Posts Tagged Health Insurance

The Constitutionality of the Patient Protection and Affordable Care Act, or “Obamacare” Lives!

At this point, you probably have heard what happened yesterday in the world of politics. The big story: President Obama’s signature accomplishment, the Patient Protection and Affordable Care Act (ACA), commonly referred to as “Obamacare,” was held to be constitutional by the United States Supreme Court in a 5-4 ruling.

In what was seen by many as a surprising twist ending to the case, Chief Justice John Roberts (a traditionally conservative justice appointed by President George W. Bush) sided with the court’s four “liberal” justices to preserve the ACA in (more or less) its entirety. Anthony Kennedy, often viewed as the “swing” justice on the court, dissented, siding with the more conservative members of the court.

The heart of the question before the justices was whether or not Congress had the authority to enact the cornerstone of the Affordable Care Act, the individual mandate. The individual mandate, when it goes into effect, would require that all Americans be covered by health insurance. The more popular aspects of the legislation (forcing insurers to cover people with preexisting medical conditions, and just generally making insurance more available), ACA proponents argue, would not be feasible without greatly increasing the rolls of the insured. Basically, the idea is this: if you make it so that sick people can get insurance after they are already sick, you have to increase the number of healthy people getting insurance in order to offset the cost. Otherwise, the doomsday argument goes, every sick person in the country would run out to their nearest Health Insurance Mart and purchase policies, and the cost of treating these sick folks would put every insurance company in the country out of business. As I said, doomsday scenario, and doomsday scenarios traditionally sound a little far-fetched. Regardless, the mandate would prevent that sort of thing from happening.

Why was that relatively reasonable measure put through the Supreme Court’s wringer? Because opponents of the ACA argued that while the U.S. Constitution does indeed say that Congress has the power to make laws relating to commerce (which the nation’s massive patchwork of health care systems no doubt is), what Congress did in this instance was to make a law (the ACA) that related to the lack of commerce (the state of not having health insurance). Confused? Totally reasonable, because this is incredibly confusing. Perhaps because, as Ezra Klein of the Washington Post points out, pretty much no one thought that this was actually an issue wayyyy back in 2009-10 when the law was being written (or before that, when the mandate was an idea endorsed by Republicans and conservative think-tanks).

Now that we’ve got all that background, however, we can see what happened with the high court’s decision yesterday. Opponents of the ACA said that Congress had exceeded its power in passing a law that would “force Americans to engage in commerce”, notably using the argument that if the Affordable Care Act was constitutional, what could stop Congress from passing a law that said every American had to go out and buy broccoli. In the opinion written by Chief Justice Roberts, the Court decided that the ACA was not constitutional under Congress’s power to regulate commerce. Instead, the Court found that the law was constitutional under the power of Congress to “lay and collect taxes,” since the penalty for failure to purchase health insurance could be viewed as a tax.


Well, that was a doozy, but we got through it! To sum up: “Obamacare” is constitutional, in a 5-4 decision, with the court’s four liberals and the conservative Chief Justice in the majority. The individual mandate is a tax, and not a penalty, and Congress cannot make you buy broccoli. The end.


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Birth Control in the News: A Crash-Course

You may have noticed, over the past couple of weeks, a debate over birth control has become one of the most talked-about issues in the news. Aspects of the “birth control in the news” trend are as follows:

The office of Darrell Issa, chairman of the House Oversight and Government Reform committee, claimed that a woman witness brought to testify by the minority members of the committee was not an “appropriate witness,” saying “the hearing is not about reproductive rights but instead about the administration’s actions as they relate to freedom of religion and conscience…”

While that line of reasoning may seem sound to some, others argue that it makes no sense whatsoever. The “birth control mandate” if that is what it is being called, is what is known as a “generally applicable and neutral law,” which means that is broadly applied, instead of something targeting religious groups (which would, of course, be unconstitutional under the First Amendment). Zach Carter at the Huffington Post makes the point that we already have laws that apply broadly to people in all walks of life that some religious groups are opposed to. Pacifists are required to pay taxes that pay for wars, for example. Other laws that have been objected to on religious grounds include payment of Social Security, payment of unemployment taxes, and paying employees a minimum wage. As Lyle Denniston, who has covered the U.S. Supreme Court for over half a century writes, “laws that apply generally and do not single out religious groups may be upheld even if they intrude on religious practices”.

This issue will, most likely, stay in the headlines for the foreseeable future, as both the subject matter and the debate serve to drive television ratings and rile up both the Democratic and Republican bases. That said, however, it is somewhat difficult to believe that we are watching this conversation on televisions tuned to 2012 news coverage, and that we did not accidentally switch to a Mad Men rerun by mistake.


A fun little addition:

Little over a month ago the question of banning contraception was raised at a Republican debate held in New Hampshire, moderated by ABC’s George Stephanopoulos. When asked whether or not a state should be able to ban contraception former Massachusetts Governor Mitt Romney, in a fit of short-sightedness replied:

“George… I don’t know whether a state has the right to ban contraception. No state wants to. I mean the idea of you putting forward things that states might want to do that no state wants to do, and asking me whether they can do it or not is kind of a silly thing.”

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