This blog post is written by Megan Farwell, Public Policy Researcher and Analyst, United Way of King County

On Monday, March 26, the United States Supreme Court began hearing oral arguments regarding the Patient Protection and Affordable Care Act (ACA), commonly known as health care reform. The ACA will expand Medicaid coverage to tens of millions of low-income Americans, many of whom currently do not qualify for subsidized coverage or whose risk factors make health insurance unaffordable.  A number of legal aspects of ACA are under consideration, but the primary issue before the justices is the constitutionality of the individual mandate, which requires people to purchase health insurance coverage or face a penalty. A ruling isn’t expected until June, but Washington, whose Attorney General is one of the 26 plaintiffs in the case, continues to lay the groundwork for ACA’s implementation, starting with passage of the health insurance exchange bill.

The health insurance “exchange” bill, which Governor Gregoire signed into law on the same day as the Supreme Court hearings, establishes a forum for consumers to choose between a standard set of health policies offered by private insurers. The bill is intended to introduce benefits standards, helping to ensure more equal access to basic care. Critics of the measure, however, argue that it will force some private insurers out of the state and should not go beyond the minimum requirements of ACA – especially when the constitutionality of health care reform is still in question. Even if health care reform is overturned at the federal level, Sen. Karen Keiser, Chair of the Senate Health and Long-Term Care committee, says Washington’s health exchange bill will remain in place.

Regardless of the Supreme Court’s decision, Washington’s health care system faces significant changes in the coming years, including rising costs of care and a new coverage infrastructure. However, these changes will be most impactful for low-income populations whose access to health care is already tenuous: Basic Health – which provides coverage to those individuals at or below 200% of the Federal Poverty Line – has a wait list of more than 150,000, and Medical Care Services and Housing and Essential Needs (previously known as Disability Lifeline) – which provides health care and limited housing assistance to some individuals with short-term disabilities – is once again slated for elimination in the current budget talks. Both of these programs are a critical part of our state’s safety net, and their service populations will be covered in 2014 under ACA’s Medicaid expansion.