Struggling to make sense of the status of health care reform in America? Don’t worry; neither can Congress, the White House, nor the Courts say with certainty whether The Patient Protection and Affordable Care Act (the Act) will ultimately be considered successful legislation, whether it will be repealed, or if certain contested provisions are constitutional. The goal of this article is one of education and not political persuasion.
Last year, I discussed how the health reforms will help Medicare recipients and early retirees in my article entitled, Health Reform: Changes in Store for the Elderly. This year, I want to briefly reiterate the most important 2011 changes. As you may know, the sweeping health reform law passed last year is designed for long-term implementation.
Two Important 2011 Reforms for Seniors
There are two monumental changes worth mentioning briefly. First, preventive services (including annual physicals and cancer screenings) will now be free for most beneficiaries, including people who enrolled in private plans as of last September.
Second, a 50% discount on brand-name medicines will be available for people in the Medicare Part D “donut hole.” Seniors on the Medicare Part D drug plan subject to the donut hole pay out-of-pocket when their annual drug costs are between $2,840 and $4,550.
Illustrating the likely unpopularity of health reform repeal, US News quoted Kenneth Thrope, Head of the Department of Health Policy and Management at Emory University:
“If you do repeal the law, you’ll have to start charging people for preventive benefits. You’ll have to increase what seniors pay for prescription drugs . . . . [n]either one of those would be very popular.”
My goal is not to convince my readers to support or oppose the Act, nor is my goal to explain it: consisting of over 1,000 pages of law and policy reform, it is becoming increasingly clear that top lawmakers do not even fully understand or agree on the law. Instead, I seek to enlighten my readers on the law’s current status. Paradoxically, the same principle that ensures Democracy in America is the source of the maddening confusion, delay, and uncertainty: “the Separation of Powers.”
If you are interested in a summary of the Act, you can view the bill on OpenCongress here. For information on related legislation that will modernize America’s health system, you may want to read my recent article on the HI-TECH Act, How New Health Information Technology Will Save Money and Lives.
For those who may feel lost, allow me to quickly bring you up to speed
Obama signed the Act in March of 2010
The Act was introduced September 17, 2009, passed both the House and Senate by late December, 2009, and was later signed into law by the President on March 23, 2010. Republicans vow to repeal the law, while Democrats dismiss repeal of reform as an impossibility. One thing is certain; this is a major piece of legislation that implicates millions of lives and billions of dollars.
Virginia Attorney General Ken Cuccinilli and 13 other states sued the federal government shortly after the law took effect. Presently, more than 20 states have filed suit against the federal government over the legislation. Virginia Governor Bob McDonnell said the new laws would have “a significant and unavoidable impact on the bottom line of [Virginia’s] state budget,” reported Richmond Times-Dispatch. The Virginia Interfaith Center for Public Policy has voiced its opposition to Cuccinelli and McDonnell’s challenge, proclaiming, “[T]he political actions of Attorney General Ken Cuccinelli may simply allow health-insurance industry abuse of small business, seniors and children to continue.”
Sources of Confusion
Opposition from state Governors and their Attorney Generals is a major source of the public confusion. The New York Times criticized such efforts and said these state suits “create confusion among the public and further destabilize political support for legislation that is under fierce attack from Republicans in Congress and in many statehouses.” The media’s undivided attention to the individual mandate provision has been broad, as opposed to the seemingly jaded level of concentration allocated to the other stories related to the law. For example, beginning September 23, 2010, a key provision took effect prohibiting insurance companies from denying coverage to children based on health status. But America is divided, as evidenced by a recently introduced state law in California: According to NewAmericaMedia.org, the backlash from insurance companies started in California when large insurers announced that they would no longer offer “child-only” policies. Only after a law was introduced that would penalize these insurers for such behavior by banning them from the individual market for five years did the insurers reconsider their policy. This is but one example of how important news stories are being overshadowed by the “individual mandate” debate.
What Role does Virginia Play in Shaping America’s Health Care Reform Debate?
Fast-forward to the present day, and Republicans in the House vow to repeal the law, while Democrats insist it isn’t possible (because they control the Senate). On the other hand, there is speculation that it would be possible for the House to “de-fund” the legislation because they control the “purse strings.” It is no wonder that the American public is confused. Meanwhile, states are challenging provisions of the law in Federal Courts, and there is likely a Supreme Court case in the making, because Federal Courts can’t seem to agree on the constitutionality of a key provision – the “Individual Mandate.”
The "Individual Mandate" of the Act has been challenged in Federal District Courts
Henry Hudson, a federal judge for the United States District Court for the Eastern District of Virginia, recently found, this key provision of the Act to be unconstitutional. Hudson did not undermine the Act and even refused to suspend its implementation pending appeal … he referred to Congress’s enactment as laudable but disagreed that the Commerce Clause granted the powers contained in the Act. The New York Times provides the full opinion here. Judge Hudson is the third federal district court judge to decide one of these cases on the merits; more than 20 other judges have cases pending which seek to challenge the law.
Demonstrating the “tit-for-tat” nature of the debate, the Obama administration responded just one day after the Virginia decision in an op-ed piece posted on the Washington Post website. U.S. Attorney General Eric Holder along with Health and Human Services Secretary Kathleen Sebelius are of the belief that Americans who are presently insured are paying too much for their insurance, because of an inequitable burden placed upon them by those who don’t have health insurance. “Every insured family pays an average of $1,000 more a year in premiums to cover the care of those who have no insurance,” they said, reported CNN.
Though analysts agree that there may be a Supreme Court case in the making, it will most likely take some time before winding its way up to our nation’s highest court. Illinois State University Political Science Professor Bob Bradley commented on the aftermath of the Virginia case, stating, “The Supreme Court [is] not going to hear this for awhile…what they’re going to do is let this play through all the other federal district court challenges.” Lawyers involved say it could take two years for the Supreme Court to hear the case.
“The problem is that if [state challenges succeed], they’ll all be left high and dry with half-baked reform plans that won’t work.” Bnet offered this interesting take on the irony of state-developed reform plans, which would provide more state-autonomy but could do so at the expense of federal grant money.
An American tragedy has delayed the Republican effort to repeal.
Because of the recent shooting of Rep. Gabrielle Giffords (D-Ariz) that left six dead, the vote to repeal the Act has been postponed. Scheduled to take place this week, the vote was delayed by House majority Leader Eric Cantor (R-Va.), along with the rest of the legislative agenda.
Major Groups that Support and Oppose Health Reform.
Of the groups that support the Act, OpenCongress lists health professionals, consumer groups, elder groups, the U.S. military, and various trade unions. The opposition is composed of groups such as accident and health insurance companies, construction companies, security brokers, investment companies, and milk and dairy producers.
To conclude this article, I would like to reiterate that you should not feel bad if you are still confused about the status of the U.S. health reform law. Every day, the mainstream media plasters headlines across its networks and they can be very misleading. Some headlines I have seen could lead a casual reader to assume the Act never became law. Still others may perhaps lead one to think the Act is doomed. Whether you support health reform or not, and no matter what your political philosophy may be, something everyone can agree on is that patience is needed as Congress, the White House, and the Courts sort it out. Here is the bottom line: the Affordable Care Act is currently law. Any potential attempt at repeal or prospective landmark Supreme Court case is pure speculation at this point.
Image Credits:
Image: renjith krishnan / FreeDigitalPhotos.net
Image: renjith krishnan / FreeDigitalPhotos.net
Image: Hubpages.com/hub/inauguration-day-clip-art
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About Evan H Farr, CELA, CAP
