Waiting For The Supreme Court

Attached some of my thoughts and comments regarding the pending decision by the US Supreme Court. The court will have to answer four distinct legal questions raised by the challenge to the Patient Protection and Affordable Care Act (PPACA) Threshold Question: The threshold question is whether the court may decide the case now, or whether it must wait until 2015, when all of its provisions — including the individual mandate — have gone into effect. The judges, the plaintiffs and the defendant (US Department of Health and Human Services) during the hearing were uniformly inclined to decide the case now. Individual Mandate Question: Is the provision requiring virtually all Americans to have health insurance constitutional? The Supreme Court will have to determine whether Congress exceeded its powers to regulate commerce by creating a mandate that would force most Americans who aren't otherwise insured to buy coverage. The Commerce Clause, Article I Section 8 Clause 3 of the Constitution of the United States, grants the federal government specified powers, reserving the rest to the states and to the people. The two powers at issue in the case, set out in Article I, Section 8, concern the regulation of interstate commerce and the imposition of taxes. The administration’s primary argument is that the law is authorized by the commerce clause, which gives Congress the power to regulate commerce “among the several states.” The decision under review, from the United States Court of Appeals for the 11th Circuit, in Atlanta, said the health care law overstepped the limits imposed by the commerce clause by regulating inactivity and forcing people into the marketplace. Solicitor General Donald B. Verrilli Jr. argued that Uninsured Americans each year use $43 billion of health care they cannot pay for. Thereby, the effectively transfer those costs to other American families to the tune of about $1,000 per year, which constitutes a commercial activity. There is no question that f the court decides to strike down the individual mandate, then insurance companies cannot recoup the costs for those they have to enroll with preexisting conditions. Therefore, the health insurance premiums will substantially increase effective 2013, or even earlier! Medicaid Expansion Question: This expansion adds 17 million more people to the rolls. The states challenging the overhaul law have argued that even though the federal government will pay almost all of the cost, it is still impermissibly coercive. In my opinion Medicaid is a (poor) substitute for a failed Public Option for those who qualify: The expansion of Medicaid broadens that coverage to include all individuals and families with an income at or below 133% of the Federal Poverty Level (FPL) ($14,483.70) for an individual, and $29,725.50 for a family of 4. Additionally, applicants will no longer be required to complete an asset or resource test. Legislation also maintains eligibility limits (e.g., Medicaid limits as of March 23, 2010) through 2014 for adults and 2019 for children and provides states with the option for covering patients above 133% of the FPL. For individuals and families with an income ranging from 133% to 400% of the FPL, the expansion of insurance coverage will be in the form of state based health insurance exchanges where certain qualified patients will be eligible for premium or cost sharing assistance for private insurance. National guidelines will also govern a standard profile of benefits that will include among other things access to prescription drugs. The uniform coverage for Medicaid will also mirror the basic coverage package available to those purchasing coverage through the exchange. In an effort to empower patients, Enrollment information will be accessible on-line. States will be required to create a website for patients by January 1, 2014 where they can apply or renew Medicaid/CHIP or the State run insurance exchange. The problem with this approach is that it will create a class of Americans above 400 % FPL who CANNOT afford the expensive private health insurance premiums ( often > $20,000 per year) and therefore will have to stay uninsured WITH or WITHOUT penalty. This is already happening in Germany where the individual mandate without a viable public option has created a growing class of self-employed uninsured who do NOT qualify for the national health insurance plan for the poor. Separability Question: The Supreme Court will decide whether, if any part of the law is unconstitutional, it can be separated out, or whether the entire law has to be invalidated. Its important to understand that striking down a small component of the PPACA could have numerous consequences --both intended and unintended.For example, what will happen with the rule, already in place, that allows adult children to remain on their parents' insurance plans until age 26? Even though some of the biggest insurance companies have vowed to keep this provision in place, but if the court invalidates the law, those additional benefits might be taxable. The law waived a key tax provision to ensure that health insurance benefits are not taxed as income. But without the law, parents may have to pay income taxes on those benefits and employers could face higher payroll taxes. Personally, I consider the PPACA as leap forward in creating a better healthcare system for most Americans BUT it falls short to insure ALL Americans and to control the spiraling healthcare costs. As noted by President Obama, “Unless you have what’s called a single payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual.” In other words, single payer is the only way to actually achieve universal coverage (White House press conference, July 22, 2009). In contrast to the PPACA, an improved Medicare for all would provide truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing our wasteful private health insurance industry with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout. Research shows the savings in administrative costs alone would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending. The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program by excluding private insurance participation (through so-called Medicare Advantage plans) and eliminating co-pays and deductibles, and then to expand the program to cover people of all ages. For more information see http://www.pnhp.org/ Yours Bernd