What the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act means for kids

This is a post by Children’s Health Policy and Advocacy team. They’re nonpartisan and proudly serve as child health experts and as a resource for our elected officials.

Today, the U.S. Supreme Court upheld most of the Patient Protection and Affordable Care Act (ACA). In a 5-4 decision, the Court not only upheld the individual insurance mandate, but upheld a host of other provisions important to Children’s.

With ACA intact, private insurance reforms for children will remain, including: children with preexisting conditions will not be denied insurance coverage; children who undergo expensive procedures will not have to worry about annual and lifetime insurance caps; and young adults can stay on their parents’ insurance up to the age of 26. The law also authorizes, though does not fund, the formation of demonstration Pediatric Accountable Care Organizations, which are designed to improve and streamline care.

It is still unclear at this time how the Court’s ruling will affect the temporary increases in Medicaid reimbursement rates for pediatricians and pediatric specialists, as well as maintenance of the current Medicaid and Children’s Health Insurance Program (CHIP) coverage for children through Sept. 30, 2019.

The most substantive change arising from this decision is around Medicaid. Expansion of Medicaid has been limited, and is now largely left up to states to implement. States may maintain pre-expansion eligibility levels and receive current levels of funding, or they may comply with the federal expansion requirements and receive the corresponding federal funding. This decision will make it all the more important to make sure we protect Medicaid funding at a state level.