Health Care on Trial: Is the Affordable Care Act Constitutional?
On Monday, the United States Supreme Court will begin hearing arguments that challenge the constitutionality of portions of the Affordable Care Act, brought by a group of 26 Republican State Attorneys General. It’s a big deal, but most people have no idea what it’s about. In fact, most people don’t even know what the ACA laws even say. Here’s a quick and dirty primer, so you can understand it better (and sound smart at parties).
What is the Affordable Care Act?
Sweeping health insurance legislation that was passed by congress along party lines and signed into law by President Obama on March 23rd 2010, the ACA is intended to help more people have affordable health coverage. The law imposes new regulations on health insurance companies, state-administered and federally funded programs, like Medicare and Medicaid, and even private citizens regarding their health coverage choices. Some reforms have already begun, and most defined by the law will take effect by 2014.
Some of the more prominent legal provisions created by the ACA include:
- Insurers can no longer invalidate your policy due to an honest mistake
- Individuals with pre-existing conditions now have more coverage options
- Health coverage for young adults is expanded
- Small businesses now have new programs and tax credits available
- Additional measures to reduce fraud and waste in federal programs
- No lifetime limits on benefits payouts
- More options to appeal denials of coverage
- Free preventive care, included in insurance plans
The list is much longer than this and many of the controversial issues center on the unintended consequences of the law and legal concerns.
Opponents on the right have referred to it as “Obamacare” and socialized medicine, because of increased federal regulation. They argue that it infringes on individual liberties, state’s rights, and interferes with private industry. Opponents on the left (some of whom do advocate for a form of socialized programs, often called single-payer health care, because the government would ultimately pay all the bills) consider the ACA to be a give-away to private pharmaceutical and health insurance companies, because it is likely to increase their consumer base, and possibly profits.
The truth, as often is the case, is actually somewhere in the middle. The ACA increases regulation of the private insurance market, while also providing additional resources to consumers that private insurers do not want to accept.
Why was it Passed?
Unlike other western countries, most access to health care in the U.S. is granted through private insurance as well as private health care companies that run hospital networks. Those who argue for the value of the private marketplace point to the quality of care that competition and innovation inspire.
However, those who advocate for reform (and provide justification for the ACA) argue that the private marketplace is not actually serving the needs of consumers. They point to issues like rising costs, denial of coverage, and poorer health outcomes compared to those seen in other countries.
Reform advocates argue that the private market is inherently biased against individuals in high-risk categories and those with pre-existing conditions, for example, because it is not profitable to retain them as health care customers. This unfairness is not adequately remedied with emergency room services, or direct billing for expensive services, such as surgeries, which have led to millions of medical bankruptcies. Opponents argue that public safety nets are already in place, but that the health and well-being of every last American is not the taxpayer’s responsibility, anyway.
Differing ideas of individual justice aside, reformers claim that the ACA will help to improve overall health care costs by outlawing some insurance practices, and improving access to preventive care, which is the most cost-effective health care service, because it reduces the likelihood of higher costs later in the patient’s life. Theoretically, the ACA will lead to a healthier population and a more robust economy, as it heads off the dramatically increasing burden of health care costs.
What is the Primary Court Challenge?
In order for the Affordable Care Act to deliver on some of it’s major promises (but not all) the law requires that all individuals retain some form of health insurance coverage, or pay a tax penalty.
Unlike owning a car, a home, or other consumer purchases that have associated insurance, the economics of health care are such that no one can actually opt out of paying for health care. You have your body, and whether or not you pay for insurance that covers your costs in the event of sickness or injury, someone already pays the costs, even if you don’t. Both taxpayers and the insured essentially absorb the impact of health care bills that the uninsured or under-insured can’t fully cover on their own.
The ACA’s requirement that all individuals choose a private plan, or opt into a government-sponsored plan, according to their needs and eligibility, improve the viability of the overall concept– that private insurers and government programs, will more equitability cover costs, while helping to pay health care providers for effective care.
ACA proponents claim the government’s right to induce the purchase of a service in this case under the “commerce clause” of the constitution. They argue that in order to effectively regulate the health insurance market, for the good of the country, such a mandate is necessary and therefore legal. Similar (but not exactly equivalent) arguments have been made as in the case of mandatory auto insurance for all car owners– the difference being that you can choose to avoid owning a car. You can’t avoid having a body that needs health care.
It is possible that the Supreme Court will strike down only the individual mandate, and leave lawmakers to restructure the rest. They might strike it down, as well as some provisions that depend upon it. They may even rule the entire law unconstitutional because it does not contain a “severability” clause, which means it is constructed as one complete whole, and not distinct parts.
The Supreme Court may also delay all or part of a ruling until the individual mandate actually causes individuals to be taxed, because you can’t fight a tax until after it’s collected. Or, they might just uphold the thing all together.
What do you think will happen? What do you think SHOULD happen?