Health & Social Policy

Legally Hazy, Morally Certain

This week the Supreme Court hears oral arguments to decide if the Affordable Care Act (ACA) is constitutional. There’s no doubt the health reform law – commonly referred to as “Obamacare” – has been controversial. As expected, exaggerated claims and half-truths are again flying across the political airwaves. While it won’t be fully implemented until 2014, in the last few months preliminary evidence of the law’s benefits has started to accumulate. This demonstrates that, regardless of how the Supreme Court rules on the law as a whole, the Affordable Care Act contains numerous consumer protections that should be preserved.

For example, since September 2010, over 2.5 million previously uninsured young adults have gained health coverage. This is a result of an ACA provision that allows individuals to stay on their parents’ health insurance up to the age of 26, regardless of whether they are out of school, unemployed or married.

Another protection has made numerous preventive care services available for free. So far, around 86 million Americans have received improved access to vaccinations, cancer screenings, wellness counseling, well-baby visits and more.

New rules are also helping ensure value for consumers’ premium dollars. For example, not only do insurance companies have to publicly justify all rate increases above 10%, but independent experts now review all proposed rate hikes to ensure they are based on reasonable cost assumptions.

Moreover, depending on the plan, insurers are required to spend 80 to 85 percent of every premium dollar they collect on health care bills and quality improvement. Those that spend too much on administrative overhead, marketing and profits are required to refund the difference. The government estimates that consumers in wasteful plans will collect $1.4 billion over the next three years and companies have already begun lowering their premiums to meet the new requirement.

Most recently, a new report from the Department of Health and Human Services estimates that the Affordable Care Act has eliminated lifetime coverage limits for 105 million Americans. With the high cost of health care, too many of our family and friends have had to worry that a major accident or illness would not be fully covered – no longer.

Still, critics on the left disparage Obama for not achieving a single-payer, “Medicare for all” system, or even including a government-run insurance option to compete with private insurers. Critics on the right lambaste Obamacare for its interference with both the private market and states’ policymaking prerogatives.

Yet while few argue that the ACA is not flawed, if its coverage-expanding measures come into effect in 2014 its most important impact is likely to be the establishment of the right to universal health care.

This, more than the already-mentioned reforms or the others now in effect, such as closing the prescription drug “doughnut hole,” making policy information standardized and clear, stopping insurers from dropping individuals to avoid paying covered claims and establishing an insurance program for people denied coverage because of pre-existing conditions, will fundamentally change America’s social consciousness.

Just as we see a strong backlash against perceived attempts to weaken Social Security and Medicare, it is doubtful there will be support for revoking more than 30 million people’s access to health care once the vast majority of the population has health insurance. At that point, the questions for future reform efforts will center on how best to deliver and pay for health care, not whether it should be universally provided in the first place.

Of course, getting to that point depends on the Supreme Court upholding the ACA. While we won’t know the outcome of this week’s landmark hearing until June, we should bear in mind that there is already an array of reforms making the health care marketplace fairer and more efficient. These changes have had real benefits in real people’s lives and they deserve our support  – whether the law is upheld or not.


Leave a Reply

Your email address will not be published. Required fields are marked *