NFIB vs. The Affordable Care Act The Affordable Care Act brought to the Supreme Court by 26 states of the United States to determine its constitutionality, was confirmed by the courts as was expected by many people. The case was between National Federations of Independent Business v. Sebelius (NFIB). The Supreme Court upheld the ACA and its expansion in a fragmented and complicated opinion that saw it also limit the ability of the federal government to hold back federal Medicaid funds unless states accept and comply with the ACA Medicaid requirements for expansion. The expansion requirements include non-pregnant women below the age of 65 with income that falls below 133% of the poverty levels determined by The Federal Government (FPL) for eligibility for Medicaid benefits (Swendiman and Baumrucker 2012). This is provided for in Section 2001 of Title II of ACA, which came into effect on January 1st 2014.

In the ruling by the Supreme Court, it was found that forcing the states to comply with, or even participate in the Medicaid expansion with a treat of withholding federal funds, if such states failed to comply, was coercive and thus unconstitutional as per the United States Constitution and the Tenth Amendment; it says that Congress may make use of its spending power to give incentives to the states that comply with federal policies. However, when such pressure becomes forceful, such legislation runs contrary to the principles of federalism. The Supreme Court declared that the solution to the violation of the constitution at the moment was to restrict the enforcement of ACA Medicaid Expansion program to the aspect of withholding the matching funds from the federal government meant for newly eligible people under ACA Medicaid plan. In Actual sense three Judges, namely Justices Breyer, Kagan, and Chief Justice Roberts would have declared the Medicaid expansion program requirements as unconstitutional, but that there is a constitutional violation by virtue of the threats to the states through the proposal to withhold Medicaid funds if they do not comply with the expansion requirements. Two Justices, i.e. Sotomayor and Ginsburg declared that the expansion program was wholly constitutional. Four Justices; Justices Scalia, Kennedy, Thomas, and Alito in their dissent remarks would have struck down the expansion program (Swendiman and Baumrucker, 2012). Finally, though, the dissenting justices concurred with Chief Justice Roberts that the threat to withhold federal funding for the program was coercive and unconstitutional. This provided the required majority of 7 justices to seal the verdict on the case. Another set of five justices agreed with the chief justice in his declaration to strike out only the provision that calls for withholding Medicaid matching funds for failure to comply.

Reflect Class/Race/Gender

The Medicaid program was established in 1979. It is meant to assist all needy people including pregnant women, children the handicapped and elderly people to obtain medical care. States are required to comply with the set federal criterion that governs matters such as the particular persons eligible to the funds and the cost of their treatment. All states had decided to take part in Medicaid by 1982. The federal funds received from the federal government for the purpose of Medicaid programs have become a significant portion of the budgets that states make. Indeed, the Medicaid funds constitute 10% or slightly higher for most state budgets. The current Affordable Care Act expands the scale of the program under Medicaid and has increased the number of persons that the states need to include in their medical cover (National Federation of Independent Business V. Sebelius, Secretary of Health and Human Services).

One of the challenges in the new program is the requirement for states to extend their medical cover to adults with incomes below 133% of the poverty level provided. Several states only cover adults with children if their income is considerably low. Many of these states do not extend the cover to adults without children. The new Act has increased the funds availed to states to cover for their expanded medical program; even if the states foot part of the bill. The act points out that if states do not comply with these new requirements, they will not only lose matching funding for the expansion program but the whole Medicaid federal funding. Congress addressed the issue of people who cannot access insurance cover owing to the conditions that existed earlier or other issues related to health. The Congress addressed the matter through the "guaranteed issue' and the community rating provisos. These policies prohibit insurance firms from denying cover to those with the mentioned conditions or imposing higher premiums on unhealthy people. The "community rating' and "guaranteed issue " provisos do not address healthy individuals who do not purchase...

Sebelius, Secretary of Health and Human Services).
In actual sense, the reforms seem to aggravate the problem by giving incentives to persons to delay in purchasing health insurance cover until the point they fall ill, even as they rely on the promise by the federal administration to provide guaranteed and affordable coverage.

The reforms may also impose large insurance costs in insurance firms because they are required to accept people with health issues at hand; yet restricted from charging them extra premiums required to cover their health insurance. The scenario may lead to the insurance firms increasing cover cost for everyone.

Affordable Care Act into Democracy/Privatization in United States

The legislative body should relook at their role in implementing expanded health insurance for the next couple of years (looking beyond responding to PPACA). PPACA adoption comes with the need for the legislature to expand the patchwork programs of the state. It is our belief that the states should take into consideration the following issues that arise (The Patient Protection and Affordable Care Act: An Overview of Its Potential Impact on State Health Programs):

Consider and address the health care costs for the future by

i. Increasing the receipt of funds from the federal government

ii. Bargaining with the purchase power of the states iii. Bringing down the cost of cover for individuals with a high cost health care.

Structural Modifications to State Packages are indispensable. It is also our belief the PPACA presents an excellent opportunity for the legislative body to look again at the global structure of state health programs.

The PPACA ought to Prompt a Reassessment of the State and Local Association

. The interactions between state programs and government should facilitate the administration to reexamine the local and state relationships as fragment of the deliberations focused towards the PPACA execution.

Novel Approaches ought to Bolster Healthcare Quality and Results.

There are no drastic changes that are brought to the healthcare system by PPACA. The body avails funds, and in the form of grants, presents opportunities for projects to help states in solving problems gradually.

Health Infrastructure Needs and Prospective Workforce Ought to Be Evaluated.

There is a good chance that the expanded options for coverage by PPACA will stir an increase in requirement for health service across the states. The success of the PPACA program will rely on the response of the state to access such issues as work force, the capacity of infrastructure and the variation of the availability of health services. The states get their federal rebates from drug manufacturers and exchange it for allowing products from such companies to be availed to the beneficiaries of the program. Some states such as California negotiate additional rebates commonly referred to state supplement rebates. PPACA has changed the federal rebate rules in two significant ways;

i) By raising the minimum amount of the federal rebates payable to the states from the drug manufacturers as from the 1st of January 2010.

ii) It allows states to collect federal rebates from managed care institutions giving care to beneficiaries in the Medicaid program as of 23rd march 2010 (The Patient Protection and Affordable Care Act: An Overview of Its Potential Impact on State Health Programs).

Federal law calls for 100% refund of additional funds provided under the minimum federal rebates. However, the new law allows states to establish the exchange of leaving it to the federal government to implement the same. If the state establishes the exchange, it may choose to operate it directly via a department of the state or delegate the work to a nonprofit agency. It may even establish several exchanges in the state or join hands with other states in the creation of the exchange.

Relevance to the Nuns

Nuns normally do not have children. Medically speaking, women who do not have children experience a higher number of menstrual cycles compared to the ones with children. The occurrence of more cycles portends a higher risk of cancer. The authors of the study that came up with these findings stated that almost 95-000 nuns worldwide pay a heavy price for chastity. These women face a greater risk of developing cancer of the ovary, breast and uterus (Jaslow, 2011). If the catholic fraternity availed the oral conceptive pill available for free to all nuns it would bring down the risk of such occurrences and…