Advocates turn to bolstering ACA, pressuring Medicaid expansion holdouts after SCOTUS win

A signpost with the words Affordable Care Act
Advocacy groups believe the Supreme Court's 7-2 decision to uphold the Affordable Care Act gives them a key tool to pressure states to expand Medicaid. (Getty/kroach)(Credit: Getty/kroach)

Several advocacy groups signaled renewed efforts to bolster the Affordable Care Act (ACA) after the Supreme Court decided to preserve the law Thursday.

Groups said the ruling should embolden lawmakers to make permanent temporary enhanced subsidies in the American Rescue Plan Act and to pressure holdout states that have not expanded Medicaid.

“This ruling should put to rest the baseless, relentless attacks on the ACA, which has been a tremendous and unequivocal success,” said Kristin Rowe-Finkbeiner, executive director and CEO of advocacy group MomsRising, in a statement Thursday.

A collection of 34 patient advocacy groups also said in a joint letter that the ruling helps give patients certainty about protections they receive from the ACA. It also called for lawmakers and the Biden administration to do more to "promote access to high-quality insurance now and for generations to come."

The Supreme Court ruled 7-2 that a collection of red states did not have standing to bring a challenge to the ACA, defeating another effort to strike down the law completely.

Several advocacy groups renewed calls for Congress to make permanent enhanced subsidies that are set to expire after 2022. The enhanced income-based tax credits, which expand eligibility for the credits, were passed as part of the American Rescue Plan Act. A separate infrastructure package touted by the White House would make the credits permanent, but it remains unclear whether that provision will make it through Congress.

“It’s time for President Biden and Congress to finish the job they began more than a decade ago and pass an American Family Plan that guarantees everyone, no matter who they are or where they live, affordable, high-quality health care,” said Frederick Isasi, executive director of the advocacy group Families USA.

Isasi elaborated in a call with reporters Thursday that the ruling will put pressure on the 12 states that have not expanded Medicaid under the ACA.

“The pressure is only going to mount. It is not going anywhere,” he said. “The pressure is going to mount higher and higher on them.”

The group is pushing for additional support from Congress to convince the holdout states to expand.

RELATED: Missouri pulls application to expand Medicaid after state declines to fund it

The American Rescue Plan Act did increase the federal Medicaid matching rate by 5% for any new states, and, so far, it has yet to get any takers.

“Whatever fig leaf this misguided lawsuit offered among states that have not adopted Medicaid expansion is gone,” said Eliot Fishman, senior director of health policy for Families USA, on the call.

One legal expert said the ruling does take away an excuse that holdout states may have used.

“Sometimes state politicians say they can’t move forward with Medicaid expansion because [they] don’t know what will happen,” said Nicole Huberfeld, a law professor with Boston University’s School of Public Health, in an interview with Fierce Healthcare.

But Huberfeld cautioned that it is a “little unpredictable” to see how potent of a tool the ruling will be on holdout states.

She referenced states declining to expand even though they got a 5% bump in federal matching payments.

“I think this is the big question mark right now,” she added.