The Justices of the US Supreme Court sit

The Supreme Court Took Up The Health Care Bill And I Am Worried

I have a crush on the Supreme Court, and yesterday, they finished listening to an unprecedented 3 days of arguments about the constitutionality of the Affordable Health Care Act. I shouldn’t be having this much fun when I’m this worried.

The Justices of the US Supreme Court sit
I could totally hang with them. I look great in black.

The days have been divided up into 3 basic questions based on appeals court ruling throughout the United States:

Day 1: Can the court rule on the constitutionality of mandating health insurance with penalties for those who opt out when the penalties have not gone into effect yet?

This day was a debate over a tax law from the 1800s, which states a tax cannot be ruled on after the defendant has paid it. No one will pay the penalty for not carrying health care until April 2014. The court had to hire a 3rd attorney to argue for the tax law and against the court ruling on this issue in 2012 because both sides believed the court had a right to rule. It seems unlikely that this argument will stop the court from ruling. (Great rundown from PBS on Day 1)

Day 2: Can the federal government require eligible Americans to purchase health care insurance or pay a penalty?

The mandate goes into effect on January 1, 2014 and those who do not buy health insurance are penalized on their income tax return either $750 or 2% of their income, which ever is lower. The question is whether the government can force people to buy a commercial product because health care is a unique product in that everyone uses it and those who are uninsured cost more for everyone else. (This is the meat of the 3-day hearing so check our PBS’s summary of the players and the arguments.)

Day 3: If the mandate to buy health care is overturned, is the entire bill be overturned or just that part?

This day seemed to imply that if the mandate to buy health insurance is overturned, the entire bill including the provision that requires insurance companies to accept people with pre-existing conditions. The problem is without a mandate for healthy people to buy insurance, insurers worry people would just wait until they are sick to buy insurance, which would run the companies out of business. (NPR’s cheat sheet for Day 3)

The ruling will not be given until June, but I already am nervous. Not because I think the mandate is too far-reaching or intrusive since everyone participates in health care and the health care system as well as the belief that health care is a right, not a privilege of the wealthy.

I’m worried because this is such a conservative court. A court whose conservative members thought it was okay to rule that the 180-day statute of limitations for filing an equal-pay lawsuit was the intent of the law even if an employee had worked for 30 years before learning of the gender- or race-based pay disparity; thus, forcing Congress to enact the Lilly Ledbetter Fair Pay Act to protect employees from discriminatory income inequality allowing the statue to reset after each paycheck.

With so much argument and spin going on, let us not forget all the good the Affordable Health Care Act brings (reprinted from my March 2010 blog post after H.R. 3590 passed):*

  • Children will not be denied for pre-existing conditions effective within 6 months of enactment.  And by 2014, no one will denied for a pre-existing condition (My two cents: so N would have been put on our insurance at any time with NO PROBLEM.)
  • Prohibition against health insurance companies from dropping people from coverage when they get sick within six months of enactment
  • Prohibition against health insurance companies from placing lifetime caps on coverage within six months after enactment
  • Prohibition against health insurance companies requiring prior approval for patients to see gynecologists or visit the emergency room
  • 32 million uninsured persons will be covered persons by 2019, a 59 percent reduction in the number of uninsured
  • Dependent coverage will be provided for children up to age 26 under all individual and group policies (My two cents: My kids can live with me FOREVER… Oh wait…)
  • Increased funding for the National Health Service Corps and the nation’s community health centers
  • Medicare Part D coverage gap for Medicare beneficiaries, who have surpassed their prescription drug coverage limit, will begin to close
  • Co-payments for preventive services will be eliminated and exempted from deductibles.  For Medicare patients starting Jan 1, for new private health insurance plans within six months of enactment, and for all insurance plans by 2018 (My two cents: It won’t cost $50 a pop to see my gynecologist.  And $25 for my PCP. Maybe I’ll be willing to go as many times as my health and doctor suggest.)
  • Individuals must carry health insurance or pay a penalty that would be the greater of $750 or 2 percent of income by 2016 (My two cents: Remember the people who don’t have health insurance cost taxpayers LOTS of money when they show up at the emergency room. Because even healthy people get sick.)
  • 50 state-administered insurance marketplaces will be established by 2014 to allow small businesses and people without employer sponsored coverage to buy insurance that meets new federal standards
  • Medicaid expands to cover everyone earning less than 133 percent of the federal poverty level, or $29,327 for a family of 4. (Note: This is based on 2010 level poverty. In 2012, it would be over $30,000 for a family of 4.)

I chose not to include cost information. Not because I believe that it will bankrupt us as I believe that the bill will reduce our deficit in the long run. But because I’m unwilling to put a price tag on my friends, family, and poorer American lives.

I am grateful that over 30 million Americans have a chance to live longer and fuller lives. We are one step closer to treating our most important commodity, our citizens, with the respect and dignity that we treat our businesses and gadgets.

*The list is a conglomeration of American Medical Association FAQ on HCR and American Academy of Family Physicians. I believe doctors know the most about the human cost of inadequate health care while standing to lose the most financially with an expansion of government-aided health care, thereby, making them the least biased; although in full-disclosure, the AMA and AAFP (eventually) supported the bill.

Alex Iwashyna

Alex Iwashyna went from a B.A. in philosophy to an M.D. to a SAHM, poet and writer by 30. She spends most of her writing time on, a humor blog (except when it's serious) about her husband fighting zombies, awkward attempts at friendship, and dancing like everyone is watching. She also has a soft spot for culture, politics, and rude Southern people who offend her Yankee sensibilities. She parents 2 elementary-aged children, 1 foster baby, 3 cats, and 1 puppy, who are all Southern but not rude. Yet.

20 thoughts to “The Supreme Court Took Up The Health Care Bill And I Am Worried”

  1. As a political junkie and a Democrat, I share your concern. I have commented on all the big news blogs over this. It is likely to once again come down to a 5-4 vote with Kennedy being the swing vote. The arguments against forcing someone to buy insurance are compelling but so is the fact that the cost of insurance is directly tied to those people who choose not to pay for it. It’s the only service someone can get for free that otherwise should be paid. You can’t go into Best Buy and say you should get a free TV but the person next to you must pay for it. And it would be ethically immoral to turn people away from the ER on the basis of being able to pay if they were having say a heart attack or got shot. Everyone ultimately becomes part of the health care market. I hope at least 5 judges see it that way.

      1. Totlly agree. One benefit of the law getting thrown out is that it may make the public option the only option left to truly bring down health care costs. And as the article notes, there is no way challengers can cry legal foul over that. Of course that would require a wave of Democrats elected to Congress along with the reelection of Obama to even have a prayer of happening.

        1. My hope is that if the law gets thrown out, then we see some actual push for a real single-payer system in this country. It should say something when we’re the only First World country without universal coverage, and we pay double what the next closest country pays for health care.

  2. it really doesn’t cease to amaze me that having health insurance for everyone should be a no brainer.

    I mean, “life, liberty, and pursuit of happiness”. Don’t you need your health for ALL of those things?

    We require car insurance if you want to own a car. isn’t your BODY and LIFE more important than a damn car?

    After college, but before getting a job when I was in “no insurance limbo”, I bought insurance. Not because I get sick (I never get sick), but because WHAT IF. I didn’t want to be one of the statistics draining tax payers AND i wanted to know I could go to my doc if I had a bladder infection or to the ER if my appendix chose to revolt.

    The more I accept that I am an adult and need to know things about politics, the more astounded I am that common sense has zero place in our government.

  3. Thank you for doing the post I wanted to do. Let me retort. First I think the whole law should be trashed and rewritten. Bad law is Bad Law. Remember Nancy Pelosi saying “We have to pass it to see what’s in it.”? Yes there are a lot of good things in the current law. But that’s candy to get you to swallow the castor oil. Rewrite it. Keeping the good and washing out ALL of the bad. Two. You can keep your insurance if you like it. Ummm, no. I had one of those Cadillac Plans and paid nothing for an apendectomy. Since Obamacare, my E-room visit copays went from $50 to $300 as my plan adjusted to comply with the law. I have a family member who had a great plan and the copays jacked up so bad they cannot afford it and have to opt for the government plan which isn’t as good by way of coverages and procedures and [GASP!] pricing. All Hail Great Leader Comrades. Please come visit me in the Re-education Camp.

    1. The law is not perfect. What law is? But it does a lot more for health care than his been done in decades. Most people aren’t lucky enough to have a Cadillac plan and even with insurance have to pay for surgeries. I have decent insurance and still had to pay about $1,000 out of pocket for a colonoscopy. And about $2,000 for the birth of my second kid. What I envision as a good alternative is a sort of hybrid single payer/private model in which basic preventative and catastrophic care is covered by the government and everything else would require optional supplemental insurance in which rates can be tied to one’s health status like life insurance is. A healthy, athletic person of normal weight should pay less than someone who is 200 pounds overweight and eats Big Macs for breakfast, lunch, and dinner.

      So under this system, annual check ups as well as emergencies like heart attacks or gun shot wounds would be covered for everyone, but if you want something like being able to see a doctor every time you get a cold, then you get the supplemental coverage. Also, under this plan, if you DONT have adequate coverage and make too much money to qualify for Medicaid, and need to go the ER because you drank a cup of Drano, then I believe the hospital should have the right to garnish your wages instead of passing the cost onto others who do pay.

  4. Im concerned as well. One type of person who is overlooked when it comes to health insurance are early retirees. Not everyone has retiree health insurance offered by their employers. What is someone who wants to retire at 60 but has a condition supposed to do? In the current system they must work. With hcr, maybe they could actually afford to buy insurance.

  5. If a state had passed this law, it would be ok. It’s fine for a state to require a person to buy insurance or pay a no-insured penalty, which states do all the time with car insurance. That’s because states are not limited except by their own state constitutions in what they can enact. The only reason the Supreme Court can declare a state law invalid is if it runs afoul of the Bill of Rights.

    On the other hand, the federal government is limited in what it can enact based on the Articles in the Constitution. We would have been better off if this had been called a tax, because the federal government has an almost unlimited capacity to tax its citizens. And there is no severability clause in the Affordable Care Act, so if one part is struck down, the whole law fails. And with the current congressional make-up, it is unlikely to pass again in a more constitutionally-acceptable form.

    1. But states couldn’t afford this type of law in the short-term (before it would make back its cost) and insurance companies would run off to states without it, don’t you think?

      PS. I do think it’s weird that there were no severability clauses in the act although it’s not necessarily true that the Supreme Court can’t rule part of it invalid. Justice Scalia clearly thinks that idea is ridiculous because they’d have to read the whole bill and pick and choose themselves, but they do have the power to do that as I understand it.

      1. Oh absolutely, I agree about states not doing this. I just mean it’s probably legal for states to do it, but more problematic for the federal government.

        Someone was telling me this morning that the main reason the bill isn’t as clean as any of us would like is because it had already passed the Democrat-controlled Senate and gone to the Dem-controlled House when Ted Kennedy, who was for the bill, passed away. Scott Brown, who eventually won his seat, campaigned vigorously against the Affordable Care Act. The House would have had to send the bill back to the Senate if it made any changes. They decided it was too risky because Brown had replaced Kennedy, so they just passed it as-is when it got to them from the Senate. Don’t know whether that is true, but it does explain why there’s no severability clause and some of the sections are more clunky than others.

        1. Under the Tenth Amendment the States have the Right to do pretty much anything. The Constitution limits the powers of the Federal government. The Congress regularly ignores this limitation nad in this case says the Affordable Health Care Act falls under regulating interstate commerce where there isn’t any interstate commerce. Thus the entire law is rendered unconstituti0onal.

          1. How is the health care market not an interstate market? At my previous job I worked in NC, but our health care insurance was administered by Blue Cross/Blue Shield of California. Saying that health care isn’t an interstate market is asinine.

            You’re also ignoring the part of the Constitution where it says that federal laws shall be the law of the land; but a strict 10th Amendment reader would say that. They’d also strike down Social Security, Medicare, and Medicaid, but hey, it’s not like we need those programs.

  6. I’m incredibly worried, too. And not just for myself, because I have cancer and take lots of preventive/maintenance medicines and I am hoping to go abroad in 2013 – and I might need to pay for health insurance in the U.S. while I’m gone even though I will have health insurance abroad, just so I don’t come back and lose coverage for preexisting conditions – but for everyone in our country who doesn’t have the money to have equal access to necessary care. I believe access to health care should be a right, not a privilege- and sometimes I fantasize about moving to a country whose government supports that notion.

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