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The Affordable Care Act and the Supreme Court

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Speculation as to when the Supreme Court will issue its decision on the Affordable Care Act abounds. Rumors about their decision are flying; Ruth Bader Ginsburg made a statement at a conference held by the American Constitution Society last Friday that, “Those who know don’t talk. And those who talk don’t know.” True to her word, she wouldn’t give any hints about what the decision will be. Most news outlets are speculating that America will have a decision in the next two weeks.

There are three ways the Supreme Court can go: strike down the act in its entirety, uphold the act completely, or do away with the individual mandate and leave everything else intact.

The Affordable Care Act is divisive and polarizing. It’s nearly impossible to find a source that doesn’t add their spin to the issue. So much of what has been written is so blatantly opinionated it’s hard to take it seriously. But I’ve sifted, searched, and read articles on both sides of the fence. Here’s my brief breakdown of what could happen after the decision is made.

The Affordable Care Act is upheld: Speaking on This Week with George Stephanopoulos, President Obama’s senior advisor David Plouffe stated that he and the administration are confident the act will be found constitutional. When pressed, he did admit that while he would not go into details the administration is prepared for any decision the court makes. I haven’t found any sources that agree with Plouffe’s view that the act will be upheld in its entirety. But as Justice Ginsberg says, “Those who know don’t talk.” So while I don’t believe this outcome is likely, it shouldn’t be completely discounted.

The individual mandate is struck down, but the rest of the act survives: The individual mandate is far and away the most unpopular aspect of the act. Writing in the New York Times, Robert Reich, former secretary of labor in the Clinton administration, argues that striking down the individual mandate could have some good unintended consequences. His reasoning: with the individual mandate gone but the act still in place, insurance lobbyists will swarm the capitol. They’ll argue that without the mandate, they can’t possibly continue to cover individuals with pre-existing conditions. However, coverage for individuals with pre-existing conditions (like people with juvenile diabetes or a heart condition) has proven to be one of the most popular aspects of the law. Reich writes, “This opens the way to a political bargain. Insurers might be let off the hook, for example, if they support allowing every American, including those with pre-existing conditions, to choose Medicare, or something very much like Medicare — in effect, what was known during the debate over the bill as the ‘public option.’”

There are some aspects of the law that are popular on both sides of the fence. Forbes ran a story in April reporting that obesity now costs Americans more in healthcare spending than smoking does. Rick Ungar writes, “Reuters is reporting that obesity in America is now adding an astounding $190 billion to the annual national healthcare price tag, exceeding smoking as public health enemy number one when it comes to cost.” A provision in the Affordable Care Act allows employers “…to charge obese employees 30 to 50 percent more in what they contribute toward their health insurance benefit should an employee refuse to participate in a qualified wellness program designed to help them lose weight. You may also not know that the reform law includes incentives to Medicare and Medicaid beneficiaries to get them into a primary care doctor to discuss and execute a weight loss program.”

Children are able to remain on their parents insurance until age 26. That policy accounts for millions more insured individuals, and has also proven to be one of the most popular provisions contained in the law. If the individual mandate is ruled unconstitutional, some popular aspects such as these will likely remain.

The Affordable Care Act is ruled unconstitutional: Republicans in Congress have already begun to craft their own versions of a health care law. President Obama, despite declarations of confidence in his law, has no doubt begun to plan for this outcome. The end of The Affordable Care Act does not mean the end to health care reform. Annual spending on health care in America is unsustainable and threatens our economy. With the election in full swing, don’t expect anything of significance to take place until at least January 2013. But we can be sure action will be taken. As Robert Reich puts it, this isn’t the end; it’s the end of the first round.

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