Right wing sore losers in the Republican Party and the insurance business have questioned the constitutionality of health care reform, and now the matter will be decided by the U.S. Supreme Court.
The main issue is whether the individual mandate in the 2010 Patient Protection and Affordable Care Act, which requires all Americans to buy health insurance by 2014 or face financial penalties, passes muster with the Constitution. Opponents dishonestly claim that health care is a “product” that some people may neither need nor want. But supporters correctly point out that health care is one of life’s necessities that everyone uses at some point in their lifetime. As such, no one can choose whether or not to participate in the health care market.
Health care reform came about because health care in this country had become a dysfunctional and unsustainable racket for the insurance companies, with 45 million Americans uninsured, producing $43 billion a year in uncompensated care, primarily in emergency rooms. The cost of this uncompensated care has been shifted by insurance companies to their customers as higher premiums, amounting to a hidden tax. In response, the individual coverage mandate, by reducing the number of uninsured by about 30 million, would lower the overall cost of insurance and make health care more viable.
The Supreme Court decision will resolve a split between U.S. Court of Appeals circuits over the constitutionality of health care reform. The Atlanta-based 11th Circuit upheld a challenge to the individual mandate filed by Florida and joined by 25 other states, including Michigan. Three other circuits, including the Cincinnati-based 6th, which covers Michigan, have upheld the constitutionality of the entire law. Opponents claim that if the individual mandate is found unconstitutional, the entire health care reform law should be thrown out. They have also challenged a requirement that states expand their share of Medicaid costs and administration or lose federal funding, and a federal mandated level of health care coverage for state employees.
There will be five-and-a-half hours of oral arguments in late February or March, with the Supreme Court issuing its decision by June, and the result likely proving to be a hot-button issue in the 2012 presidential race. The four most liberal justices, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan, are likely to find health care reform constitutional. Only one of the more conservative justices needs to join them to form a majority.
We have a hint on a possible Supreme Court outcome in the 6th Circuit decision on a case that originated in Michigan. Judge Jeffrey Sutton, a conservative appointee of George W. Bush, wrote the majority opinion in which he found the entire health care reform law a valid exercise of legislative power under the Commerce Clause of the Constitution. Besides that, federal mandates on individuals go back to 1792, and have included requirements to buy muskets and ammunition, serve on juries, register firearms, and sign up for the draft.
Health care reform opponents are in a race against time, for once it is completely implemented, it could very well become solidly entrenched as most Americans experience its benefits. Benefits implemented so far include no co-pays or deductibles for preventive care, dependent children allowed to remain on their parents’ policies until age 26, a limit on insurance company overhead, and bans on insurance companies canceling policies on people who get sick and setting lifetime benefit limits.