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.

How to Get More Mileage Out of Your Frequent Flier Miles

While I realize that we are all anxiously awaiting the Supreme Court Decision on health care, which should be coming any minute, I am going to share an article that will help us all get away once the dust settles. Unfortunately, writing about the health care law would feel a little bit too much like my day job.

I have no doubt that I will do that at some point, but for today, I am going to write about travel, my first love. Suffice it to say that we have an intractable health care problem in this country and I hope we find a way for more people to get affordable health care.

With that said, an article in the New York Times about services to help make frequent flier miles more user-friendly intrigued me. In our house, we look for every opportunity to obtain frequent flier miles. Heck, I would even pay a little more for an item if I knew I was getting miles in return.

And we use them. We have even racked up enough miles to fly first class to Argentina – more than once! And I will tell you, for an overnight flight, it is worth every mile. Instead of stumbling to our destination and falling into bed for a nap, we awoke refreshed and ready to enjoy the day.

It can be complicated to use frequent flier miles, as there are often restrictions and blackout dates. The services in this article are meant to help consumers ensure that they can find a way to get the most out of their miles.

I don’t know; I haven’t found it to be so complicated to use miles – perhaps I should have started one of these agencies myself! The agencies charge fees in the ballpark of $150. I thought the point of using frequent flier miles was to save money!

What do you think? Do you accumulate frequent flier miles? Have you had trouble using them? Would you use one of these services? If you have used one of these services, what was your experience? Do you have any exciting frequent flier travel coming up? If so, where are you going?

I would love to hear your thoughts. Thank you for reading.