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What Does the Constitutional Affordable Health Care Act Mean for Nebraska and Rural America?


The U.S. Supreme Court’s 5-4 June 28, 2012 decision upheld the Affordable Care Act (ACA) in its entirety (with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read). The Court could have struck down all or part of the bill as unconstitutional, but instead, upheld each of four distinct legal challenges.
What does the court’s decision mean to rural America?
Many provisions were included in the bill that benefit both the rural provider and patient. The provisions are designed to improve rural America’s access to health care providers by resolving the workforce shortage crisis in rural areas, and eliminate long-standing payment inequities for rural providers.
Rural supporters of the Act won key rural workforce and payment improvements in the bill. Each of these decisions will remain intact in light of the Supreme Court’s decision. Complete funding for several of the provisions will likely continue to remain challenging. Many programs “authorized” in the ACA, must actually be funded through a separate act of Congress.
Key Issues
The Supreme Court reviewed four separate legal issues based upon the four previous federal appellate court challenges. The four issues on which the court granted review and subsequently upheld today are:
• Whether the Anti-Injunction Act prevents challenges to the Affordable Care Act at this time (that is, is there legal “standing” to challenge a tax that hasn’t gone into effect yet);
• The constitutionality of the individual mandate, requiring most Americans to purchase health insurance by 2014;
• Whether the individual mandate is severable if it is found to be unconstitutional, or whether the entire Act would have to fail; and
• Whether the Affordable Care Act's expansion of the Medicaid program is constitutional.
The constitutionality and severability of the individual mandate attracted the most attention in the federal courts and among the public.

Rural Impact

The Act will have extensive impact on medical services in rural America, including Nebraska, Iowa, the Dakota’s and rural Michigan. These are some key aspects:

·Rural Physician Training Grants
·Expanding Area Health Education Centers (AHEC)
·Graduate Medical Education (GME) Improvements
·Redistribution of residency slots with rural protections
·National Health Service Corps
·Undergraduate medical education
·National Health Care Workforce Commission
·Medicare Physician Fee Schedule – Adjustment of the Geographic Practice Cost Indices (GPCI) Formula
·Providing Adequate Pharmacy Reimbursement
·Changes to the Independent Medicare Advisory Board (IPAB)
·Technical Correction for Critical Access Hospital Method II Billing Reimbursement
·Additional Payments to Hospitals in Counties with the Lowest Medicare Spending
·Floor on the Wage Index for Frontier States
·Extension of Programs Ensuring Access to Physicians and Other Services Otherwise Set to Expire
·Extension of Important Rural Medicare Protections
·Strengthening Indian Health Services
·Small Business Tax Credit
·Increases in Funding for Community Health Centers
·Expansion of the 340B drug program
·Establishment of the Office of Minority Health
·Community Transformation Grants

Universal Health Care coverage is closer at hand now, though much work remains to be done. Domina Law Group pc llois committed to helping build a nation in which all rural Americans are covered and care is only denied when a potential user is abusive of the system and the rights of others.

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