The U.S. Supreme Court Ruling on the Affordable Care Act – What’s Next for Children and Youth with Special Health Care Needs?

June 28, 2012 — The long-awaited Supreme Court ruling on the constitutionality of the Affordable Care Act (ACA) was announced this morning.  In short, the Court ruled that the law is constitutional.  The provisions that have already been implemented, such as prohibiting pre-existing condition exclusions for children under age 18 and allowing adult children to stay covered under their parent’s health insurance until they turn 26, remain in effect.  Those scheduled to roll out over time will proceed as planned, with the exception of the Medicaid expansion.  The Court ruled states could not be compelled to participate at the risk of losing all federal funding for their Medicaid program; the expansion is now optional.

Since the passage of the law in 2010, the Catalyst Center has been working to provide states and stakeholders with information and analyses on the implications of the ACA for children and youth with special health care needs (CYSHCN).   We have identified three essential components of health care reform for CYSHCN; the following describes them and some associated ACA provisions:

1. UNIVERSAL AND CONTINUOUS coverage. To protect their families against financial hardship and to ensure access to critical health care services, CYSHCN must have stable health coverage. The National Survey of Children with Special Health Care Needs (2009) tells us that approximately 12% of CYSHCN experienced gaps in coverage during the year. The ACA offers a safety net of consumer protections such as a prohibition against pre-existing condition exclusions and a ban on coverage rescission.  It also offers young adults aging out of foster care the opportunity to retain their Medicaid coverage until age 26 and simplified eligibility and enrollment processes for Medicaid and Children’s Health Insurance Program (CHIP) coverage.
   
   
2. ADEQUATE coverage. Over one third of CYSHCN have health insurance that does not meet their needs.¹ The ACA includes several provisions related to adequacy of coverage, including the removal of annual and lifetime benefits caps, health homes for Medicaid-enrolled children with chronic conditions and a comprehensive list of “essential health benefits” that will be required in the individual, small group and Exchange plans beginning in 2014.
   
   
3. AFFORDABLE coverage.  Financial hardship is a fact of life for many families of CYSHCN.  Over 20% of families report they experience financial problems due to their child’s health care needs.² High premium costs keep some children uninsured.  Out-of-pocket expenses like co-payments and deductibles mount quickly for insured children with disabilities and chronic health conditions.  Under the ACA, the plans offered through the State Health Exchanges that will open in 2014 will include premium tax credits and cost-sharing subsidies.  Currently, well-child visits and preventative services must be provided without cost-sharing (e.g., copays).

With the uncertainty over the constitutionality of the law resolved, there remains much work to be done in preparation for full implementation in 2014. The Catalyst Center will continue to provide information and analyses to assist states and stakeholders in maximizing the opportunities within the ACA for ensuring that CYSHCN have access to continuous, adequate and affordable health coverage.  We invite you to visit the health care reform section  of our website, where you will find issue briefs, articles, webinar recordings and more.

Resources on the Affordable Care Act and the June 28 Supreme Court Decision  

Read a copy of the Supreme Court ruling

Kaiser Health News
Justices Uphold Individual Mandate, Set Limits On Medicaid Expansion
By Julie Appleby
KHN Staff Writer
June 28, 2012

Association of Maternal and Child Health Programs (AMCHP)
National Center for Health Reform Implementation

National Public Radio
Interactive: Inside the Health Care Ruling
by Erica Ryan and Matt Stiles
June 28, 2012

The Commonwealth Fund Blog
Nation to Move Forward on Ensuring Affordable Access to High-Quality Care for All
By Sara Collins and Karen Davis
June 28, 2012

Healthcare.gov
Affordable Care Act Implementation Resources: The ACA in Your State

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¹The National Survey of Children with Special Health Care Needs (2009)

² Ibid.