June 28--If you are not rich or not well, you had a good day on Thursday.
To the surprise of many, theU.S. Supreme Courtupheld the constitutionality of the Affordable Care Act, including its mandate that virtually all Americans buy health insurance. For Connecticut, the landmark decision means that a half-million people will not lose optimal health insurance coverage, and the state won't lose $100 million in aid, according to Gov.Dannel P. Malloy's office.
According to the White House, thousands of Connecticut residents have already benefited from provisions of the 2010 law -- 23,000 young adults under 26 have been able to stay on their parents' health insurance policies; thousands of Medicare clients have gotten prescription drug rebates and free preventitive services; more than 77,000 families will receive an average rebate of $168 under the rule that insurance companies must spend at least 80 percent of their premium dollars on health care, among other things.
The law keeps the U.S. health insurance system intact -- also a plus for a state that is home to major health insurers -- but challenges the private companies to meet stricter requirements and find more efficient and effective ways to provide coverage.
Although it was a good day for the 99 percent, it never should have come to this. Having millions of Americans without health insurance has been a national embarrassment for decades. That President Barack Obama and Congress were able to pass a reasonable health care law in 2010, after much debate and compromise, was a major accomplishment that promised coverage for 30 million of our fellow citizens. The legal/media circus was unfortunate, though perhaps inevitable in the current political climate.
A principal objection to the Affordable Care Act was its requirement that most individuals buy insurance, a mandate seen as an intrusion into personal liberty. Opponents said Congress shouldn't be able to compel an individual to buy something he or she doesn't want. If Congress can compel you to buy health insurance, opponents argued, can it compel you to eat broccoli or buy a health club membership?
Chief JusticeJohn G. Roberts Jr.agreed with the law's conservative critics who said Congress does not have the power to mandate the purchase of a private product such as health insurance, but ruled that the government may impose tax penalties on those who do not have health insurance.
The better position, we believe, is that health insurance is different than broccoli. In one of the early appellate decisions upholding the ACA, Justice Jeffrey Sutton of the U.S. 6th Circuit Court of Appeals, aGeorge W. Bushappointee, spoke of the unique nature of health care: "Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life."
Also, to keep the private insurance model afloat, we need everyone who can afford to buy insurance in the risk pool, sharing the cost. Otherwise insurance likely becomes too expensive, a factor that, ironically, could push the country toward a single-payer system.
The Supreme Court also invalidated a requirement that, as a condition of receiving federal Medicaid funds, the states provide Medicaid health coverage to all persons earning less than 133 percent of the federal poverty line. The court held that the states cannot lose all their funding if they decline to participate, only the new funds they would have received. We understand the difficulty of dealing with unfunded mandates; hopefully states will find innovative ways to cover the working poor.
All in all, a huge sigh of relief. Having working people go untreated or broke because of illness and inadequate health insurance shouldn't be a part of American life. But Republicans have vowed to repeal the ACA, so attention now turns to the November election. Stay tuned.
(c)2012 The Hartford Courant (Hartford, Conn.)
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