The US Senate conducted
their expected vote to repeal the ACA
(Affordable Care Act), as demanded by Minority Leader Mitch McConnell (R-KY). Dems lined up in unity to protect ACA, and
the effort was defeated as expected, and along purely partisan lines 51-to-47.
This effectively kills the House bill to repeal the ACA. So, in this regard,
the ACA’s prospects of proceeding toward full implementation (in 2014 and
thereafter) was enhanced by this outcome.
Nonetheless, and at the same time, you all saw the parallel
potentially calamitous legal ruling from Florida US District Court judge (a Republican appointee) Roger Vinson. This judge opined that
the ACA violates the Constitution and therefore cannot
proceed in the 26 states (25 of which are R states) that have filed suits
against on common grounds. These filings all claim that the law is
over-reaching and violates the controversial “Commerce Clause” of the
Constitution. Unlike two other court decisions opining against the law’s
‘individual insurance mandate,’ Vinson’s ruling would void the entire law. He opines that the individual mandate
provision is such a central and interwoven provision of the ACA that halting implementation
of the act is necessary, and thus requiring that the whole law be voided.
However, he didn’t issue an injunction to actually halt its
implementation, believing the federal government is obligated by tradition to honor
his decision, unless or until his order were to be successfully appealed.
Regardless, the federal government says it will NOT halt
implementation, which already has proceeded to issue rebate checks to millions
of seniors to cover their ‘donut hole’ prescription costs; establish
high risk pools for those unable to get insurance; and implement various
insurance reforms including allowing children up to age 26 to piggyback on
their parents’ coverage. Federal attorneys cite in their defense that two
similar courts have opined that the law can stand as is. But this new decision
complicates things. Proponents of the
ACA are a bit scared. As we have noted
before, the controversy must and will go to the Supreme Court before it is
resolved, and most likely first through the federal appellate courts, meaning
this controversy will drag on for a year longer.
State and other ACA opponents will ask that implementation
be halted following this decision; while the Administration and supporters will
ask for a stay of this ruling until they appeal it. People who already have
received new benefits, including voting seniors, won’t like having to pay back
their benefits if the law is voided! So
this will be interesting to watch.
The Republican governors in the states of Wisconsin and Florida have
already stated they will halt all activity around health reform and the ACA. I
suspect Arizona will follow. But, most states are going to proceed, if
cautiously, noting they will otherwise get too far behind to catch back up, and
hoping they can contain or slow health care cost increases through such efforts.
Most DC constitutional legal experts still seem convinced
the law will sustain legal challenges at the Supreme Court, based on historic
decisions and precedent around the Commerce Clause. And Congress hasn’t stopped
its own pro- and con- actions around the ACA.
I think that’s important to
consider for us as doctors and health care professionals and patients. We are
politically spread over the spectrum like the general public. But health care
is not a mainly partisan issue. Do people have the freedom to avoid health coverage,
and then allow EMTALA to require us physicians and hospitals to provide the
care, and/or include the costs of uncompensated coverage for all other American
at an average of $1000 per year? I think fixing the ACA is smarter than
repealing it (this also seems consistent with ACC reform principles). But I
also agree with most Republican opponents of the ACA that the deficit must be seriously
addressed, something liberal Dems don’t want to take very seriously.
I think individual liberty requires taking responsibility for yourself.
As physicians, we get stiffed if people want to opt out of health coverage (or refuse
to chip in for their fair share of health care costs). So does every insured
person currently have to pay for those who don’t chip in for their own health
care needs -- and we all end up needing health care.
But this is the discussion we need to have as a nation.
I still suspect the law will stand, and get amended significantly
to fix its glitches and gaps. No guarantees though. And all said, it’s important to remember that with or without
the ACA, folks, we’re heading up a
metaphoric creek without a paddle if we irresponsibly drift along with the
status quo any further. Health reform is essential to remedy the economic
nightmares created by the incessant and future projected cost increases of
US health care, public and private; and the fact that the average family is now
spending more than a third, and will be spending in less than 5 years nearly
half, of their income (45%) on health costs is unsustainable for business,
families, or government! Hello. We live in a time with amazing health care
options and services. But we have to figure out how to pay for them, and how
much to pay for as a society. Doing nothing in the current circumstance is NOT an option.