Health Care Reform - To Be or Not To Be? The Justices Will Decide

Ernie Shannon's picture

Months of anticipation ended this week when the U.S. Supreme Court finally heard arguments in support of and opposition to the Affordable Care Act, the nation’s new health care law. The three days of hearings didn’t disappoint in terms of theatre. The justices mixed serious questions with humor while the U.S. Solicitor General representing the administration’s case for health care reform, unwittingly mixed humor with legalese. Outside the venerable Supreme Court building rallies were held consisting of song, shouting, verbal abuse, and a GOP presidential candidate. All in all, a memorable week.

However, the reality of what transpired in the nation’s supreme courtroom is not so comedic. The four conservative justices joined by their more moderate colleague, Anthony Kennedy, came to the hearings with grave concerns regarding the federal government’s right to mandate health care coverage for all Americans. Even the four liberal judges raised questions on that matter and though generally supportive of the administration’s arguments, they were by no means in lockstep with the Solicitor General. Where the justices brought the issue to the level almost any American could relate to: cell phones, broccoli, food shopping, Solicitor General Donald Verrilli stumbled through arcane cases few outside the legal community had ever heard of and terminology guaranteed not to inspire anyone, but law professors and their most ardent students. For an administration that has owned its opposition for more than three years with down home homily and real-life examples of Americans in need of better health care, the omission of any effort to personalize the hearings was striking.


Some of the justices were not shy about signaling their intent regarding the constitutionality of the Affordable Care Act. Their decision is expected in June and their written opinions should be interesting reading to say the least. The question now is – what happens to the nation’s health care system?

The Department of Health and Human Services has worked doggedly to implement as much of the new health care law as allowable. Much of the law doesn’t take effect until 2014, but many interim steps have already been taken. For instance, the fifty states have been granted millions of dollars to establish health care exchanges whereby small businesses and individuals can purchase medical coverage from approved vendors. At least half the states have moved forward in adopting the exchanges or preparing guidelines for doing so.

Multiple insurance companies have had their hands whacked when trying to raise premiums beyond a level Health and Human Services felt was justified. And other companies have been put on notice that their expenditures for non-health care related items were too high. That part of the health care law requires insurance providers to spend at least 80 percent of their income from premiums on actual medical care. Will these decisions rendered by the federal agency be overturned now? Or will they simply be ignored by states and the health care industry now confident the Supreme Court will deem the law unconstitutional?

Finally, the pundits are now having their say. Opponents of the Affordable Care Act are thrilled that the law may soon be put out of its misery while supporters are suggesting the rejection of health care reform will actually help Democrats in the November elections.
The fact of the matter may well be this: the American health care system is not a failure as some would have us believe. Every day, dedicated scientists and researchers throughout the United States lead the world in developing innovative treatment for disease while devoted physicians provide care most nations could only dream of. On the other hand, costs are spiraling out of control and for many Americans access to quality care or any care at all is out of reach. There must be solutions somewhere between doing nothing, as has been the case for decades now, and mandating and micromanaging the administration of health care that is at the core of the Affordable Care Act.