Carolyn Long Engelhard spoke at the Wednesday, September 12, 2012 meeting of the Senior Statesmen of Virginia. The program was moderated by SSV Vice President Bob McGrath.

On June 28, 2012, the Supreme Court handed down its historic ruling upholding the Affordable Care Act (ACA), with the sole exception that Congress cannot penalize states that decline to expand Medicaid. What does the court’s decision mean for the ACA’s economic viability and the potential to provide health coverage for most Americans? What are the challenges facing President Obama’s signature health care legislation and how might the presidential election affect the fate of the ACA?

Standard Podcast [ 1:22:50 ]

Carolyn Engelhard is a health policy analyst at the University of Virginia School of Medicine, where she also directs the Health Policy Program in the Department of Public Health Sciences. Ms. Engelhard’s academic activities include studying and monitoring changes in health policy at the federal and state governmental levels and teaching in both the Graduate School of Arts and Sciences and the School of Medicine. In 2007, Ms. Engelhard co-authored a book looking at the myths surrounding the U.S. health care system. In 2009, Ms. Engelhard completed a project in conjunction with the nonpartisan Urban Institute examining the use of public policies to reduce obesity. More recently, Ms. Engelhard co-authored an article in the New England Journal of Medicine examining health insurance premium rating regulation under the new health care reform bill, and completed a textbook chapter examining the effect of the new law on health care organizations.

Program Summary

On June 28, 2012, the Supreme Court handed down its historic ruling upholding the Affordable Care Act (ACA) with the sole exception that Congress cannot penalize states that decline to expand Medicaid.

Where it all began…. the ACA got through Congress in a very messy way, but was signed into law by President Obama in March 2010. The act was envisioned by the Obama administration to provide almost universal coverage. The United States is the only industrial country in the world that does not have some form of universal coverage for its citizens.

The ACA was designed to build on employee-sponsored coverage (50% are currently covered by their employers), and it would expand Medicaid. However, Medicaid is a categorical program and so only some categories of people are eligible: poor kids, poor pregnant women and persons with disabilities (an adult can be completely destitute but still not eligible for a government program). The act would establish insurance exchanges, and people who fall through the cracks (uninsured, under-insured, those with pre-existing conditions) can go to the exchanges for coverage, and the government will give a subsidy if they are between 100 to 400 percent of the federal poverty level (20 million will go to these exchanges). This will happen through the individual mandate——for the first time in our country, legal citizens will be required to carry health insurance. It is projected that there will be over 30 million newly insured people by 2019——that was the promise.

Where are we now? How many are touched by ACA? Over 3 million young adults have enrolled in parents’ insurance plans; 5.3 million seniors and people with disabilities have saved more than $3.9 billion on prescription drugs; 54 million are eligible for preventive services with no out-of-pocket costs——1 in 4 Americans received a free mammogram, colonoscopy, or flu shot last year; 600,000 new adult Medicaid enrollees in 7 states that have expanded Medicaid; 70,000 are enrolled in temporary “pre-existing condition insurance plans”; 360,000 small businesses who used the 35% tax credit to purchase insurance.