Dear Ms. Kirst:
Thank you for taking the time to contact me about the Supreme Court’s recent decision on the Affordable Care Act. I appreciate hearing from you about this issue.
On June 28, 2012, the Supreme Court ruled in the case of National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al. This decision upheld most of the key provisions of the Patient Protection and Affordable Care Act.
As a result of this ruling, countless Pennsylvanians will be able to secure affordable health coverage in the coming years. Provisions of the law that are already improving access to quality health insurance will remain in effect, such as the provision allowing the 91,000 young adults in Pennsylvania on their parents’ health insurance to keep that coverage and the provision that has provided discounted drugs provided to 240,000 older Pennsylvanians on Medicare who have fallen into the “donut hole.” Starting in 2014, health insurance companies will be prohibited from discriminating against or denying coverage altogether to the millions of Americans with pre-existing conditions such as asthma, diabetes or heart disease. This will ensure that they have access to the health insurance they need to manage their conditions and stay healthy.
One of the key provisions upheld in the ruling was the requirement that individuals who can afford health insurance, but choose to let others bear the burden of their health care costs, be assessed a penalty. The Supreme Court rejected the argument that the individual responsibility requirement was constitutional under the “Commerce Clause,” finding instead that this “free rider” penalty is constitutional. However, the Court found that the individual responsibility requirement was not prohibited by the Anti-Injunction Act, which would have prevented the Court from ruling on the constitutionality of this penalty until after it had been applied.
Health insurance is a shared responsibility among individuals, employers and the federal government. Individuals will be responsible for purchasing health insurance, employers will be responsible for providing health insurance and the federal government will ensure that all Americans can afford health insurance. The requirement to purchase health insurance takes effect in 2014 and individuals will only be penalized if they have access to affordable health insurance, but instead choose not to obtain it. The average Pennsylvania family pays an additional $900 per year in health insurance premiums to cover the health care costs incurred by uninsured individuals, and the modest penalties in the Affordable Care Act will help encourage people to enroll in health insurance. About 99 percent of Americans would either be exempt from the requirement to purchase health insurance — because they have employer-sponsored coverage or public health insurance, or because they are low-income — or they would be given subsidies in the form of a premium assistance tax credit to help them purchase affordable health insurance through the new health insurance exchanges.
Section 1312 of the Patient Protection and Affordable Care Act expressly prohibits noncitizens from participating in health plans sold in the health insurance exchanges that will be established in 2014. Since these individuals will be prohibited from purchasing health insurance through the exchanges, they will also be unable to apply for or receive the premium assistance tax credits that will be available to low-income individuals. On the other hand, Members of Congress who choose to enroll in the health insurance offered to federal employees will be required to select one of the plans offered through the exchanges; they are not excluded from the requirements of the Affordable Care Act.
The Affordable Care Act also included language that I helped to strengthen during the Senate debate on the bill, which creates a religious exemption to the individual responsibility requirements. My amendment clarified the religious conscience exception in the law so that members of a recognized religious sect with tenets that reject insurance would be exempt from the insurance mandate. The amendment expanded the definition to include self-employed individuals, employees of employers who qualify for the exemption, and employers of employees who qualify for the exemption. This would apply to groups such as the Amish and members of health care sharing ministries.
I do not support efforts to repeal or defund the Affordable Care Act, and I oppose any efforts to do so. While I respect the many people who remain opposed to the Affordable Care Act, after many months I spent working on this issue and talking both to Pennsylvanians who supported the law and those who opposed it, I concluded that the cost of doing nothing was too high for too many working families. I believe this legislation will provide families with security and peace of mind, knowing that they will have access to the health care they need. At the same time, I recognize that the Affordable Care Act is not perfect and that more work remains to be done; I am open to reasonable proposals to improve the Affordable Care Act, and I believe that Democrats and Republicans must commit to working together to continue to improve the law.
Again, thank you for sharing your thoughts with me. Please do not hesitate to contact me in the future about this or any other matter of importance to you.
For more information on this or other issues, I encourage you to visit my website, http://casey.senate.gov. I hope you will find this online office a comprehensive resource to stay up-to-date on my work in Washington, request assistance from my office or share with me your thoughts on the issues that matter most to you and to Pennsylvania.
United States Senator
P.S. If you would like to respond to this message, please use the contact form on my website: http://casey.senate.gov/contact/