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WASHINGTON — A portion of the Supreme Court’s ruling upholding the Affordable Care Act could have an impact on community pharmacies that fill prescriptions covered by Medicaid.
While the court upheld the most controversial part of the health care reform law — a requirement that most Americans have health insurance or pay a penalty — it said that states do not have to expand Medicaid as Congress had intended.
The decision leaves a huge question mark over the law’s mechanism for providing coverage to 17 million of the nation’s poorest people. Republican officials in more than a half-dozen states have said they either oppose or have serious doubts about expanding Medicaid, even though the federal government would pick up all the costs in the first few years and at least 90% of the expenses after that.
When they wrote the health care overhaul law three years ago, federal lawmakers assumed that the poorest of the uninsured would gain coverage through Medicaid, while many people with higher incomes would receive federal subsidies to buy private insurance.
However, the Supreme Court’s ruling that states do not have to opt into the Medicaid expansion program could leave poor people living in a state that refuses to expand its Medicaid program unable to obtain either Medicaid or subsidies.
Some state lawmakers, many already facing mounting budget deficits, say adding thousands of patients to their Medicaid rolls will only add to their economic woes.
The Republican governors of Kansas, Nebraska and South Carolina and a handful of other states have already said they would have difficulty affording even the comparatively small share of costs that states would eventually have to pay.
Under the Medicaid expansion plan the federal government would initially pay all the cost of expanding the program to 133% of the poverty level. The state share would slowly rise to 10% of the cost by 2020.
“As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased,” Nebraska Gov. Dave Heineman says.
Others say they oppose the Medicaid expansion plan because they feel that it is the wrong approach to getting more Americans insured.
“We’re not going to shove more South Carolinians into a broken system that further ties our hands when we know the best way to find South Carolina solutions for South Carolina health problems is through the flexibility that block grants provide,” a spokesman for the state’s governor, Nikki Haley, says.
