Point of View

Reviewing the health reform law

March 8, 2012 

— This is a big month for the national health care law, the Patient Protection and Affordable Care Act. March 22 marks the second-year anniversary of the law's passage, and on March 26 to 28 the U.S. Supreme Court will hear arguments in cases challenging the law.

What does all this mean for North Carolina? First, the anniversary is an opportunity for more public education about the benefits of the law for families. Thousands of children under age 26 in the state are able to stay on their parents' health plans and maintain coverage. North Carolina's federal health insurance high risk pool (www.nchirp.org), created by the law, has meant that many people can get more affordable health coverage despite having had the bad luck to have had cancer, back problems or another serious medical condition. Seniors and people with disabilities are getting cheaper drugs and improved preventive health care benefits under Medicare every day.

And in 2013 people who don't get their health insurance through their work will enjoy the same affordable deals and protections against pre-existing condition charges and exclusions as everyone else.

Ironically, around the time of the anniversary come the legal arguments on challenges to the law in the Supreme Court. While the health care law has been upheld by multiple courts - including by leading conservative judges - these cases have some potentially serious consequences.

Brought by states unhappy with the Affordable Care Act and a national conservative independent business association, the cases focus on two main arguments: First, that the law's individual-responsibility requirement to have health insurance is unconstitutional, and second that the expansion of Medicaid health insurance for the poor, even though it is almost completely paid for by the federal government, is also unconstitutional.

First off, let's just be clear. If the Supreme Court were to strike down the Affordable Care Act as a result of these cases - and that is exactly what the plaintiffs are asking for - then all the protections and benefits I listed above already in effect would be gone immediately, along with all future help under the act. No help with drug costs for seniors, no tax credits for small businesses, adult children forced off their parent's plans, no more rules preventing children with pre-existing health conditions from being denied health insurance.

Second, if the Supreme Court were to invalidate the Medicaid portion of the law - that states, if they want to keep running Medicaid programs financed with federal money need to expand those programs to cover all very poor adults - it would be devastating.

Why? Many federal laws, from the Civil Rights Act to environmental protection statutes, are based on the idea that if a state takes the offered federal money, the state has to accept the federal rules and conditions that go along with that money. No court has ever found this deal to be unconstitutional, so looking at this argument is a pretty radical move.

Finally, the Supreme Court is going to hear arguments on whether or not it is even the right time for plaintiffs to challenge the individual responsibility requirement. A federal law says you can't challenge a tax until the government actually collects that tax. So, since the IRS won't be collecting penalties until after 2013 for people who can clearly afford but don't buy health insurance, the court could say to plaintiffs that they must wait until then to challenge the act.

In North Carolina we are quietly implementing the national health care law, tweaking it to fit our needs and starting innovative ways of paying for care to save money and improve quality. Every day more and more people in our state are getting health care, when they had few options before. The debate in Washington may seem far away from our more practical concerns, but it clearly bears watching.

Adam Searing is project director for the Health Access Coalition at the N.C. Justice Center.

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