By Paul Nathanson

In general, June 28, 2012, was a good day for older Americans. Because of the Supreme Court ruling on the Affordable Care Act (ACA), improvements in the Medicare program remain in place and nearly half of the 8.6 million Americans ages 50 to 64 who currently lack health insurance will gain access to care through subsidized coverage in the insurance exchanges. Unfortunately, the court’s decision on Medicaid expansion threatens the future care of 3.3 million low-income people ages 50 to 64.

The Big Positives

Because the court upheld the ACA, low-income older adults across the country will maintain access to preventive health services such as annual wellness visits that the law established under Medicare. Also, because of health reform, Medicare will continue to fully cover preventive screening procedures for older women such as mammograms, pap smears and bone mass measurements. And, coverage for diabetes, HIV and obesity screenings will be available for everyone with Medicare.

The law’s phasing out of the so-called donut hole has already saved 5 million elders and people with disabilities $3.2 billion. And, the preservation of the ban on using pre-existing conditions to deny health coverage will help many younger elders enter Medicare in a far healthier state because they will have had access to healthcare. In addition, adult children ages 26 or younger can remain on their parents’ health insurance plan, relieving another burden on older adults.

For elders with limited English proficiency, the court’s decision retains new important requirements that help ensure services are delivered in a culturally and linguistically appropriate manner. Also, low-income older adults in need of long-term services and supports will find that they have more opportunities to avoid nursing home care and receive care at home and in the community.

Limited Medicaid Expansion

But the day was not all that bright for many younger, uninsured elders. The court introduced a limit to the law’s expansion of the Medicaid program for those who live at or above the poverty level. Originally, the law required states to expand access to their Medicaid program to more uninsured individuals or lose all  federal support they receive for the program. While the court upheld the expansion, it limited the federal government’s ability to sanction the states that do not comply, ruling that states will not face a financial penalty if they decide not to cover more low-income people.

The law requires the federal government to pay 100 percent of the Medicaid expansion for the first three years, and 90 percent thereafter. However, some state governors have already said they will not expand Medicaid, leaving a lot of money on the table and millions of their state’s poorest citizens without health coverage.

It is unclear how the ruling on Medi-caid will affect other shared federal and state social programs. One fear had been that such a decision would embolden opponents of safety net programs, such as food stamps, to challenge their legality. However, the justices were careful to say that this part of the decision only applied to this new Medicaid expansion, which may limit the viability of future legal challenges to other programs.

Regardless of whether there is future litigation, advocates for older Americans must pressure state legislatures and governors to take up the federal government’s offer to fund the Medicaid expansion. The ACA offers states a tremendous opportunity to provide access to healthcare to the poorest of the poor, including younger elders who do not yet quality for Medicare, but desperately need healthcare.

Paul Nathanson is executive director of the National Senior Citizens Law Center in Washington, D.C., a member of the Aging Today Editorial Advisory Committee and a frequent contributor.

Editor’s Note: This article appears in the September/October 2012, issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.