What a week for the United States. I generally shy away from writing about politically divisive issues on this blog, but there is no question that the news of the times this week in the United States was the Supreme Court decision on health reform.
I will not take a position on the merits of the bill here. As I have written previously, I firmly believe the health care system in the United States is badly broken and in desperate need of repair. But I will leave it to the experts to figure out how to do that.
This Supreme Court decision was about much more than just health care. This decision may have placed significant limitations on the future of the federal government to legislate.
While progressives collectively cheered the decision on Thursday and conservatives collectively gnashed their teeth, upon further analysis, I am not sure that these reactions are warranted.
Several recent articles have begun to explore the long-term ramifications of the decision. There will be more to come.
Many of my friends are health care policy experts and I would welcome their thoughts and clarifications here. In my reading of the Supreme Court decision, the Court rejected the use of the commerce clause as a basis for constitutionality and, in effect, punted the Medicaid decision to the states.
Looking through this lens, the decision was not a significant loss for conservatives, especially over the long term. In fact, it may go down in history as a turning point for limiting the powers of the federal government, which is a fundamental conservative principle.
An article in the New York Times goes into some detail about past use of the commerce clause, which has been used to pass legislation ranging from labor protections, to civil rights laws, to the Violence Against Women Act.
If the ruling this week limits the federal government’s ability to use the commerce clause to pass social legislation, this could be a significant gain for conservatives.
The other part of the decision, which has gotten little attention in the media, is the decision regarding the Medicaid expansion. Medicaid is the health insurance program that serves low income families in this country.
My understanding of the Supreme Court decision is that the court decided that the federal government can not take away all of a state’s Medicaid funding if a state chooses not to implement the expansions included in the Affordable Care Act.
The court limited this provision to say that the federal government can take only the portion of a state’s Medicaid funding that would have paid for the expansion, but not all of the state’s Medicaid funding, if the state chooses not to implement the expansion.
In effect, the Supreme Court made this provision, which for many, is viewed as one of the most crucial provisions of the law, a state option.
This pushes the question of whether to expand Medicaid onto state governments, where the issue will likely have to be relitigated in political halls on the state level. This will likely be highly politicized and there is absolutely no guarantee that all states will expand this program.
This could mean that, in some states, people with higher incomes, from 133% of the federal poverty level to 400% of the federal poverty level could be given tax subsidies to enable them to purchase health insurance, but families on the razor’s edge of poverty could go without insurance.
Again, I am not advocating any particular position; I am just trying to lay a foundation for robust discussion. But it seems to me that the Roberts decision may, in the long run, have done more to forward conservative ideals than progressive ones.
What do you think? What was your reaction to the Supreme Court decision? Why do you think Roberts made such a bold move? Do you believe that there will be long term legal consequences to this decision? How do you think this will affect the November election? Will you or your family personally benefit from the Affordable Care Act? Have you already?
I know this is a complex topic, but I would love to hear your thoughts. Thank you for reading.