June 24--As a single mother of two young adults, Jenny Collier knows how limited their health care options have been, since her son's and daughter's employers didn't offer health insurance.
So it was a relief to her when the Obama administration's health care law made it possible for them to go back under her East Stroudsburg University family coverage.
Now, the Portland woman is worried again that their coverage may be in jeopardy as the U.S. Supreme Court prepares to hand down its ruling on the health care law as early as Monday.
"I'd hate for us to go backwards instead of forward," she said.
Others say the only way to go forward is to strike down the law, which has divided the country.
If it stands, the law will reach deeply into America's family and business life, providing coverage to millions more Americans -- at a cost. If all or part of it is declared unconstitutional, the fallout likely will be dramatic and could add to the ranks of the uninsured -- also at a cost.
In addition, there are constitutional questions that, if the law is found invalid, could radically change the relationship between the federal government and the American people.
Any way the justices rule, the impact will be monumental.
"There's a lot at stake for individuals, seniors and small businesses," said Antoinette Kraus of the Pennsylvania Health Access Project, a supporter of the law.
The court in March heard arguments in several lawsuits over the law, known as the Patient Protection and Affordable Care Act, and is likely to hand down its ruling this week, court watchers believe. Pennsylvania, under then-Attorney General Tom Corbett, last year joined one of those suits, arguing that the individual mandate, which compels people to buy health insurance, is unconstitutional and that the law goes too far in forcing states to increase Medicaid spending.
Reducing the nation's burgeoning uninsured population was the prime goal of the law, which President Obama signed in March 2010 after it narrowly passed Congress. As of 2010, 16 percent of Pennsylvania adults 18-64 were uninsured, while the national average was six points higher, according to the U.S. Centers for Disease Control and Prevention. The main thrust of the law, the mandate requiring most individuals to purchase health insurance or face penalties, becomes effective Jan. 1, 2014.
Striking down the entire law would be the best outcome, said Elizabeth Stelle, a policy analyst with the Commonwealth Foundation, which supports free-market solutions.
Legislation that has lingered in state houses for years -- allowing consumers to buy health care across state lines or providing options for consumers to tailor coverage for their specific needs -- could get a real hearing, she said.
"We think this is a great opportunity for the states to step up to the challenge," Stelle said, noting that the measures "haven't gained any traction" up to now.
"I think there's going to be a change because people are going to be more aware of what hasn't worked," she said. "Health care is getting more and more expensive, so there should be renewed pressure to push some of the reforms that have been around for decades that [state legislatures] have continued to ignore."
Kraus, however, said people like the benefits that have already become available. Under the law, young people with pre-existing conditions cannot be dropped from coverage, $3.7 billion in payments have helped seniors bridge the Medicare Part D "doughnut hole" and around 5,000 adult Pennsylvanians with pre-existing conditions now get insurance through Pennsylvania Fair Care, funded by the Affordable Care Act.
"If they take away their benefits, people are going to get really upset," Kraus said.
But the law has failed to gain widespread public support. In a recent AP-Gfk poll, 33 percent said they supported the law, while 47 percent opposed it. Other recent polls have had closer margins, but Gallup in a report Friday characterized Americans' feelings for the law as "at best mixed."
Some measures already taken or under development will continue regardless of the court ruling. Health care providers are converting to electronic medical records. Some states may keep and operate the exchanges being developed as one-stop shops for people searching for health insurance. Affordable Care Act-related mergers and consolidations that occurred in recent months and years won't be easily undone, either.
Other measures have yet to take full shape. Qualified small businesses would get a 35 percent tax credit to lower the cost of providing insurance, rising to 50 percent in 2014. But a recent Government Accountability Office report said participation was low, as 28,100 small businesses got the full credit in 2010, although early estimates were that as many as 4 million small businesses might qualify.
A decision finding the law unconstitutional would throw into question the federal government's role in society in many different ways, said Seth Kreimer, the Kenneth W. Gemmill professor of law at the University of Pennsylvania.
Kreimer said the two main constitutional questions -- whether the government can compel individuals to purchase health insurance or pay a fine and whether it can compel states to increase Medicaid spending -- are concepts that have been supported by courts for the past 70 years. It would require "a very different analysis" of prior court decisions to find constitutional grounds to reject the act, he said.
A rejection of the law would put "a large array of federal programs" in question, Kreimer said, citing as an example the federal government's authority to have states apply the teaching standards set by the No Child Left Behind law.
Upending that authority would radically change constitutional law, he said.
"As a teacher of constitutional law," Kreimer said, "it would be convenient if I didn't have to rip up all of my notes."
The Obama administration in recent days has been promoting the benefits vigorously, sending Health and Human Services Secretary Kathleen Sebelius and regional deputies around the country to highlight the act's benefits.
Last week, Joanne Grossi, director of the HHS region covering the mid-Atlantic states, came to Allentown to announce that the Neighborhood Health Centers of the Lehigh Valley would receive $650,000 in funding issued through the law. A few days earlier, the centers also learned they would share in a $14 million grant to finance a comprehensive community health project.
It is unclear what would happen to the funding, and funding for countless other projects, if the court rules the law unconstitutional. It's also unknown how a complete or partial overturning of the law would affect insurers that are counting on the additional customers, as well as their existing policy holders.
THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
Benefits already provided:
-- Three million young adults nationwide who would otherwise be uninsured received insurance coverage under their parents' plans.
-- $1.1 billion in insurance rebates paid to consumers by insurance companies that spent more than 20 percent of their premium revenues on administrative costs. Pennsylvania consumers got $51.6 million in rebates.
-- 105 million people, including 4.6 million in Pennsylvania, with chronic diseases and serious illnesses no longer have a lifetime limit of insurance coverage.
-- $5.7 billion paid to more than 100,000 providers and 2,400 hospitals as incentive to establish electronic health records systems. Pennsylvania providers received $291.5 million.
-- Under new rate review authority, insurance companies are required to provide justification for high rate increases to the federal government, which posts those justifications online. The government found that two rate increases affecting 42,000 people in nine states were excessive.
Source: U.S. Dept. of Health and Human Services
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