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 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.