than 133% of the poverty level (about $14,000 for an individual and $29,000 for a family) to be eligible to apply for Medicaid coverage.1

The ruling enables federal and state officials to continue implementation efforts around the law, though the exact scope and way the law is rolled out remains in question as many provisions of the law have not yet come into effect. The law includes numerous popular provisions, many of which have already come into effect, for instance, allowing young adults to remain covered under their parents' health insurance plan until age 26, elimination of copays for select preventive services, including some cancer screenings, and directing that children with pre-existing conditions cannot be denied health insurance coverage. As mentioned earlier, the law provides for an expansion of Medicaid as well as the creation of state-run health insurance exchanges, meant to provide affordable insurance options to more than 30 million uninsured Americans. In 2014 the law will prohibit insurance companies from denying health insurance coverage based on preexisting conditions, a particularly important provision for people with or who have survived cancer.

Additional information on the PPACA is available at HealthCare.gov. The Supreme Court's ruling on the constitutionality of the PPACA is available in PDF format at: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.


1U.S. Department of Health and Human Services. HealthCare.gov available at: http://www.healthcare.gov/index.html. Accessed June 29, 2012.