by Philip Alcabes, Ph.D.
Although the Justices were expected to strike down the Affordable Care Act, the Obama administration’s health-care financing law passed in 2010, the Supreme Court upheld it in a 5-4 ruling today.
The law has a number of favorable effects, as Josh Levs at CNN cogently explained today.
Most important for students, Americans may now be covered on their parents’ health-insurance policies up to the age of 26. Important for everyone, it will no longer be permissible for insurance companies to refuse to cover young people with so-called pre-existing conditions or, beginning 2014, to refuse to cover anyone with a pre-existing condition.
The most vexatious provision of the law, the mandate that everyone not covered by either Medicaid or Medicare buy an insurance policy, stands for now.
To enforce the mandate, a family can be fined $285 or 1% of income, whichever is greater, if it doesn’t have health insurance in 2014. And the fine would go up to $2085 or 2.5% of income by 2016.
The Obama administration had argued that this financial penalty is okay under the Constitution: it’s a way to force more people to buy health insurance, the administration said, and that is the best way of making insurance less expensive for everyone–the more people who pay premiums to an insurance company, the cheaper the premiums can be. Congress has the right to regulate interstate commerce so, for the administration and its supporters, the Affordable Care Act is constitutional.
Others, including some private companies and 26 states’ attorneys general, had said that the mandate amounts to the federal government forcing citizens to buy a product, and therefore unconstitutional.
The big surprise is that Chief Justice Roberts, who usually sides with Court conservatives, cast the deciding vote and wrote the upholding opinion. The second big surprise is that Roberts’s opinion upholds the law not because Congress can regulate commerce – as Obama had wanted. Instead, he says it’s okay because the mandate is really a tax. And of course Congress is allowed to levy taxes.
What should we make of this? Surely it’s a good thing to make health insurance more available to more Americans. And especially good to stop insurers from refusing to indemnify people who are already sick or injured.
But if the mandate is a tax, then it seems that it’s okay for Congress to tell you to pay a tax either to the federal government (the fine for not having insurance) or to a private company (in the form of insurance premiums).
Wait–is it really okay to have to pay taxes to a private corporation?
Another problem today: the ACA’s expansion of Medicaid–the state-based programs that provide health insurance for the poor–has been questioned by the Supreme Court’s decision.
The Affordable Care Act has lots of good things in it. But it isn’t really health care reform–it’s more of a health care financing law. It doesn’t apply to everyone. And it might not work to create more insurance coverage for the poor.
Plus, the high court’s decision upholding the law seems to break new ground in giving private corporations the power to determine how Americans should look after our health and how much we should pay.
Some people think that’s better than letting governments make those decisions.
Others disagree.
What do you think?
Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.
