By NATALIE LUCZKOWIAK
Hearings were held before the U. S. Supreme Court this past March in order to deliberate a few of the provisions within our health care reform law, known as the Affordable Care Act. The Supreme Court also heard arguments to determine if the mandate provision is so substantive, would the Affordable Care Act be able to stand on its own?
The contentious topics, to be law in January of 2014, are the expansion of Medicaid, an individual mandate for the purchase of health insurance, penalties if one decides not to purchase health insurance; and, if the mandate is unconstitutional, can the act go forward.
Medicaid is a health plan for the poor and the disabled which is run by individual states with both state and federal dollars. The Affordable Care Act will expand those eligible for Medicaid, to adults earning 133 percent above the federal poverty level from the current 100 percent. But in order for states to continue to receive any federal money for Medicaid, the Affordable Care Act requires them to comply with this expansion.
Arguments against: 26 states have challenged this requirement, stating that withholding all monies for Medicaid is coercive and unconstitutional.
Arguments for: The states which support this expansion say that Congress can constitutionally attach such conditions under what is known as the "Spending Clause." Congress has expanded Medicaid many times in the past and never has an expansion been struck down. The extra 33 percent will mostly come from federal monies (97 percent) as opposed to the usual approximate 50-50 split.
Of the four questions the Supreme Court is considering, the individual mandate is the big one. The Affordable Care Act will require all Americans to purchase health insurance or pay a penalty/tax. If your income is below a certain level, the government will provide subsidies or tax credits to help you. The primary legal question is: does the Congress have the authority, under the Commerce Clause of the U.S. Constitution, to require Americans to purchase a product, in this case health insurance?
Arguments against: The mandate is unpopular. This is the first time Congress has required Americans to purchase a product and it's unconstitutional.
Arguments for: Congress can both regulate interstate commerce and legislate taxes. If your employer provides health insurance or if you are a Medicare recipient, nothing about your personal situation will change.
The act requires that people purchase health insurance or pay a penalty. Many people say this penalty is a tax in disguise. The Tax Anti-Injunction Act bars people from suing over a tax until they actually pay the tax. Since the mandate goes into full effect in 2014, no penalties will be paid until 2015; so, 2015 will be the soonest someone who paid the tax could challenge the constitutionality of the ACA. Will the Supreme Court make this decision in 2015 instead?
Arguments? Well, this is a question only lawyers can love; so, let's go to the last question.
Severability was the word in court during these deliberations. If the Supreme Court decides the individual mandate is unconstitutional and severed from the Affordable Care Act, will the act be able to stand as a valid law? In the last days of drafting the act, when things got so hectic, a severability clause was not included; usually, Congress includes this clause.
Arguments against: This is the Supreme Court that passed Citizen United, be afraid.
Arguments for: Many experts think severability is implied; and, if the mandate is struck down, the rest of the law can stand.
The Supreme Court's decisions are expected in later this month; or, possibly early July.
The Affordable Care Act stands strong without the mandate because it incorporates new regulations which protect us from private health insurance abuses. Also, because of greater efficiencies, we will get more health care out of our health spending; a great example of this is competitive pricing which has saved the Medicare program over $200 million since the inception of the act.
Hopefully, all will stay the same. Everyone insured is cheaper on everyone's pocketbooks.
Let me share a favorite story of mine from a talented doctor who runs a clinic. A homeless and employed man couldn't afford insurance and utilized a clinic, which can only do so much. Once he began Medicare, his needed tests and operations cost our tax dollars millions and he died six years later.
Moral of the story? Everyone insured will bring better health automatically and save us billions of dollars.
Natalie Luczkowiak is a Dunkirk resident.
