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Supreme Court Ruling Sets Stage for Full Rollout of Health-Care Reform Law
Date:7/2/2012

It's unclear whether states will decide to pursue Medicaid expansion or not, but this part of the ruling could affect the poor.

Lewis explained that prior to the Supreme Court's decision, "the Affordable Care Act would have required that states expand Medicaid programs by 2014 to cover all individuals under the age of 65 with incomes below 133 percent of the federal poverty level."

The federal government would pay 100 percent of the cost of expanded coverage through 2016, with the states assuming a small portion after that.

"This expansion of Medicaid would have done a great deal to eliminate much of the state-by-state variation we currently see in [the coverage of the] poor, but after [Thursday's] ruling, states may decline to participate in Medicaid expansion," Lewis said. "This would no longer eliminate disparities in coverage in the very poor from state-to-state."

On the other hand, Herrick noted, because Medicaid reimbursement rates run an average of only 59 percent of what private insurers pay, doctors may opt out of covering these people.

"If we have 16 or 17 million more people on Medicaid and doctors are saying they don't want to take Medicaid enrollees, that's not good," Herrick said. "We're afraid that could drive up emergency room visits."

And requirements that employers with 50 or more employees provide health benefits may mean a squashing of cash raises, he added.

Regardless of the perceived pluses and minuses, the Supreme Court's ruling does mean that many people are letting out a long sigh of relief.

"At least now we have some certainty about how we're going forward," said Stream. "We can work to implement those components of health care reform that are already underway that we think are in the best interest of patients... Even the strongest advocates wouldn't claim it to be perfect."

Thomas Oliver, a professor of population health sciences at the University of Wisconsin School of Medicine and
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