Last year was a big year for healthcare in general, and specifically President Obama’s Affordable Care Act (ACA). The law reached its two year anniversary, while facing opposition and the ongoing threat of repeal. The House of Representatives voted over thirty times to repeal all or part of the ACA during the 112th Congress. Throughout the year, the House held hearings on the status of the Obama Administration’s implementation of the ACA, requesting testimony from key Administration officials. In addition, House Budget Committee Chairman Paul Ryan (R-WI) released The Path to Prosperity, which proposed replacing the current open-ended Medicaid entitlement with a block grant to states. Overall the House budget reduced Medicaid funding by over $800 billion over 10 years. The House passed the Ryan budget by a mostly party-line vote of 228-191.
The President’s FY 2013 Budget opposed any efforts to block grant the Medicaid program, and instead proposed streamlining the financing and reimbursements by establishing blended matching rates for Medicaid and CHIP spending and replacing the current patchwork of matching rates. The Budget also continued to support funding for pregnancy prevention efforts targeted to foster care youth, family planning, maternal and child health, substance abuse, and mental health programs and services.
March 23, 2012 marked the second anniversary of the ACA, which coincided with the US Supreme Court’s hearing of the oral arguments on key aspects of the ACA including the individual mandate and the expansion of Medicaid. In June, the Supreme Court issued a ruling upholding the majority of the ACA, including the constitutionality of the individual mandate. Regarding the expansion of Medicaid, the Court upheld the expansion but ruled that the federal government could not financially penalize states that refuse to participate in the expansion. Following the ruling, House leadership decided once again to hold a vote on a bill repealing the ACA.
The 2012 Presidential Election played a key role in determining the future of the ACA, and while the reelection of President Obama protected the ACA from repeal, it remains less clear how Congress (with Republicans maintaining control of the House) will work with the Administration to ensure full implementation.