NPR and Bloomberg.com reporting the Affordable Care Act (Obamacare) has been upheld by the U.S. Supreme Court...and Congress had the power to impose a tax, albeit the individual mandate. I am shocked Justice Roberts, apparently not wanting to go down in history as being part of a neocon SC, sided with Pres Obama and voted to uphold ACA.
Rachel Maddow points out the role of the Affordable Care Act in solving the problem of America's terrible health care system, and talks with Dahlia Lithwick, senior editor and legal correspondent for Slate, about the bigger picture of Thursday's Supreme Court ruling upholding the Affordable Care Act's individual mandate.
A second chance for Democrats to make the case for health care
The Rachel Maddow Show June 28, 2012
Rachel Maddow makes the case for why the real benefit to Democrats of the Supreme Court's upholding of the Affordable Care Act is that they can campaign on its politically popular components - provided they can compete with the massively funded opposition advertising that will run over the course of the unduly long 4-year roll-out of the plan.
This is the first article in Bedside, a new series about nursing and health care.
He was one of those salt-of-the-earth guys from the rural part of Pennsylvania. Middle-aged, married with adult kids, he’d worked his whole life running his own small business, a local restaurant that he jokingly called a bordello. His wife worked, too, and she had health insurance, but he wasn’t on her policy. Maybe he couldn’t afford it, or he was saving money by playing the odds. After all, he’d always been healthy. And then one day he had leukemia.
I was his nurse, and he surprised me one afternoon by bringing up “death panels.” Usually I avoid having political conversations in the hospital, but he was preoccupied with something that wasn’t real. I didn’t want him worrying about a chimera when he was adjusting to a diagnosis of cancer and an inpatient hospital stay that would last six weeks or more.
I told him there was no such thing as death panels.
“Really?” he said, in his raspy voice. “Because I hoped there were.”
Since he lacked insurance, he feared treatment would bankrupt his family. Trading his life for their livelihood wasn’t an exchange he could make. A death panel, he reasoned, would spare him that cruel choice.
This was not suicidal ideation, but the worries of a kind and caring man. Hospitals are filled with people like him, patients who will need thousands of dollars of medical care just to have a chance at staying alive. At the top of the list are those with a fatal cancer. But there are many other less obvious ones: a patient who got kidney failure from strep throat, a healthy 22-year-old who needed a stay in the intensive-care unit to survive the H1N1 virus, a flight attendant far from home and desperately short of breath because of a blood clot in the lungs.
As a result of the 1986 Emergency Medical Treatment and Labor Act [ http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html ] [and see (linked in) http://investorshub.advfn.com/boards/read_msg.aspx?message_id=73816231 and preceding (and any future following)], patients needing immediate care cannot be turned away from an emergency department because of an inability to pay. But who picks up the cost of that visit and any later care that’s required? Either uninsured patients get huge bills from the hospital, or the rest of us pay for their care indirectly, through higher insurance premiums and increased out-of-pocket costs and deductibles.
The problem is, this robbing-Peter-to-pay-Paul system is quickly becoming economically unsustainable. The uninsured are not paying into the system up front, but one way or another the costs of their care are still being covered.
To address this cost-benefit disparity, the Affordable Care Act requires all Americans to buy health insurance — the idea being that if most of us pay regular insurance premiums, then we as a nation will have enough money in the insurance pot to cover everyone needing care at any one time. Additionally, requirements for getting insurance will become more uniform, and costs will drop.
If the Affordable Care Act is overturned — either legislatively or by the Supreme Court, which might announce a decision on its constitutionality this week — the insured will continue to subsidize the uninsured. Costs of coverage and care will rise, in turn making insurance affordable for fewer and fewer people.
Critics of the Affordable Care Act argue that many Americans neither want nor need health insurance, and that it forces them to pay for coverage against their will. But just as the government collects taxes to pay police officers and firefighters, the individual mandate compels Americans to pay for a service they may not immediately want but could at any time desperately require.
Much of the debate has focused on the role of government in everyday life. I don’t discount the value of that question, but my focus is on real needs. I treat patients with $20,000 chemotherapy injections or monthly doses of IV immunotherapy that cost $10,000 a bag. If they don’t receive these drugs my patients will die, so to me, the most pressing issue here is compassion. Without change, the patients will resemble the man with leukemia, human beings without insurance terrified that their lives aren’t worth what it will cost to save them, all because of a broken but fixable system.
Crowds at conservative rallies have, astoundingly, cheered the idea that uninsured people should, if they become ill or badly hurt, be left for dead [again, (linked in) http://investorshub.advfn.com/boards/read_msg.aspx?message_id=73816231 and preceding (and any future following)]. It’s easy to imagine such a thing in the heat of a rhetorical moment. But the reality is, I hope, harder to embrace. Because reality means a real person — you, me, someone we know — condemned to a possibly preventable death because, for whatever reason, they don’t have insurance.
My patient with leukemia is dead. He got the best care money could buy, but his disease only briefly went into remission and he went home on hospice care. Should he, because he did not buy insurance, have been denied this chance for a cure?
The Affordable Care Act is not the health care solution everyone wants, but when patients wish for death panels as a response to leukemia, something needs to be done, and soon. This plan would help any patient facing a tough diagnosis not view treatment as a choice between his money or his life.
Former GOP Spokesman: 'Is Armed Rebellion Now Justified?' Lansing attorney does not like Supreme Court Obamacare ruling June 28, 2012 http://www.michigancapitolconfidential.com/17151 [with comments]
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President Obama Victory Message on Health Care Law
In a surprise move in its decision to uphold the ‘Obamacare’ mandate, the Supreme Court declared that states may opt out of the law’s Medicaid expansion without losing all federal funds for the program.
“In the 47 year history of the program, there has never been a successful challenge to any of the Medicaid expansions, so this was rather unusual,” said Ron Pollack, director of the consumer group Families USA.
The decision is expected to at least slow down implementation of the new Medicaid provisions. If states refuse to participate en masse, it could lead to significantly fewer people than the projected 17 million being covered under the Medicaid expansion.
The Supreme Court held that the Medicaid expansion in itself constitutional. But it essentially decreed it a new program, which means states cannot be punished for turning it down. The court rejected the Obama administration’s argument that states must accept the expansion or risk losing all federal Medicaid funds.
“The practical effect is that it will make the Medicaid expansions go more slowly,” said Sara Rosenbaum, a professor of health law at George Washington University. She added that it may be left to future courts to determine which parts of the Medicaid expansion count as a new program and which parts are merely additions to the existing one.
Republican governors will face pressure to reject the Medicaid expansion or risk being accused by conservatives of willingly embracing a big part of ‘Obamacare.’ But there’s an incentive in the other direction; namely: a huge cash gift from the federal government, which covers the full cost of the first three years of expansion.
“It’s very easy for these Republican governors, pulled by the tea party, to say, ‘Oh we’re going to pull out,’” Sen. Chuck Schumer (D-NY) told reporters Thursday after the Suprme Court decision. “When they see what it does to pull out … they’re going to lose the incentives. They’re going to lose the dollars. They’re going to lose the new people covered. And their small businesses are going to lose the subsidies. I don’t think they’re going to be so eager to do that when they actually look at the benefits to the states in the Medicaid provisions of the bill.”
“It will be interesting to see what happens in the 26 states that challenged Obamacare,” said Adam Winkler, a professor at UCLA School of Law. “Will they go through with their threats of not expanding their own Medicaid coverage? Or will the promise of federal money persuade them to expand coverage?”
But even for the willing states, the ruling gives them more leverage with the Department of Health and Human Services before they opt in, a negotiating tool that Democratic governors may also want to take advantage of.
“I think that transcends party lines,” said Rosenbaum.
Neither the White House nor top Democrats expressed much concern that states would decide to opt out. “We’re not bothered at all with the decision in regard to Medicaid,” said House Minority Leader Nancy Pelosi. The view that it wouldn’t significantly disrupt coverage under the law was echoed by outside advocates of Medicaid and the expansion.
“I think the states are going to pick this up,” said Pollack. “It would be an act of fiscal malpractice for states to turn this down.”
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