As the world awaits the U.S. Supreme Court's Thursday decision, some openly question the timing of the decision. U.S. Department of Health and Human Services v. Florida decision will be announced on Thursday; however, some are reducing the significance of the decision to "just another right wing attack on President Obama." But when the justices rule, the decision affects everyone and may change the lives of tens of millions of Americans. The Patient Protection and Affordable Care Act (Obamacare) became law two years ago. It is short of a total solution to the nation's health care problems, but is it an improvement over what existed 2 years ago with the hope of more benefits to follow?
Consider that the law has implemented the following changes:
•Ban on "lifetime limits" on the amount of benefits an insured person can collect.
•Insurers must justify decisions to increase insurance premiums.
•50,000 children age 18 and under have been able to obtain coverage despite pre-existing conditions.
•Millions of women now receive mammograms with no deductibles or copays.
•2.5 million children are now able to stay on their parents' health insurance policies until age 25.
•5.1 million seniors receive discounts on prescription drugs reducing the Medicare Part D "doughnut hole."
Yet the
Rasmussen Report poll demonstrates that a majority of Americans feel they've haven't benefited at all from Obamacare. Furthermore, twice as many voters say they've been hurt by the law as those who say they've been helped. 26% of voters polled claimed higher health insurance premiums, and layoffs from employers unable to afford insurance. Only 13% who say they've been helped by the new law. However, many of the law's biggest benefits haven't taken effect yet. If Obamacare survives, it won't be until 2014 when the following benefits accrue:
•Prohibition on denying coverage for pre-existing conditions.
•Prohibition on capping the annual amount that will be paid out on a patient's claims.
•Requiring insurers to cover the cost of experimental treatments.
•Tax credits for "low-income" consumers -- $43,000 annual income for an individual, or $88,000 for a family of four.
•Creation of a competitive market for insurance plans (insurance exchanges.)
•Health-care tax credits for small businesses.
•"Individual mandate" -- a requirement that everyone in America either buy a health insurance or pay a penalty. This is the most controversial of the provisions. The court must first decide whether health care is part of "interstate commerce." And second, it must decide whether Congress can use the Constitution's Commerce Clause to require Americans to buy insurance. If the court finds in the negative on either point, then the individual mandate goes away. The insurance industry will be saddled with a host of expensive benefits it must provide, but not enough money to pay for them. Insurance rates will drastically increase.
Our Supreme Court might end Obamacare this week. But to some extent, health-care providers have already instituted new consumer protections to health plans and altered the mechanism for medical providers to get paid. On the other hand, just watch how high the insurance companies jump for joy if Obamacare is declared unconstitutional. Then ask yourself, just why are the insurers so happy?
Update June 28, 2012: Did you see the insurance companies dancing in the street? No, that tells you how the Supreme Court ruled that the individual health insurance mandate is constitutional. The Supreme Court upheld the central provision of President Barack Obama's signature Affordable Care Act. Chief Justice John Roberts' controlling opinion upheld the mandate as a tax, although concluded it was not valid as an exercise of Congress' commerce clause power. Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan concurred. The majority concluded that the mandate, which requires virtually all Americans to obtain minimum health insurance coverage or pay a penalty, falls within Congress' power under the Constitution to
"lay and collect taxes."
Chief Justice Roberts wrote: "The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress's power to tax." However, on Medicaid expansion, the court upheld the expansion with a caveat that the federal government may not threaten the states that don't comply with the loss of their existing funding. Justice Ginsburg, wrote a separate opinion for the four democrat justices which indicates that they would have upheld the mandate under the commerce clause too.
"Unlike the market for almost any other product or service, the market for medical care is one in which all individuals inevitably participate... Virtually every person residing in the United States, sooner or later, will visit a doctor or other health care professional."
The National Federation of Independent Business v. Sebelius follows the six hours of heated oral arguments held over three days in March. Chief Justice Roberts joined four Democratic appointees in a bipartisan upholding of the law. However, you can bet that GOP candidates and incumbents will focus the 2012 campaign upon repealing the law.
Update 7-3-13: The government will not require employers to provide health insurance for their workers until 2015, delaying a key provision of Obamacare by a year. At issue: Complex (and fairly recently introduced) rules and reporting requirements for businesses. Retailers and restaurateurs would have been effected the most by the mandate.
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