Tag Archives: role of government

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.

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

Pineapples, The Limits of Privatization and Corporate Influence in Education

Gail Collins wrote an opinion piece in the New York Times earlier this week entitled “A Very Pricey Pineapple.”  This article highlights the increased influence of big business in the US education system since the No Child Left Behind Act passed Congress.

The article raises concerns about whether the companies who profit from education are more interested in improving kids’ educational attainment, or whether their main interest lies in improving their bottom line.

This story is directly related the post I wrote earlier this week about the new book by Professor Michael Sandel, entitled “What Money Can’t Buy: The Moral Limits of Markets.” That book appears to argue that certain fundamental things should not be subject to market whims and to the eternal quest to increase corporate earnings.

Access to health care comes immediately to mind. I realize this is a highly contentious issue currently being debated in a wide variety of venues, from the corner coffee shop to the Supreme Court. Of course, the morality of the market determining what type of health care a person can access is not what the Supreme Court is debating; they are simply deciding whether people can be required to purchase health insurance and whether the federal government has the authority to enact the law. Even if these provisions of the law are upheld, the market will still dictate which insurance a person will purchase.

For all of the opposition in some camps about “Obamacare,” in many ways, the Affordable Care Act was one of the greatest corporate subsidies ever passed by Congress. This is a stark example of the tendency of policymakers in the United States to cater to the marketplace, regardless of the issue. Campaign financing plays a major role in this, as it does in most policy decisions. When the largest campaign donations consistently come from large corporations, policy decisions are inevitably impacted. The Citizens United Supreme Court decision will likely only make this worse.

Education is another area where corporate influence should be minimized. In a time when educators feel constrained by the need to “teach to a test,” it is disturbing to learn that the tests that have become so ubiquitous in our schools deliver a hefty corporate profit and may or may not be delivering actual value to the students and educators. The influence of the corporate lobbyists in crafting the No Child Left Behind law is striking as well.

What do you think? This raises the persistent question regarding the appropriate role of government in our society. Is there really anything wrong with a corporation making a profit on educational testing if the outcomes lead to better educated students? Are there safeguards that could be put in place to ensure that the interests of students are placed above the interests of corporate shareholders?  Are teachers finding that they must cater their classes to these tests? Do they find that this inhibits their ability to cater to an individual child’s needs? Are you concerned about the move to privatize government services and programs or do you believe that this will improve services and programs?

Please take a minute to share your thoughts. And thank you for reading!

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Filed under Education, Policy, Privatization, Role of Government