Broccoli Battles: What are the Long-Term Consequences of the Supreme Court Decision on the Affordable Care Act?

Photo courtesy of Wikimedia

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.

32 Comments

Filed under Affordable Care Act, Culture, Economy, End of Life, equality, Ethics, Health, Income inequality, Obamacare, Policy, Politcs, Poverty, Role of Government, Women

32 responses to “Broccoli Battles: What are the Long-Term Consequences of the Supreme Court Decision on the Affordable Care Act?

  1. I think you may be right. Well done. We do tend to jump to conclusions and see what we want to see, don’t we. This may turn out to be just what the conservatives wanted — and they don’t seem to realize it! Thanks for the thoughtful blog: there are too few of them.

  2. There are so many issues wrapped up in one. My general reaction is wait and see. Some want to repeal it. Some want to tweak it. Many will be shouting about it. Since I have no contributions or TV fees riding on my words, I will wait and see and perhaps write my rep when a particular piece is up for tweaking or installment.

  3. As a young person, I have already benefitted from the ACA. Without it, I wouldn’t have been able to stay on my Mom’s insurance, and I would be having a lot more trouble making ends meet. In today’s economic climate, I think this is especially important for youngsters like myself.

    I suspect that Justice Roberts is a little miffed about the conservative reaction to his decision. Like you said, I think his decision may represent new limitations on the Commerce Clause. Only time will tell how this precedent affects future rulings.

    As for the elections, I’m still trying to figure out if this will be better for the left or the right. I think this will be seen as a vindication of Obama’s policies, but I’ve also heard that Romney had a huge fundraising spike right after the decision. It’s already become obvious that conservatives intend to run against the ACA.

    • I’m not sure how this will play in the elections either, although it does seem to providing fuel for the conservative fire in terms of fundraising, as you said. We shall see. At least some more people will have access to affordable health insurance. That is a huge silver lining regardless of other political implications. Thanks for reading my marathon post and for commenting!

  4. It will be interesting to see how this plays out. I’m not sure that the affordable care act will help me personally or not. I haven’t had health insurance for the last few years, so the idea of having to pay a tax penalty is not appealing to me. I’m almost with the conservatives on disliking that aspect of the law. However, the pre-existing condition law and the extension of benefits for children mentioned in one of your other comments seem like steps forward.
    My true desire would have been a law that created socialized health care as it is in many other developed countries, and not just for myself. Socialized health care would be a big boon for business (both big and small) in this country, but it seems like no one is looking at that. With the political divide the way it is in this country, socialized healthcare is not likely to be happening anytime soon, which is unfortunate.

  5. Thank you for your comments. I really enjoy your blog and invite you to mine.

  6. I do believe Obama’s intentions going into this Bill were to better the healthcare system for this country, nothing more. Sadly, it has been so distorted in the Media, primarily by the conservatives, that no one can see the good it has to offer at this point, again primarily the conservatives. They sincerely believe their own propaganda to the point of delusion. Since Thursday I have heard more than my share of misinformation regarding the ACA, that frankly I need to start getting compensated for my defense and clarifications. Let the waiting games begin….

    • I know what you mean. I think a lot of that stems from the fact that much of it has not been implemented yet. Unless you have kids with a preexisting condition or under 26 who needed insurance, you may not have been impacted yet. People are not even aware that they don’t have to pay for preventative care because of this bill, it seems. Maybe with all of this discussion, people will start to understand the positives a little more. Thanks for reading and for the comment!

  7. I have a lot to say about this topic, so I’ll limit this comment to the personal side of things. I had cancer 10 years ago when I was in grad school. The worst part of it was not the insurance or the chemo, it was battling insurance companies. After that, I could never again be insured in the private US market, which means that if I were unemployed even for a short time, the consequences could have been serious.

    Now I live in Canada (1.5 years in Toronto, 2 years in Quebec). The health care system here differs by province, and is much better in Ontario than Quebec. While it is far from perfect, as a whole it is much better than the system in the US (though the US system is better if you have a good insurance plan and live in an area with good hospitals). I never have to worry about coverage as long as I’m here.

    The ACA is far from ideal – it might not eliminate the sorts of battles I had with my insurance companies, for example – but, in the long run, it may make it feasible for me to return to the US if I ever choose to. And it makes me a bit less embarrassed to call myself American, in a world where every other rich country takes care of its citizens’ health.

    • What a beautiful story – and sad story – of why this is so important and so personal. Thank you so much for sharing. I hope your health has recovered and that lack of health insurance does not have to guide future life choices. Thank you again for sharing.

      • It’s funny, but in some ways I consider my story a happy one. I am healthy now and receive good medical care. I’ve gained some unique life experiences. But I do want these kinds of experiences to help make the system better for others…

        • I hear you. But you shouldn’t have had to move to get care. That is what is sad. And you are not alone. Good thing you are resourceful! Sharing your story could really help make sure others don’t have to do the same. THANK you!

      • Let’s hope the ACA is around long enough to work the wrinkles out of it. Those who would throw out the baby with the bath water need to stop and think about what they are doing. I have seen ads by the Republicans that insist that this means “the largest tax hike in history.” That’s the angle they are taking to have the law repealed. It’s all or nothing, and that’s just plain stupid!

  8. I was pleasantly surprised about the supreme court’s decision. I believe every American should be covered with health care so you can imagine my surprise when a conservative court ruled in favor of Obamacare. Perhaps the fights will continue in some way or another for a few years, but for now, Obamacare is the rule of he land.
    I have 3 grandchildren who will all benefit in some way from this new law. .

    • I shared your surprise. Maybe that is what made me question the motives a bit. But maybe I am being too skeptical. I am glad to hear that your grandchildren will benefit. Thank you for reading and for your comment!

  9. I am hopeful that we can move forward with ACA and use the opportunity to improve the areas where it falls short and make it less complex. The extension of coverage in and of itself will help get preventive health opportunities in front of people who did not have coverage. The mandate which was heavily supported by Romney in MA when he put a similar plan in place and has been supported by Senator Jim DeMint in a letter to Pres. Bush in 2007 and Senator Charles Grassley in 2009 (and even Newt Gingrich) is critical as a key principle of insurance – the good risks pay for the bad risks. Yet, even the good risks need preventive services and insurance for pregnancy or a catastrophe. To date, the parts that have been operationalized have added 2 million adults under 26 to coverage, eliminated lifetime maximums, eliminated pre-existing restrictions for kids and made preventive visits now affordable. Keep shining a spotlight on this issue. This law is not perfect (no law is), but it will helpfully move us up in ranks from our 38th in the world position on health care quality and down from our spot as the most expensive health care in the world per the Wold Health Organization.

  10. Being Canadian, I am not really sure what all the new issues are in the US except that health care can be astronomically expensive and like Alan mentioned, there can often be conflicts with insurance companies to get the necessary care covered. I’ve heard many horror stories about how some people have had to declare bankruptcy because they could not pay for the care they received after serious illness struck.

    I remember my father, a Conservative supporter and insurance company employee, complaining about the proposed MediCare program when it first was proposed. I am certain, once things were implemented, that he felt fortunate to have his and my mother’s cancer care covered. While we still need extra coverage for things like dental and eye care, ambulance services, prescription drug services, etc, we do not have to pay for child immunizations, regular check-ups, emergency care (unless an ambulance was called) and most operations (extra coverage is needed if you want a semi- or private room). No one is turned away from a hospital because their insurance has lapsed or is non-existent.

    I would hope that any improvements to your system should be applauded, as long as it means that more people can get the care they need without having to ‘sell the farm’. This is just my opinion, of course. 🙂

    • Thank you for your opinion!! Sadly, I understand that medical bills are the leading cause of bankruptcy in the United States. I hope this law will change that and ensure more coverage for more people.Thanks again for reading and for your comment!

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