WASHINGTON (CBSDC) – It’s “Decision Day” on Thursday for President Obama’s health care law as the Supreme Court is expected to make its ruling on whether to uphold it or strike it down.
Late this past March, the Supreme Court heard several days of debate after appeals of the Patient Protection and Affordable Care Act were heard in lower courts of increasing import throughout the nation.
The oral arguments were offered from both those who feel that the Obama administration has taken matters too much into their own hands with multiple provisions – including the controversial individual mandate that would require Americans to either secure health care coverage or pay a fine – and those who feel the law is what the nation truly needs to inspire long-lasting health care reform.
A lot of the debate, especially in relation to the individual mandate, has referenced the Commerce Clause in the Constitution, which states that Congress has the power to “regulate commerce … among the Several states,” but depending on interpretation, could prohibit the federal government from forcing citizens to purchase insurance.
Thursday’s decision could effectively reverse significant portions of the health care law, after it initially passed in March 2010. In addition to the individual mandate, a Medicaid expansion, employer mandate and a health benefits exchange program could all be repealed.
What would it mean for Americans, if the Supreme Court decided to cancel some – or all – of the provisions on the proverbial chopping block?
Gerard Anderson, director of the Center for Hospital Finance and Management at John Hopkins Bloomberg School of Public Health, told CBSDC that repealing the law would have a devastating effect on health care in general.
“We would have a Humpty Dumpty problem if the Supreme Court overturned the full [PPACA]. There are so many things already [set in motion] that it would take several years just to untangle all the provisions that have been started,” he said. “I am not sure how it could be done. Putting Humpty Dumpty back together again would be a nearly impossible task.”
Anderson cited provisions such as the providing of health care for people age 26 and under through their parents’ plans, and much of the forward progress made with Medicare as specific examples of policies that would be tough to reverse.
“One interpretation of the full repeal is that these children never had coverage in the first place so any benefits paid out under this provision would have to be repaid to the insurance company. This would involve years of litigation,” he noted. “All the other provisions allowing Medicare beneficiaries to get preventive services free of charge, the filling in of the doughnut hole for Medicare prescription drug coverage, and other provisions would have to undergo similar types of assessment.”
Other experts noted the compromised position in which many would find themselves following a successful appeal of the health care law.
“If the whole law is repealed, there will be a lot more suffering and death, particularly among the [United States'] most vulnerable citizens, due to [lack of insurance] or under-insurance,” Frank A. Pasquale, Schering-Plough Professor in Health Care Regulation and Enforcement at Seton Hall Law School, told CBSDC. “Employer-based insurance is getting harder and harder to find, and PPACA … was the major U.S. initiative to make the individual insurance market fair and affordable.”
Dr. Vivek H. Murthy, who is both a hospitalist at the Brigham and Women’s Hospital in Boston and the president and co-founder of Doctors for America, agreed.
“[The PPACA] is not perfect, and it doesn’t have everything that needed to be in it, but on the whole it is a big step forward toward a health care system that provides high quality health care for everyone,” he said. “It would unfortunately be a huge setback for Americans if the law were overturned in its entirety. It would mean essentially less security for all Americans, including those who currently have insurance.”
Murthy spoke specifically to the individual mandate, and its effect on what he called the “free rider problem.”
“Currently our hospitals, physicians, nurses, and society as a whole are providing for lots of uncompensated care, and a high percentage of the population is uninsured. The money has to come from somewhere, so it comes from the rest of us who are insured,” he explained. “The idea behind the mandate is to make sure everyone is paying into the pot, and ultimately, everyone will benefit from it. In other markets, such as auto insurance, you can opt out by not driving. You can’t guarantee, however, that you are never going to be sick.”
Judith Stein, Esq., the executive director at the Center for Medicare Advocacy, Inc., highlighted other issues with a possible repeal to CBSDC, in the forms of all those who would lose out on the availability of health care.
“Tens of millions of people will be left with limited access to health care if the Affordable Care Act is entirely overturned. This will include people of all ages − older and disabled people with Medicare, moderate income families, children with asthma and other pre-existing conditions, and adults with on-going medical needs,” she said. “At this time, when family incomes are stretched to the max, more people are unemployed, and fewer jobs provide health insurance, individuals and families all over the country will lose if the [Supreme] Court strikes down health care reform.”
Medicare reform was another provision Murthy felt the PPACA has positively helped in the United States, and would be a great loss to the country if voted down.
“I worry about specific populations, in particular seniors. Contrary to a lot of myths, [the law] doesn’t weaken Medicare, but rather, strengthens it in several ways,” he said. “It closes the doughnut hole in the cost of prescription drugs, offers free preventative services that come without copay costs, and … cracks down on Medicare fraud.”
Stein agreed, adding that if the law were to become a part of our past, “we will all lose.”
“The number of people with inadequate or no health insurance will rise – but those same people will still get sick and injured,” she said. “And we will all pay, in emergency rooms, unpaid hospital bills, or by simply catching their illnesses.”
Added Murthy, “What most people on the ground, in the trenches, who understand the core elements of the law realize – and what many unfortunately don’t understand – is that this is one of the biggest steps forward in a generation. This should not be a partisan issue, or a divisive issue. This is an issue that should unite people. The fear is not only losing the benefits [of PPACA], but also, the momentum to finally get health care reform.”