A Possibly Dismembered Health Care Law — and What’s at Stake

Posted June 24, 2012

By Ulfat Shaikh, MD, MPH, MS

We are on the eve of the Supreme Court’s decision on the 2010 health care law. If the law passes, it will be the most transformative health care law in the U.S. since 1965, the year Medicaid and Medicare were enacted.

A looming question is whether the individual mandate — which requires most Americans to purchase health insurance or pay a penalty — will be overturned. And if it is overturned, what other parts of the health care law will it take down with it?

Two key aspects of insurance reform — a ban on denial of coverage based on pre-existing conditions and charging variable rates based on health status — heavily depend upon the individual mandate to offset costs.

But even if the individual mandate is invalidated, other important elements of the bill not associated with the mandate will be important gains. The ruling should not affect health coverage to the uninsured through the expansion of Medicaid, the establishment of state-run health insurance exchanges, and federal subsidies for the purchase of private insurance plans on exchanges.

Fervor about the law has risen to a fever pitch. According to a recent poll, over two-thirds of Americans hope that the Supreme Court overturns part or all of the law. Marketing has played a disturbingly key role in framing the debate. Over the last two years, over $200 million was spent on advertising opposing the law. In contrast, just $69 million was spent on ads supporting the law, with only $700,000 of that money coming from the Obama campaign.

Whatever plays out this week, I am reminded of Uwe Reinhardt’s words in T.R. Reid’s book, The Healing of America: “Every nation’s health care system reflects that nation’s basic moral values. Once a nation decides that it has a moral obligation to provide health care for everybody, then it can build a system to meet that obligation”.

If this is so, then what essentially is at stake is our nation’s moral compass.

Ulfat Shaikh, MD, MPH, MS is director of health care quality integration at the University of Caifornia Davis Schools of Health. She blogs about health care quality improvement at Pulse.

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