Let’s face it-
This week’s signing of the bill into law has been met with everything from cheerful applause to scathing critiques and legal challenges. Even protests involving vandalism and violent threats have already been reported. Personally, I like the idea of extending health care to more people, especially to those whose health truly needs attention. Yet I noticed upon closer scrutiny that the law does contain some questionable provisions- namely the mandates that all must purchase health care coverage, and the law’s treatment of illegal immigrants. Of course, not all attempts at reform are perfect, but it is definitely worthwhile to take a close look at the law’s effects.
That being said, the new health care law does purport to accomplish a huge, sweeping overhaul of the nation’s current health care system. Such a broad scope of reform has not been seen since the passage of Medicare and Medicaid in the 60’s. So what exactly does the new piece of legislature entail? And why are so many people upset at what appears to be a legitimate step towards improvement?
What it entails: Basic Provisions of the Law
To begin with, the law purports to extend health care coverage to an estimated 32 million more Americans who are previously without coverage. This would raise the percentage of Americans who have health care insurance to about 95%, while currently it is estimated at 83%. The law seeks to accomplish this in both major and minor ways. Some of the more immediate “minor” effects of the law have to do with changing the way that health insurance providers have been enforcing their policies. For example, the new law makes the following changes:
- Health insurance companies can no longer deny coverage to children with pre-existing conditions
- Adults who do have pre-existing conditions will have more coverage plans available to them than before
- Dependents can remain on their parents’ coverage plans up to the age of 26
Most of the above provisions regarding insurance policies will go into effect immediately. However, most of the controversy of surrounding the law has to do with the more far-reaching effects of the law, which don’t kick in until 2014.
2014 and Beyond: Huge Changes and Questionable Mandates
Here are the major provisions of the law, most of which will not take effect until 2014.
Creation of State-Based Health Insurance “Exchanges”
- As of 2014, states would be required to create health insurance “exchanges”- literal marketplaces wherein uninsured and self-employed people can purchase insurance. These would be available to people with income between the 133-400% poverty level.
- For small businesses, separate exchanges will be created where they can purchase coverage for their employees.
Mandatory Insurance Requirement:
- Employers: Employees who have more than 50 employers must provide health insurance. Failure to do so will result in a fine of up to $2000/year per worker.
- Individuals: In 2014, everyone must purchase health insurance. Failure to do so results in a $695 annual fine, though some exceptions exist for those with low-income. (This specific mandate is where all the controversy is focused at)
Various other provisions:
- Medicare and Medicaid: The law provides for various adjustments in these areas with regards to seniors, families, and childless adults, attempting to close the “doughnut hole” in current coverage.
- Abortion: Health care coverage would not be required to obtain abortion coverage. Further, private insurance funds would be segregated from taxpayer funds, and abortion coverage would be paid for in two separate payments.
- Illegal immigrants: Illegal immigrants would not be allowed to purchase health care insurance from the state-based exchanges. They also would not be eligible for Medicaid under the new law.
- Tax effects: Funding for the new provisions will come largely from new tax expansion efforts, covering everything from Medicare payroll tax effects to increased taxes for insurance companies selling high-end premiums. There will even be a 10% excise tax on indoor tanning services (!!!)
Criticisms of the Health Care Reform Law: Immediate Legal Response
Just moments after the bill was signed into law, prosecutors from 13 different states gathered together and filed suit in a Florida federal court, claiming that the new health care law is unconstitutional. Specifically, the lawsuit focuses on the mandatory insurance requirement, i.e., that all individuals will be required to purchase coverage. The prosecutors claim that such a mandate is unconstitutional and that Congress lacks the power to make such a requirement. There may also be a challenge based on the “deem and pass” procedure that was used in getting the bill passed.
On the other hand, proponents of the law point out that Congress does have the power to regulate interstate commerce under the commerce clause of the Constitution. They claim that it is hard to imagine that the purchase of health care insurance does not in some way affect interstate commerce. Thus, the lawsuit has now become a question of whether or not Congress may undertake such an unparalleled regulation of interstate commerce.
There are several other criticisms circulating as well. Among these are that the law’s motivations are blatantly political and that it is strikingly non-bipartisan. Not one Republican voted for the bill; also, a comparison the timing of the key provisions of the law reveals that they conveniently coordinate with the upcoming election schedules. So some suggest that the passage of the law is part of carefully arranged political program rather than an honest attempt at benefiting citizens.
Another point is that while the law is far-reaching, the major effects will not really start to be felt until 2014. In the meantime, people will have to endure the current conditions of health care until the major provisions take effect. Four years can be a long time, most especially for someone with a serious health condition.
Finally, many are confused at the law’s seemingly discriminatory treatment of illegal immigrants. Those who are not validly in the country will be denied access to health care through the routes which are created and required by the law itself. It’s almost as if the law creates channels through which treatment may then be withheld for some.
Final Notes: Separation of Powers and Legal Recourse
In spite of all these criticisms, to me it seems unlikely that the court will overturn this new law. Health care reform has been an area of struggle for far too long, and this legislation is much too comprehensive to be struck down in a single ruling. Also, from what I understand, courts have traditionally been reluctant to challenge Congress’ decisions. In the past they have ordered claimants to resort to legislative process rather than the court system for change, especially with regard to all-encompassing themes such as the commerce clause.
In fact, this is one of the twists that initially struck me with this new law being passed. Normally we are used to seeing a person raising a challenge in court, only to have their claim denied, with the court instructing them to seek justice through the legislative process. On the flip side, here we have a piece of legislature which, even before being signed, already had a legal challenge waiting to pounce on it. Recognizing the futility of trying to oppose the bill through the legislative branch, recourse is consequently being sought through the judiciary branch.
If anything what we have here is a fascinating example of the principle of separation of powers. It is an excellent case study of the system of checks and balances upon which our government is founded. The passage of the act has been already been called “the pinnacle” of Obama’s executive career. It will be exciting to see how the various clashes play out through the different branches of government. In the meantime we can expect to see all kinds of arguments for and against the new law, and an even more diverse array of responses.
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