Supreme Court Hears Case Against the Affordable Care Act

The dust is still settling inside the Supreme Court. With all arguments now present before the nine justices in the case against the Affordable Care Act, pejoratively dubbed Obamacare by its opponents, and with still so many railing against it, including the activist conservative judges currently sitting on the Court, and a near-equal chorus in and out of Washington, it bears a moment to step back and look at where things now stand.

With so much media focus on the Affordable Care Act, there are still wide misperceptions of what exactly the law will do. Many of these misconceptions center around a simple premise: “I don’t want to pay for someone else’s health insurance.” Think of Rush Limbaugh’s vitriolic attack on a Georgetown law student two weeks ago, ignorantly claiming this woman a “slut” because she wants the university to pay for her contraception since they mandate that she purchase health insurance through the school. Limbaugh displayed a complete and total lack of understanding of how contraception works, as well as how insurance companies under the Affordable Care Act are supposed to cover these basic medical needs. And it stands to reason this ignorance extends to his listeners’ understanding of the implementation of the individual mandate in the Affordable Care Act, whether intended by Limbaugh and other opponents of the ACA or otherwise.

It is the individual mandate at the heart of the case heard before the Supreme Court. The mandate is that every individual would be forced to get insurance, and if the government is justified in compelling an individual to purchase health insurance, what is the ‘limiting principle’ stopping the government from compelling people to buy broccoli, GM cars, or something else. Those who brought the suit against the Department of Health and Human Services argue that compulsion by the government violates individual freedom and is thus unconstitutional. The government argues that this mandate is non-compulsory because every individual gets sick and is in essence already a participant in the health insurance industry and cannot be compelled to join a group they are inherently a part, and that by the powers vested in the Commerce Clause of the Constitution, Congress has a right to regulate this industry and those participants therein.

That’s the arguments for both sides in a nutshell, but it doesn’t necessarily address the premise that one person is paying for another’s health insurance, i.e. the well-off are subsidizing the poor. This, sadly, is a simple talking-point hounded and harped by those opposed to the bill, and is grounded with no factual basis. The truth is no one is paying for another’s health insurance under the law. The individual mandate forces the person without health insurance to purchase insurance from a private supplier. So, in essence, this is assisting the free market. If the person fails to purchase health insurance, the government retrieves a fee from them off their yearly tax return. Here’s the kicker in all this: without the law, you, me, and everyone else are already paying for other people’s health insurance. When someone without health insurance walks into an emergency room, those visits are paid by other taxes. The government spends over $100 billion per year to cover the uninsured. The additional revenue of mandating all individuals to have some form of health insurance far outweighs these costs.



So how did these arguments go over in the Court? Mostly in accordance with pregame analysis. Conservative judges hit hard against the bill. The Liberal Justices hit back hard against the States. There were moments of trepidation on Day Two of the hearings when Donald Verilli nearly collapsed beneath the pressure of arguing before the Court and many reporters in the room thought for sure the bill would be struck down that very day. Luckily, the Liberal Justices were there to bail Verilli out, and he gathered himself up for the third day of arguments and delivered a more forceful defense of the law. But the Court is tilted in Conservative favor and it seems likely the bill rests on the pen of Justice Kennedy alone. To paraphrase a Robert Reich tweet: how is it democracy when the fate of 30 million people’s health insurance rests in one man’s hands? But it’s not completely lost for the individual mandate, nor health care reform overall. Even if the individual mandate was struck down, many analysts believe most or all of the rest of the bill can stand. Then again, many think the Affordable Care Act hinges directly on the individual mandate and that if the mandate goes, the entire law crumbles after. Would this spell complete doom for President Obama, to repeal his signature social legislation before the 2012 election? Hardly. Thousands, if not millions, of Americans have already benefitted from aspects of the law that have gone into effect, from college graduates having the ability to stay on their parents’ insurance until age 26, to millions of Americans now with access to coverage because insurance companies can no longer deny someone with a pre-existing condition, to many other benefits. More and more Americans are beginning to understand that this bill serves to help, not to hinder. Also, if health reform should fall, many do not think the private insurance industry could last. It would almost certainly open the door to a single-payer system, or Medicare for everybody, and that’s a win for us all.

White House Releases Affordable Care Act Accomplishments

From a study released today from the White House regarding the Affordable Care Act:

Health reform is already making a difference. Thanks to the Affordable Care Act:

•2.5 million more young adults have health insurance on their parent’s plan.

•In 2010 and 2011, over 5.1 million seniors and people with disabilities on Medicare have saved over $3.1 billion on prescription drugs. These savings include a one-time $250 rebate check to seniors who hit the "donut hole" coverage gap in 2010, and a 50 percent discount on brand-name drugs in the donut hole in 2011. And everyone with Medicare can get key preventive services like mammograms and other cancer screening tests for free.

•Insurance companies can no longer drop your coverage when you get sick because of a mistake on your application, put a lifetime cap on the dollar amount of coverage you can receive or raise your premiums with no accountability.

•Insurance companies can no longer deny coverage to children because of a pre-existing condition. And in 2014, discriminating against anyone with a pre-existing condition will be prohibited.
Even as some Republicans refuse to except the basic accomplishments of the law, the White House is adament to show how important this law has become for many Americans. You can read the rest of the study here.

Thoughts on Health Reform

Last week, the House passed H.R. 4872, the highly contested Health Insurance reform bill the country desperately needs. The provisions within the bill should help millions of Americans either already insured, or those uninsured combat the abuses and out of control insurance rate increases of the current health care system. Many of the projections for what the bill will do are not set in stone. They rely heavily on a step-by-step implementation process to curb the rising costs and increasing population of those who daily become uninsured. I will admit that some things may not align accordingly with all the projections set forth by the administration or economists, and future fixes are still needed, but this legislation, no matter how inchoate you may think it is, was a necessity. Reactions to the bill have been varied, ranging from the left's now complete crush on Obama (regardless of how he handles job creation and banking reform) to the despicable, unapologetic, and violent rhetoric and actions of the Tea Party movement. Perusing the blogosphere, I've come across some interesting arguments for why exactly this bill is so bad for our country, and will take this opportunity to offer counter arguments.

1. Health Care reform was not necessary.
The simplest of argument against the passage of the bill is plainly just ill-informed, or blind to the facts. Since 1980, the cost of health care, based on GDP, has nearly doubled. Over the next two decades (which would be right around the time my generation is reaching the critical age of 50), without reform the amount of money spent by the average American on health care would be right around 30% of their income. Imagine trying to save for retirement all the while dealing with some chronic, life-threatening illness and paying monthly, or even weekly, for prescription medication (which would of course be more expensive than it is today). Reform was something that could wait no longer. A Republican controlled House, Senate, and President did nothing to steer the industry from the precipice. The runaway train was hurtled at the Democratic party, who successfully laid their body out over the broken rails.

2. Now my premiums are going to go up.
This has been a humorous argument to see come up. In case you haven't been listening, insurance premiums were already rising at an astronomical level, far out-pacing inflation. Just weeks ago, some companies were reported to raise rates on individuals up to 39%, and on small businesses up to 75%! The Health Insurance reform looks to curb these arbitrary rate hikes by adding more people, and more competition into the market. Personally, I feel having some regulations in place so that insurance companies cannot raise rates without warning, or viable excuses, or denying coverage altogether is a plausible position. Liken this to the repeal of the Glass-Steagall Act of 1933. Repealing Glass-Steagall in 1999 deregulated Wall Street and set us up for the Great Recession, allowing the financial giants to take risky bets for the possibility or enormous profits (They lost...). Millions of people are up-in-arms over arbitrary credit card rate increases, but many of these same people are against insurance regulation. Are you kidding me? No regulation on Wall Street was disastrous. The same can be said about "Health Street." Yes, premiums will continue to rise (at a far less inflated rate than previously), but legislation was set in place so that even though you may pay a little more in premiums your total personal health care costs ultimately go down (as well as the government's, reducing the federal deficit). That's an important distinction to make.

3. Forcing 32 million Americans to have health insurance is just a big gift to the insurance industry.
Strictly speaking, this seems like a no-brainer argument from the left. Yes, adding 32 million more people as customers to the insurance corporations numbers looks like it would undoubtedly raise their revenue stream, quite substantially too. But this complex system doesn't mean at all the insurance giants' profits will soar. Look at the numerous examples brought to national attention by the media of everyday Americans who after learning they were sick, spent months in the doctor's office, racking up hundreds of thousands in bills, thinking all the while their visits and treatments were covered, only to learn their insurance company will in fact not pay for treatment because the corporation either found some loophole to establish a preexisting condition, or the person reached their coverage limit and they were dropped. All over the country this was happening leading to the record profits the health care companies garnered in 2009, despite the recession. Under the new laws, this no longer happens. Which means that yes, they have more customers and more revenue generating into the system, but they are now required to cover all treatments, no matter the cost; they cannot arbitrarily drop coverage, and the coverage limits are no longer viable. Most likely, these changes will off-set any projections for insurmountable profits by the insurance companies without damaging the companies' bottom-line.

4. No abortion coverage for women?
Liberals are especially angry over this one with the President. And it's not even his fault. Of course he wanted the measures in the bill to include coverage for abortions, but it was the House wrangling that ultimately defeated any abortion coverage. The House passed the legislation with 220 votes, just 4 more than the needed 216. To get those votes, the House needed 12 votes from conservative Democrats called the "Stupak 12." The "12" threatened to vote against the Senate bill if there was any language preserving federal dollars for abortions. So, the President did what needed to be done; he signed an executive order. This tallied the final votes needed for passage. As Bill Clinton said during his own fight for Health Care reform, "Do not let the perfect be the enemy of the good." Overall, the bill was needed. Not every provision could be included (see Public Option, also), but ultimately we've moved forward. Now, if you're angry about the abortion part: first, stop blaming the President. If it wasn't obvious, he wasn't happy about having to sign an executive order. Case and point: the totally unceremonious signing of said order the day after the bill passed the House. No cameras, no media allowed. Also, an executive order can be repealed by...an executive order. That simple. Further, if you want to see abortion rights progress in this country, go volunteer. Work to ensure Representatives like Bart Stupak are not reelected and replaced by more Pro-Choice Reps.

5. We have to wait until 2014 before so many provisions are enacted??
Yes. Part of the entire debate centered on the bill was the threat it would plummet our national deficit into unsustainable, and irreversible levels. "This bill will bankrupt us!" was the cry. As I mentioned in the introduction, the bill was written as a step-by-step implementation. First, the initial provisions occur to keep people insured: tax credits, the beginning of closing the 'donut hole' in Medicare, restrictions on denying coverage to children, or those with preexisting conditions, and dropping people arbitrarily. All these work to keep the amount of people already insured, insured, instead of having over 1400 people per day lose their insurance, as was the numbers prior to passage. Eventually this builds towards insurance for all. To cover 32 million extra Americans the government would have needed incredible capital to do that immediately (and in case you didn't know, we have a bit of a debt problem right about now). The only way to raise that kind of money quickly: taxes. And we all know how the majority feels about those. So enacting every provision immediately just was not fiscally possible, or responsible.
Furthermore, to contend that waiting until 2014 for these other provisions to kick in means John or Jane Doe, already on death's bed, will not see any benefits from the legislation is a terrible argument against any health reform. Would you rather we wait another 16 years before a Democratic majority attempts health care reform again? Would you rather not have the reformation process begin now so that Chris, or Sue, or Rosana, or anybody else who in the next 3 1/2 years will be diagnosed with some malicious, but curable disease, who without health care reform starting now, they would not have the coverage they need at that time to survive? It will happen, and most likely to someone you know. Now they have a far greater chance of survival and it boils down to simply giving people the coverage. This should have been done when Pres. Clinton was in office, and it hurts me to think of all those who suffered and ultimately died because reform was not achieved back then. But the past is gone, that bleak horizon of darkness. And standing here in the present as I am, the future, to me, just got a hell of a lot brighter.