What the Supreme Court ruling means to you

June 29, 2012 Ryan Schuster

Thursday's announcement of the Supreme Court ruling to uphold the Affordable Care Act (ACA) health care reform law was historic. The impact of the decision is still rippling through the health care industry and leading to pointed reactions from politicians on both sides of the issue.

But what does all this mean to you?

The Supreme Court's decision means that the core provisions in the law, some of which are already in effect, will continue.  Parts of the law could be changed by Congress in the future. Some politicians have pledged to overturn the entire law. But for now, the ACA is the law of the land. The Supreme Court decision does not change the course Blue Cross Blue Shield of North Dakota (BCBSND) has taken since the law was first signed into law in 2010 — to drive toward North Dakota solutions to providing members affordable care. We have planned for the changes the law mandates from health insurance companies  and will continue to comply with the law (some provisions such as allowing young adults to stay on their parents' insurance until age 26 have already been implemented).

Here is video of BCBSND President and CEO Paul von Ebers talking about the ACA and the Supreme Court's decision during a press conference in Bismarck on Thursday.

The law will extend coverage to about 30 million who were uninsured, covering as many as 90 percent of the U.S. population. That would decrease the number of uninsured people in North Dakota (which was estimated at about 83,000 in 2010). Insurance companies will also be barred from dropping or denying people coverage based on how healthy they are. The insurance industry will also be taxed to help pay for some of the reforms in ACA (it has been estimated that the tax would cost our members an additional $65 per year for an individual plan and an extra $200 a year for a family plan). We know this kind of increase could be difficult for many of our members, which is why BCBSND would like to see this portion of the law removed and it be replaced by an alternative funding mechanism.

Here is a breakdown of some of the key provisions in the law and a timeline for their implementation:

ALREADY IN EFFECT (already implemented by BCBSND)

  • Young adults can stay on their parents' health insurance until age 26 (BCBSND implemented in 2010)
  • Children with pre-existing medical conditions can no longer be denied or be required to wait to receive coverage (BCBSND implemented in 2010)
  • Insurance companies prohibited from dropping existing members who get sick, except if fraud is involved (BCBSND had not been doing this before ACA was passed and still doesn't do it)
  • If they fail to spend less than 80 to 85 percent of member premium dollars on medical care, insurers are required to give members rebates (BCBSND is in compliance, beating the federal requirements by a health margin and was not required to give rebates)


  • Insurers will not be able to deny coverage to those with pre-existing medical conditions starting in 2014
  • Most Americans will be required to carry health insurance starting in 2014 or pay a tax. This is a highly-charged political issue, but the Urban Institute has estimated that only about 6 percent of the U.S. population would be required to purchase insurance, as the rest either already has the coverage or would be covered through Medicaid.
  • Health insurance exchanges will start in each state, allowing small businesses and individuals to comparison shop for coverage in an online marketplace.
  • Companies with 50 or more employees who do not offer health insurance would be subject to federal fees for full time employees who qualify for federal subsidies to help them afford insurance on an exchange.

As always, we are listening to our members and are here to answer any questions you may have. Check back to our blog, visit our Facebook page and find out more about the health reform law on our website. Let us know what you think.