There has been so much discussion about “Obamacare,” the Supreme Court, and what will happen with health care, that maybe you will appreciate this basic information. The Patient Protection and Affordable Care Act (PPACA), otherwise known as “Obamacare” was signed into law by President Obama on March 23, 2010 (Public Laws 111-148 and 111-152). There have been various legal challenges of it, and the United States Supreme Court listened to the basic arguments in March. Although the Supreme Court can set its own schedule, a ruling is expected before the end of June.
Basically, the legal question is this: In order to make health care affordable to everyone in the United States, is it necessary and proper for Congress to make a rule that says that everyone must buy insurance? Most experts agree with these statements:
- The legal question is whether it is necessary and proper to use the Commerce Clause of Article I Section 8 of the United States Constitution to require or “mandate” that American citizens shall buy health insurance.
- Congress and the President do have the Constitutional power to impose a federal tax for heath insurance. Probably to claim that they did not raise taxes, Congress and the President instead required everyone to buy insurance, which has resulted in this legal challenge. Because there is no question that Social Security and Medicare are funded legally by taxation, don’t worry that whatever the Supreme Court does in the next few months will jeopardize your Medicare or Social Security, because it will not.
- While many Americans choose not to drive a car and therefore are not required to buy car insurance, no one can similarly choose not to need health care, because we cannot decide that we will never become seriously ill or badly injured. (And, incidentally, auto insurance is required by states and not the federal government.) There is a present “hidden cost,” to those who are insured or otherwise pay for health care, to offset the cost of the medical care for uninsured people, who are not turned away by hospital emergency rooms when they show up for care.
As if these questions do not provoke enough arguments and problems, if the Supreme Court rules that the federal mandate to buy health insurance is unconstitutional, the next question (of “severability”) is whether that means that the whole PPACA-Obamacare legislative package must be thrown out, or whether some parts may remain. The Laws total 961 pages, and the related regulations are expected to be five times that large. On a practical level, it could be difficult administratively to understand which parts of the Laws would be invalid if not all of it. Many experts say that, if everyone is not required to buy insurance, what remains in the PPACA-Obamacare plan can not work. Along that line of thinking, The Community Living Assistance Services and Supports (CLASS) Act, which was a component of Obamacare, was abandoned by the President and Congress after the Government Accountability Office concluded in October 2011 that it would not be economically viable since not all Americans were required to participate in that program, which was intended to provide long term care insurance.
If the Supreme Court rules that PPACA-Obamacare is Constitutional, some opponents suggest that this will open the door for the federal government to impose additional requirements on individual Americans to make other purchases that are in our collective best interests. For example, Supreme Court Justice Scalia suggested that, since we all know that obesity is a major cause of excessive health care costs, if the PPACA-Obamacare is Constitutional, Congress might then use the same logic to require individuals to join an exercise club. Other Supreme Court Justices have commented in a way that suggests they believe that Justice Scalia is exaggerating, and minimizing the necessity of making the mandate to buy heath insurance an exceptional circumstance.
Whatever the Supreme Court decides, it would be unwise to expect the federal government to be financially able or otherwise competent to guide individual Americans towards getting the best heath care. Those of us at Keystone Elder Law encourage everyone to eat healthy foods, exercise regularly, get regular medical check ups, and buy long term care insurance. In fact, each of us is doing at least one of those things. If you have a tip for how to improve the healthy living of senior adults or caregivers, feel free to share it with us. We promise not to appeal your suggestion to the Supreme Court!