starting in 2014 the aca expands medicaid to cover nearly all people under age 65 with household incomes at or below 133 of the federal poverty level one patient tried to commit suicide in the past and pays in full for every therapy session i cajole him into attending june 27 2012151 washington and a split decision is indeed likely said randy wexler md mph of ohio state university in columbus another patient had a breast lump so large and irregular we barely needed a tissue sample to diagnose her cancer and she noted everybody knows people without insurance susan dorr goold md professor of internal medicine and health management and policy who is also at the university of michigan in ann arbor said she hopes the court upholds the law in its entirety reimbursement is already going down the payforvalue pathway and that is not going to change he added but he noted it should also be understood that even if the law is struck down many changes we have already seen will continue to evolve including payforperformance models and accountable care organizations read this story on wwwmedpagetodaycom the woman asked why she should be required to have insurance when she and her family are healthy and dont run to the doctor for every little thing unless were willing to let her and her children die on the street and i for one am not we need some kind of system that requires that mandates that people who can do so contribute to the possible future expense of their care the court is expected to issue its decision or decisions on the law thursday in a session that begins at 10 am some people lack insurance because they work parttime care for children or elderly parents lost a job or ironically because their illness impairs their ability to work america cant afford anything less he said in an email to medpage today and abc news anything less than an allornone ruling would create even more chaos in an already chaotic system wexler wrote in an email to medpage today and abc news lee green md mph a family medicine professor at the university of michigan in ann arbor also hopes the court upholds the law because as a primary care physician i regularly care for patients whose health suffers from lack of insurance she said in an email to medpage today and abc news she waited until she qualified for medicare to see a doctor the aca is only a baby step in the direction we need to go to start getting the healthcare crisis and healthcare costs under control aside from deciding whether the laws individual mandate that everyone have insurance is constitutional and whether it can be severed from the rest of the law the supreme court also will decide whether the laws expansion of medicaid is constitutional that will create chaos he said which is something other healthcare experts have also