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Health Care Ruling: Experts Discuss Outcome of High Court Decision

The Supreme Court upheld the health care reform law on Thursday, ending--at least temporarily--a battle over the controversial act that served as background for most of President Obama’s incumbency. We’ve asked some of our Perspectives contributors, a diverse collection of think tanks, advocates and leaders in their fields, as well as several other experts to tell us what they thought on the ruling.

Here’s what they had to say.

Mee Moua, president and executive director of the AAJC, said in a statement that she applauded the ruling, calling it “critical in ensuring that communities of color have access to health care and key preventative services.”

“Our task at hand is to spearhead and move forward with implementing this law, so that the 2.5 million Asian Americans, Native Hawaiians and Pacific Islanders will have affordable health insurance, eliminating the current health disparities that plague our communities.”

“While we welcome today's decision that brings us one step closer to health equity in this country, we cannot forget the Supreme Court's ruling, just three days ago, in the Arizona anti-immigrant law, which will likely lead to discrimination against communities of color. These important debates reinforce the need for our communities to act and make our voices heard, loud and clear."

Kathy Lim Ko, president and CEO of the APIAHF, said the Supreme Court’s decision “validated a landmark civil rights law.” The APIAHF is an advocacy organization promoting policy and community programs that benefit the health of Asian-Americans and Pacific Islanders.

“The ACA will improve access to quality health care for millions of Asian Americans, Native Hawaiians and Pacific Islanders, protect our communities from unfair insurance company practices and make substantial investments in our nation’s public health infrastructure,” she said in a statement.

“We know that the work ahead is still significant and we must continue to fight to ensure that all people--including our nation’s immigrants--have the right to health and health care. We will continue to analyze today’s decision in more detail and work to defend the ACA against continued attempts to repeal the advances that have been made.”

Neera Tandeen, president of educational institute and think tank Center for American Progress, called the ruling a “victory for millions of Americans who are already benefiting from the health reform law.”

“It’s not about Democrats or Republicans winning or losing, it's about people’s lives. All of us—Democrats and Republicans—must move forward with making health care work for every American and that means stopping the political games and implementing the law,” she said in a statement.

Tandeen called for an end to the bipartisan battle over the act, adding in her statement, “But will Republicans stop their politics-at-all-costs campaign long enough to make sure America’s health care system works for every American?”

“No more slash-and-burn politics. No more delay tactics. Republican attorney generals have wasted millions of dollars using the courts to achieve their political ends. Today the court affirmed its role as the neutral arbiter of the law for all Americans.”

The GOProud, a gay and straight alliance promoting conservative ideals, criticized the Court’s ruling, saying the decision gives the federal government “unchecked power.”

“Today is a good day for big government and a bad day for individual liberty,” said Jimmy LaSalvia, executive director of GOProud, in a statement.

He continued: “This decision reminds us of how important it is to elect conservatives to the House, Senate and the White House that will protect our individual liberties, because it is clear that the Supreme Court is unwilling to do so.”

“Free market healthcare reform would expand access to domestic partner benefits and put gay people in charge of their healthcare decisions. By upholding Obamacare, the Supreme Court has upheld legislation that hurts all Americans, but especially hurts gay and lesbian families.”

The Hispanic Leadership Network, an initiative by the American Action Network to engage the Hispanic community on center-right issues, issued the following statement from Executive Director Jennifer Korn.

Korn maintained that the Supreme Court’s decision would ultimately hurt Latinos and the American public, especially in light of the faltering economy. She called on Congress to work on a bipartisan solution that would replace the key provisions of the health care act that would create “quality and affordable healthcare while protecting future generations from a mountain of debt.”

“In its opinion, the Court shed light on the truth--that Obamacare is, in fact, a one trillion dollar tax-hike imposed on the American people,” she said. "A federal mandate is not what the American people need or want to improve our health care system. Simply because something is deemed constitutional, it doesn’t mean it is good policy.”

“This law endangers quality private coverage for families, while robbing $500 billion from seniors to help pay for it. As it stands, this law puts the financial security of countless Hispanic families at risk and irresponsibly places the burden of debt on our children and grandchildren--jeopardizing the American dream.”

The HRC, a civil rights advocacy organization for LGBTs, said the ruling “paved the way for important new protections for and investments in the health.”

“The Affordable Care Act addresses a number of the barriers LGBT people face in obtaining health insurance, from financial barriers to obtaining affordable coverage to discrimination by insurance carriers and healthcare providers,” said HRC President Chad Griffin.

“While there is a great deal more that must be done to ensure that the health needs of all LGBT people are fully met throughout the healthcare system, today’s decision is an important victory in the fight for healthcare equality.”   

NAACP Chairman Roslyn M. Brock released a statement saying she applauded the decision to uphold the health care act.

“Access to quality, affordable health care is a civil and human right that should not be reserved for the wealthy or the few. The 32 million American men, women and children covered under this law can now breathe easier,” she said in a statement.
“Many serious health issues are preventable,” Brock said. “But far too often, patients who lack health insurance--especially patients of color--enter medical facilities late in the progression of their diagnosis. This sad reality is costing lives and costing American taxpayers hundreds of millions of dollars in unnecessary health care bills. States can now move forward in implementing health care reform with the knowledge that the Affordable Care Act is not going anywhere anytime soon.”

The conservative organization dedicated to closing the gap between the Republican party and America’s Hispanic population expressed its dissatisfication with the Supreme Court’s decision.

“President Obama and the Democrats in Congress forced Obamacare on America without one Republican vote of support and against the sentiment of the American people,” said RHNA chairman Alci Maldonado in a statement.

“We Americans must repeal and replace Obamacare with a more common sense reform to our health care system, currently the best in the world, although all would agree that it does need reasonable reform.”

The RHNA sided with Sen. Marco Rubio, R-Fla., and Gov. Mitt Romney in their assertion that the health care act would only increase taxes on all Americans, affecting the middle class most severely.

Perspectives regularly features guest commentary, analysis and insights from a diverse field of thought leaders, think tanks, research institutes and more. The Next America is always looking for input from all sides of the story. If you or your organization is interested in participating in this conversation, please e-mail The Next America team.

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Is Court's Health-Care Ruling a Wise Decision? It Depends...

THURSDAY, June 28 (HealthDay News) -- Supporters of the Obama administration's health care reform law said Thursday that the U.S. Supreme Court's decision upholding the landmark legislation protects the health of millions of Americans, but critics claim it does so at the expense of key civil liberties and exacts a high economic toll.

The 5-to-4 ruling "means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," Dr. Jeremy Lazarus, president of the American Medical Association, said in a statement.

"This decision protects important improvements, such as ending coverage denials due to preexisting conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies," Lazarus said.

Already, about 54 million Americans are benefiting from expanded preventive and wellness care coverage, Lazarus noted.

But many of those who oppose the legislation fear the federal government is intruding into the lives of private citizens.

"I'm disappointed that the Court is willing to give the federal government the power to tell you what has to be in your health care plan down to your contraceptives and mammograms," said John Goodman, president and founder of the National Center for Policy Analysis. "That's a great deal of power."

Economically, the Affordable Care Act "is one reason economic recovery has been so anemic," he suggested. Although hours worked across the United States are now what they were before the recession, hiring is not at pre-recession levels, he said, attributing that lag to "Obamacare" insurance requirements.

"The mandates come with a big price tag for employers and employees," Goodman said. The cost of family coverage works out to $6 an hour, he added.

Whether for or against the law, experts voiced relief that a decision was reached.

"We're very relieved and eager to move forward from here now that we have some certainty," said Dr. Glen Stream, president of the American Academy of Family Physicians.

The law's comprehensive primary-care initiative ensures funding for important health practices related to the "medical home" approach, he said. Preventive services, such as wellness coaching, dietitians and electronic record-keeping programs, are now accessible to many Americans through public and private payers, he noted.

Another benefit, according to Stream, is the provision for primary care work-force training. "Federally qualified community health centers have the capacity to train family physicians, which is critical," he said.

"Now we can work on other meaningful reforms," he said, mentioning liability reform.

Alison Renner Manson, manager of government affairs and policy for the National Coalition on Health Care, predicted that Congress has some hard work ahead. In some ways, the ruling was only the tip of the iceberg, she noted.

"The decision upholds existing law, so we're not looking at major changes," she said. "A lot of decisions on health care need to be made over the next year that will have a larger impact."

For instance, even with the Affordable Care Act in place, as much as one-third of U.S. health spending benefits no one's health, Manson said.

"It's an ongoing problem we have to deal with one way or another," she said. These issues include unnecessary or duplicated tests and services, excessive administrative costs, and instances of fraud and abuse, she explained. "We want to get more for our health-care dollars, but we don't want people to go without services," she said. And for that to happen, consumers, politicians and policy makers will have to work together, her group believes.

Because the court decision upheld the individual mandate of the Affordable Care Act under a constitutional tax provision, there could be surprise financial implications, some say.

Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said in a statement that she anticipates financial obstacles as a result of the ruling. AHIP is a Washington, D.C.-based trade association representing the health insurance industry.

"The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed," she noted.

"Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition," she said.

Figures reviewed by AHIP indicate that the minimum essential health benefits requirement "will result in less affordable coverage for individuals, families and small employers by forcing them to 'buy up' and purchase more coverage than they may want or need," she added.

More information

To learn more about a medical home, see the American College of Physicians.

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Health Care Law: Supreme Court Decision Live Blog

The big day has come for the president's health care law. The Supreme Court hands down it's verdict on the Patient Protection and Affordable Care Act at 10 a.m. ET. We'll be here all day updating with the decision, what's going on outside the court, what it means for politics, the health care industry and your health care coverage.

8 a.m. ET - Prep Work - Here's some things to get you started. Click on the images below for flow charts, infogrpahics, and what the justices have said previously about the legal issues surrounding the ruling.

The Court - Meet the nine Supreme Court justices who will decide whether you have to purchase health care coverage. Here's what they've said about the health care law in the past. Click below:

How could they rule? The Supreme Court has these options by our estimation. They could get creative, but these are the general questions:

Here's how Americans get their health insurance:

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Health Dialog to Showcase New Online DECISION Dialog® Solution on Capitol Hill

Thu, Jun 28, 2012, 8:12 AM EDT - U.S. Markets open in 1 hr 18 mins

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Understanding the health care decision in three minutes

The Supreme Court’s historic decision on President Barack Obama’s health-care reform program seems complicated, but much of it can be broken down to a few concepts we can all understand.

512px-Obama_signs_health_care-20100323Constitution Daily boils down the battle between Obama and his opponents, the role of the Supreme Court as referee, and what happens after the decision.

Here is the bottom line, in three one-minute chunks.

In March 2010, President Obama and Democratic leaders were able to pass the Affordable Care Act.  Every Republican in Congress voted against the act.

The Democrats’ general theory was that broad health coverage would allow health care providers to stabilize prices because costs for uninsured patients wouldn’t be pushed onto other consumers. To do this, most Americans would need health insurance, even if it were government subsidized.

The GOP, libertarians and others believed the ACA wasn’t in the best interests of individuals, states and the economy; Congress had overstepped its powers; and parts of the law were illegal. Most of all, the ACA was seen as a program that allowed the federal government to run the nation’s health care system.

The ACA’s opponents mounted an effort to have the Supreme Court decide if the law was constitutional.

Background: Health care’s big constitutional test is at hand

In November 2011, the Supreme Court decided to hear the case. Arguments were presented in late March 2012. A decision was expected in late June.

Parts of the law already have been enacted. But other key parts don’t start until 2014, when consumers must buy health insurance, or pay a penalty on their annual tax returns.

It’s a complicated case with many issues, but the Supreme Court must deal with two key ones that will decide the rest of the case.

A key part of the ACA is the individual mandate, which requires consumers to carry health insurance starting in 2014 or pay a federal tax penalty.

Background: The clause that could kill the Health Care Act

The mandate’s funds will help insurers pay for expanding coverage to anyone with pre-existing medical problems.

Conservatives and libertarians argue the mandate violates the Commerce Clause, a power in the Constitution that lets Congress regulate trade.

They say Congress has abused this power by forcing consumers to buy a product– health insurance. The ACA’s supporters say the mandate is a tax penalty, and not a product. They also say consumers can decline to buy insurance, and just pay the fine.

Background: Here’s a basic explanation of the Commerce Clause

A second big issue is the expansion of Medicaid, which uses federal and state funds to supply health services to lower-income consumers, at a state level.

Federal funds pay for most of the Medicaid expansion, but states are already trying to cut current costs.

If a state doesn’t agree to the expansion, the federal government can cut off all federal Medicaid funds to it, even for existing programs.

A group of governors claims Congress is coercing the states by threatening to withhold all Medicaid funding as part of the ACA.

The Supreme Court will issue a decision at 10 a.m. EST, most likely next week.

The court could decide to uphold the entire law, which would put the ACA on course for its 2014 deadline. GOP lawmakers will try to repeal the law if they have enough power after the 2012 general election.

The court could reject the entire law as unconstitutional and the health care debate returns to its status as of 2009.  One reason for this could be that the court believes the entire law can’t work without the individual mandate.

Temporary measures would then be put in place to deal with parts of the ACA already enacted.

The court could reject the individual mandate and keep the rest of the ACA. That would leave insurers figuring out ways to cover new customers with pre-existing conditions, and to determine how insurance rates would change without the funds from the mandate.

Survey: 16 predictions on the health care decision

The court could also reject the expanded Medicaid program.  Depending on how the court rules on the Medicaid part of the ACA, all programs funded jointly by states and the federal government could be affected, or just the ACA.

What the government, insurers and health providers don’t agree on is how much all this will cost consumers.

Some insurers are taking matters into their own hands, committing to offer parts of the ACA to consumers even if the Supreme Court rules against it.

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Medicaid’s future tied to court decision on health-care reform

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Medicaid’s future tied to court decision on health-care reformText SizePrintE-mailReprints By Phil Galewitz, The Washington Post

The future of the nation’s largest health insurance program — Medicaid — hangs in the balance of the Supreme Court’s decision on the 2010 health-care reform law.

The state-federal program that covers 60 million poor and disabled people would be greatly expanded under the health-care reform law, adding 17 million people starting in 2014.

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But if the entire law is struck down, states for the first time since 2009 would be free to tighten eligibility and make it more difficult for people to apply. The law had barred such changes.

And under another scenario — if the justices declare unconstitutional just the law’s expansion of Medicaid — the entire program enacted in 1965 as part of President Lyndon B. Johnson’s Great Society agenda could be threatened, health experts say.

Twenty-six states challenged the expansion, arguing that it was “unduly coercive” because they would lose all their federal Medicaid funding if they refused to expand the program.

“Depending on how sweeping and broadly written the decision is, it could be the entire Medicaid program has been unconstitutional since 1965, but we didn’t know it,” said Sara Rosenbaum, a professor of health policy at George Washington University.

Medicaid is the workhorse of the nation’s health system, covering 30 percent of all children, 70 percent of nursing home residents and 40 percent of all deliveries. But because of its byzantine eligibility rules, the program still covers fewer than half of the people with incomes under the poverty level, or $23,025 for a family of four.

Today, in all but four states, children in families with incomes under 200 percent of the federal poverty level are eligible for Medicaid or the Children’s Health Insurance Program. Yet coverage for adults varies greatly by state, and whether a person is pregnant, working, disabled or has dependent children.

The median income level for parents to be eligible for Medicaid is now 63 percent of the poverty level, or about $14,000 for a family of four. Eight states offer full Medicaid coverage to adults without dependent children and 13 states offer limited Medicaid benefits to childless adults.

But under the health-care reform law, eligibility will become simpler in 2014: Every American with household income below 133 percent of the federal poverty level (about $31,000 for a family of four) would qualify.

The federal government would pay the full cost for those newly eligible for Medicaid through 2016, then the states would gradually assume some costs, topping out at 10 percent after 2019. Those costs are now more evenly split, with the federal government picking up approximately 57 percent and states paying the rest.

To help ensure enough doctors are willing to treat Medicaid patients, the health law also increases pay to primary care doctors to Medicare levels in 2013 and 2014 — an average reimbursement increase of about 34 percent, according to the American Academy of Family Physicians.

“If the law survives, Medicaid will grow and look much different in 2014 than it does today,” said Alan Weil, executive director of the National Academy for State Health Policy. “If the law goes, states would begin looking at rollbacks in eligibility.”

— Kaiser Health News

Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

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