Monday, October 20, 2014
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The politics of health care

A conservative judge’s ruling that a key provision of President Obama’s health-care overhaul is unconstitutional hardly spells the death knell being sought by tea-party adherents and Republican leaders for the landmark reform.

The politics of health care

A conservative judge’s ruling that a key provision of President Obama’s health-care overhaul is unconstitutional hardly spells the death knell being sought by tea-party adherents and Republican leaders for the landmark reform.

With his conclusion that Congress exceeded its authority in requiring Americans to buy health insurance, Virginia U.S. District Judge Henry Hudson stands in direct opposition to two other federal judges who upheld the law.
 

It seems that the legality of health-care reform depends on which judge of which political party decides the matter. That’s unfortunate, since the politics of the misguided legal challenge by 20 states, including Pennsylvania, threaten to undermine the law all the way to the Supreme Court.
 

It’s good to hear Obama administration officials insist that they’ll move ahead with implementing the Affordable Care Act. Even with his ruling on the insurance mandate, which brought guffaws from some legal scholars, Hudson himself said other provisions of the law could stand.
 

Americans already are seeing benefits from early provisions of the health overhaul. Among them: young adults qualifying for coverage under their parents’ insurance plans, wellness visits for Medicare patients, more help with drug costs for low-income seniors, and tax credits for small businesses that provide their workers with health insurance.
 

Even if Hudson’s view prevails at the right-leaning Supreme Court, his ruling presents Obama mostly with a tactical challenge to make the sweeping health overhaul work as it was designed.


That’s no small challenge, to be sure. The mandate that everyone must obtain insurance coverage after 2014 is a central tenet of expanding access to medical care while also taming runaway growth in health-care costs.
 

To help the millions of uninsured Americans obtain insurance, the Affordable Care Act prohibits insurers from denying or pricing coverage based upon a person’s health. But the flip side to that is making sure people can’t blithely avoid buying insurance coverage until they become ill, which sharply raises the cost of insurance for everyone.


Unable to gain Republican support, congressional Democrats chose the stick approach to get people to buy insurance by imposing a financial penalty — in the form of a federal-tax surcharge — on anyone failing to buy health coverage.
Republicans opposed to the law have seized upon this provision, calling it a mandate, even though you can still go without insurance if you prefer to pay the penalty.
 

Hudson agreed with the lawsuits filed by GOP attorneys general, including Gov.-elect Tom Corbett, saying Congress exceeded its powers. If that view prevails, Congress could switch to the carrot approach. Incentives to buy insurance, rather than penalties, would appeal to the young and healthy among the uninsured.


Legal challenge or no, the nation still has a moral mandate to assure affordable, quality medical care for 50 million uninsured Americans at risk of suffering debilitating illnesses and death.
 

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