Today, the U.S. Supreme Court rejected a challenge from Nebraska and 25 other states against the federal health care law, known as the Affordable Care Act. The Court ruled 5 to 4 that, among other things, the federal government does have the ability to mandate health coverage and impose tax penalties if people do not have coverage.
For more on what the ruling means, Grant Gerlock of NET News talked with Julie Sebastian, dean of the College of Nursing at the University of Nebraska Medical Center in Omaha. Sebastian said the ruling sends some questions back to the states.
GRANT GERLOCK, NET NEWS: One of the controversial parts of the Affordable Care Act at the state level is Medicaid, federal coverage for low-income individuals. Can you explain what the law does with Medicaid and what the Supreme Court said about that?
JULIE SEBASTIAN, UNIVERSITY OF NEBRASKA MEDICAL CENTER: Well, the law indicates that states can choose to expand Medicaid coverage to people at up to 133 percent of the federal poverty level. And the decision today indicated that states can determine for themselves whether they wish to add any additional Medicaid enrollees. So states that elect not to add enrollees would not receive the additional funding to cover the expansion because they wouldn't have the expansion.
GERLOCK: Before that the federal government said it would take away some of the funding for existing enrollees if states didn't expand and that's a change with the decision, right?
SEBASTIAN: That's correct. That won't occur.
GERLOCK: This is something that's been a concern for Gov. Dave Heineman. He's talked about how expanding that cost would weigh on the state budget to cover more low-income Nebraskans. So is this now a decision for state lawmakers to make, whether or not they cover more people under Medicaid?
SEBASTIAN: Yes, that's exactly where those decisions will occur, is within individual states. So each state will have to decide what works best in that particular environment.
GERLOCK: Let's talk about another thing on the state level and that's the health insurance exchange. Why don't I let you explain what that would be and what it would do.
SEBASTIAN: Well, the basic idea is that people who don't have insurance could go to the health insurance exchange and either purchase individual insurance, or if the state is participating in the expansion of Medicaid, then if they would be in the category for expansion they might secure their insurance in that manner.
GERLOCK: So the state has been doing some planning on that. Now that we know the law will be moving forward, what does the state need to do?
SEBASTIAN: The state will need to determine first, I think, what will occur in terms of Medicaid. and how that would affect any earlier analysis of how the insurance exchange might work. One would need to know both pieces. And that's not to say that the insurance exchange could not go forward without the expansion. I'm not saying that. It's just that in order to make well-informed decisions, you would need to know which pieces would go into the decision.
GERLOCK: With the law going forward, with more people having coverage, there are questions about people getting access, having enough people to provide that care. Can you talk about some of the issues that might still be out there even if the law stays in its current form and goes in place in its current form?
SEBASTIAN: Well, one issue related to access is, those of us in higher education, educating future health professionals, know there will be demand for additional health professionals to take care of the increase in the numbers of people who have access to care. So, for example, from the perspective of nursing, the latest projections are that by the year 2020 we will have a total of 1.2 million job openings for nurses. And this is due to both the growth in job opportunities or the need for nurses, as well as the need to replace nurses. So for us the expansion and the need to focus on health workforce issues, and in our case health workforce issues in Nebraska is really quite vital.
GERLOCK: Julie Sebastian, thanks very much.
SEBASTIAN: Yes, thank you.