Health care reform, politics and power: Is the Supreme Court Crunk?

28 Jun


At 10:07am Eastern Standard Time the Supreme Court of the US (SCOTUS) released its long-awaited decision on whether the Affordable Care Act (ACA), President Obama’s major policy achievement during his first term, was constitutional. The ACA was Congress’ first major effort at reforming our health care system in many years, with many Presidents trying and failing to make it happen.

Given the balance of the Supreme Court, there was lots of speculation in the hours before the decision that the ACA would be found unconstitutional and struck down. That did not happen, Chief Justice Roberts, a staunch conservative, broke the tie by joining with the 4 more liberal members of the court to uphold the law.

Here’s the breakdown (and here’s a news round-up):

  1. The Individual Mandate: The ACA’s key provision is known as the “individual mandate” which requires virtually all citizens to buy health insurance meeting minimum federal standards or to pay a fine if they refuse. Supporters of the mandate said it was necessary to ensure that not only sick people but also healthy folks would sign up for coverage, which is how we keep health insurance premiums affordable. (Note: the ACA offers subsidies to poorer and middle-class households, varying with their incomes. It also provides subsidies to some businesses for insuring their workers.) Twenty-six states opposing the law challenged the individual mandate and the Supreme Court was asked to rule on whether the mandate was constitutional. They found that it is indeed constitutional, but in the form of a tax – click here to understand what that means.
  2. Medicaid expansion: The ACA requires states to expand Medicaid coverage for poor and nearly-poor households. About 30 million people are expected to gain insurance from the law, according to the Congressional Budget Office. Medicaid expansion is one path to making sure that everyone has health insurance coverage. The Supreme Court was tasked in determining whether it’s constitutional for the law to make states expand their Medicaid eligibility, or risk losing funding for Medicaid from the government. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding. Here’s more about what that means.

There’s much more in the ruling itself, to read it click here. But these two issues were the major pivot points for the law’s survival.

So, what’s does all this mean? The real impact and significance of this ruling will shake out in the coming days and weeks, but here are some important things to keep in mind:

1. The opponents of the ACA were fighting against the law as an unconstitutional use of the government’s power, not to mention the horribly racialized imagery that accompanied the messaging around “Obamacare.” Much of the opposition was yollering that the ACA was socialized medicine and a scourge that would best be eliminated. That is expressly not true: the ACA is anything but socialized medicine. In fact, some would argue (me included) that the ACA is a love letter to insurance companies, who stand to gain millions of new customers with the implementation of the law.

Also, please note this comment from SCOTUS Blog: “The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws. Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.”

The only mitigating factor here is that the ACA has many new, and rather strong, consumer protections, like making sure that insurance companies use almost all of the money they get from us on actually giving us health care, eliminating lifetime caps on the amount of health care they will cover, making sure they can’t deny folks health care if they have a pre-existing condition, making sure all kids are insured and making sure that insurance companies can’t just charge women more than men just because they’re women. The bottom line is that this law is not socialized medicine (would that it were), but that it’s also got some accountability measures to protect us from insurance companies. There were many passionate and dedicated advocates that fought for these protections during the passing of the law, and I’m proud to have stood with them to make sure they made it into the final law.

2. The narrow reading of the Medicaid provision is, in a word, unjust. By not requiring states to expand their Medicaid coverage, so many poor folks will have no recourse for getting health care, aside from buying it from insurance companies. How will states ensure that it will be affordable? That remains unclear. States are going to have to do a lot more work to make sure that the poorest and most vulnerable get health care coverage, and given that many states are facing extreme budget crunches, I have very little faith that the most marginalized amongst us will get what they need. There is a legitimate fear that many Southern states will opt out of the Medicaid expansion, and given that many of those states have disproportionately high poverty rates, it’s a recipe for exclusion and further marginalization. The Medicaid expansion was my favorite part of the law, and it’s just been significantly weakened.

3. The ACA was NEVER a perfect bill. It was never really even close to that. The big problems that were there, still remain. It’s not a bill that gives us Medicare for all, which is the only real way that we can get equity across the board.  Access to abortion and health care coverage for immigrants were thrown under the bus in an effort to get the law passed.  It’s unclear, based on budget projections whether and how the law will save the country money. And finally, the principle of using corporations as the way to help us achieve human rights is historically proven to be a hot mess. We still need to repeal the Hyde Amendment. We still need to challenge capitalism. And we still need grassroots organizing. Therein, lies our hope for getting real, affordable, accessible, health care for all.

So, is the Supreme Court crunk, you ask? Today, maybe a little.

I’ll share more in the comments as I learn more about the bill since this is a really speedy assessment, and I’ll also share any amendments and clarifications. Please feel free to crowd source info in the comments as well.

13 Responses to “Health care reform, politics and power: Is the Supreme Court Crunk?”

  1. Francesa June 28, 2012 at 10:06 AM #

    Really good analysis of the decision and its impact. Thank you. I love reading the pieces that comes from this blog. Thank you again.

  2. Susan L Daniels June 28, 2012 at 10:09 AM #

    putting this up on my FB–well said!

  3. eeshap June 28, 2012 at 10:54 AM #

    Here’s another breakdown, for the wonks amongst us. What the health reform law means for insurers, hospitals and drugmakers:

  4. sheridf June 28, 2012 at 11:35 AM #

    Eesha, thank you so much for this break down. It is very useful and I will share it with my folks.

  5. Alicia Bell June 28, 2012 at 12:17 PM #

    Much agreed that the decision on Medicaid expansion will adversely affect the health of people who live in “expansion opt-out” states. Even with today’s clearly historic, albeit relatively small victory, millions are left uninsured and underinsured and the place a person happens to live in America (still) greatly determines health care coverage, access, and health outcomes. Misinformation and outright lies about the real impact of the already complicated ACA will still abound as this plays out state-by-state (for a reality check, see
    …e.g. according to Mr. Romney in his response to today’s decision, I now have to fear being kicked off my current insurance and forced to buy more expensive coverage. Lies, damn lies! Sigh…the tax aspect will be a likely target of misinformation, too. It is a real “tax penalty or credit” depending on how you view it. If a person who is supposed to buy insurance does not, she will owe a tax. But unlike federal income taxes, she cannot be criminally prosecuted for not paying. And as you aptly pointed out, many will be exempt from the tax in the first place. KFF has a nice, concise overview of the real impact of the tax provision: Keep it crunk!

  6. libpatriot June 28, 2012 at 1:59 PM #

    Thank you so much for analysis. Your blog is now my favorite.

  7. Tracey Hutson June 28, 2012 at 10:48 PM #

    I’m torn with the passage of this. While I believe that this country is “rich” enough to provide medical coverage for all of it’s legal occupants (especially if we stop spending needless money elsewhere), the main aspects I grapple with is are tax/fine imposed for not buying insurance and also what this will do to sm. employers. Lastly, once the gov’t starts down the path of “purchase this or that or be taxed/fined because we say so”, it’s all down hill. Where will it end?

    First of all, a friend of mine works for a sm. business. Before now, he has not been mandated to provide insurance for his employees. It’s not a great plan, but it’s a plan nonetheless that he provides. He has told his employees that if the cost goes up to con’t with insurance (his business is struggling), but it’s cheaper to NOT provide the insurance and pay the tax (or FINE if we are being honest), he will have to opt for the tax/fine. He knows that tax/fine will be cheaper than keeping everyone insured. He doesn’t want to go that route, but what are the options when your business is already struggling. The ppl will still be employed, but now they are uninsured. If they can’t afford to buy insurance on their own, they will be added to the roll of ’employed but uninsured’. How many other employers are in his shoes? How many of these ppl can we (the paying members of society) afford to absorb?

    As for me and mine, I can only wonder what will happen. I’m tired of the gov’t stating an arbitrary yearly income and deciding that based on that amount, I can afford this or that. They don’t walk in my shoes nor do they pay my bills (especially in So Cal where it ain’t cheap). Although I’m more fortunate than some, no dime gets spent without thought as to whether or not it’s necessary. Ppl don’t elect to not get insurance because they just don’t feel like it (there may be some, but they are not the norm). Insuring you and your family comes down to dollars and cents. If it comes down to buying insurance for me and my 2 kids vs. paying the mortgage, keeping the lights on and putting food on the table, guess which way I have to go? But if the gov’t deems in it’s ‘all knowing’ wisdom that I can afford to do it all, I get hit with a tax/fine. Sorry, but that doesn’t quite sit right with me.

    Like many, I will have to wait to see how this shakes out. I’m hoping for the best but know in my heart the fallout will be deep and heavy. Although this should be a time to celebrate (all American’s being insured), those in power are so out of touch with the real world, that they have no REAL idea how this impacts regular people….we’re the ones that are neither poor or rich and are just trying to make it.

  8. tactlessgracewriting June 28, 2012 at 11:03 PM #

    great article/breakdown and following discussion. We definitely need to understand the ACA and it’s impact better in order to improve upon it. Thanks for your addition to the news roundup!


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