Mary P. Kivlighan, J.D., M.A.P.A.

1. The Patient Protection and Affordability Act (ACA): Legal Challenges and Lessons Learned To Sustain Health Care Reform Mary P. Kivlighan, J.D., M.A.P.A.

2. Overarching goal • Provide access to health care for all; and • Eliminate health disparities

3. In sum… • The ACA closes a gap in access to quality health care using powers granted to the Congress through the U.S. Constitution to regulate the health care markets. • Legally, this creates tension between State’s rights and the federal government.

4. Four dimensions of the ACA • Policy • Political • Legal • Public Health* *Lawrence Gostin, 2012

5. The Public Health Dimension • Organizational reforms • Funding • Insurance • Infrastructure

6. The Legal Dimension • Anti Injunction Act • Individual Mandate • Severability • Medicaid Expansion

7. Anti Injunction Act • What is this? • How does this implicate the Affordable Care Act?

8. The Individual Mandate • Commerce clause • Necessary and Proper clause • Tax and spending powers

9. Severability of the Individual Mandate Guarantee-issues, community rating and individual mandate The issues: 1. Have these provisions been legitimately enacted? 2. Are these closely allied?

10. Medicaid expansion provision Argument before the court • Is the voluntary nature genuine or is it coercive? • Does coercion matter?

11. Lessons Learned Sustain the support and imagination of stakeholders through: Extension Academic partners Grassroots coalitions Evidence based policy

12. Design infrastructure that engages these stakeholders Stakeholder commissions and council: • Health Benefit Exchanges • Health Information Exchanges • Accountable Care Organization (ACO)

13. The Public Health Dimension • Organizational reforms • Funding • Insurance • Infrastructure