If you listened to much of the coverage of the Supreme Court's consideration of the Affordable Care Act (ACA) you will have undoubtedly heard people say things like "if the Court rules the individual mandate unconstitutional and that they decide that the entire law is therefore unconstitutional not only items like coverage of pre-existing conditions be at stake but so will all the other things in the law." OK, so maybe they say it a little more eloquently but you get the idea. So what are all those other things? The list is long so let's just take a look at a few items that those who care about public health may have on their mind.
First there is the obvious – if the law is ruled unconstitutional items like coverage for the uninsured and underinsured are in jeopardy. Frankly, those items are probably in jeopardy even if the Court finds the individual mandate unconstitutional but severs some of the law and let's other parts stand. If the whole law goes or if they find the Medicaid provisions unconstitutional and those go, it would be another blow to coverage for the uninsured.
Then there are the provisions that get less publicity. The Prevention and Public Trust Fund is one of the items at stake. It is a guaranteed funding stream and an ongoing commitment to prevention created in the ACA. States and communities are using these funds for things like modernizing vaccine systems, reducing tobacco use, and helping to control obesity. The Patient-Centered Outcomes Research Institute, created to provide patients and health care providers information about the best available evidence to help inform their treatment decisions. The ACA also contains the "permanent" reauthorization Indian Health Care Improvement Act, which provides broad support and funding for tribal health programs and for Indian citizens. There are also provisions that affect the ability of coal miners and surviving spouses ability to receive payments through the Black Lung Benefits Act. Funding for healthcare professionals workforce development and training, childhood obesity projects, programs relating to congenital heart disease, and a funding for young women's breast health awareness and support of young women diagnosed with breast cancer could all be at stake if the law is ruled unconstitutional. And those are just a few examples of the all the other things.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.