Affordable Care Act

A New Challenge to the ACA

Since conservatives were unsuccessful in repealing the Affordable Care Act (ACA) through a new president, they have continually turned to lawyers to prove the law’s unfeasability. Although the Supreme Court upheld the invidual mandate, many dissidents still find fault in the law. In addition to implementation hardships, conservatives believe there are many legal roadblacks still in place.  Challenges such as ones made in Oklahoma, questioning exchange subsidies for federally facilitated exchanges are likely to be discounted. Yet, in a recent Wall Street Journal article, David Rivkin and Lee Casey raise a new valid question. They claim that because of Justice Robert’s interpretation of the individual mandate as a tax and his ruling that the Medicaid expansion is optional, it poses a threat to tax law. The Uniformity Clause in the Constitution states that all indirect taxes shall “be uniform throughout the United States” and and must “operate with the same force and effect in every place where the subject of it is found.” With only 17 states agreeing to the Medicaid expansion as of date, that leaves the majority of states subject to the individual mandate tax without the extra coverage. The Uniformity Clause was designed to protect states from bearing the extra burden of a federal tax, and this ACA provision threatens to breach that protection. Even though in principle the law violates the Uniformity Clause, in practice, the individual mandate tax will never be imposed on people who are denied the Medicaid expansion. According to the ACA Medicaid expansion, anybody up to 133% of the federal poverty level would be eligible for Medicaid. This allows a family of four with an income up to $31,809 to gain Medicaid coverage. Yet, according to the Kaiser Family Foundation, these people would still not be subject to the individual mandate. The CBO estimates that a bronze plan, the lowest available plan, will cost around $12,000-$12,500 in2016 for a family, making the premium almost 40% of the income of the highest bracket of people under the Medicaid expansion. Since the Affordable Care Act exempts anyone from the mandate who’s premium is more than 8% of their income and anyone too poor to file taxes, this population is obviously excused. The real question in this challenge of the ACA will be interpretation of the law, and how technical we should be. Although this might prove to be a difficult battle, it is yet another example of the faults of the ACA, and how we should continue to question it’s provisions and the possible effects on our country.