How are you planning to spend the extra day on the calendar tomorrow? Sadly, Leap Day hasn't been declared a national holiday, so we'll be at USM in Portland tomorrow, Feb. 29th hosting a forum on health reform.
With the current debates swirling about the role government should play in helping people access health care coverage, the timing of tomorrow's panel on the Affordable Care Act (ACA) and the constitutional challenge before the Supreme Court couldn't be better. A new USA Today/Gallup poll released this morning gives us further evidence of the sharp divide among the American public on this issue. The ACA celebrates its second birthday next month (March 23 to be exact) but we've only begun to see a small fraction of the numerous benefits and changes that the law has in store for 2014. So 2 years down, 2 years to go...now here's a preview of what to expect at tomorrow's forum, we hope you can join us!
For those missing football season, rest assured, this will be the Super Bowl of legal cases so we've got the Giants of the health law and policy world to give us the play-by-play. (But Patriots fans shouldn't feel left out - two panelists are from Massachusetts.) The panel will feature both legal and policy experts representing various sides of the ideological spectrum, including Tufts Professor Amy Lischko, former health policy advisor to then Governor Mitt Romney, and John McDonough, a Harvard Professor who previously worked for the U.S. Senate to help draft the ACA.
Although the Supreme Court will hear arguments on a variety of issues over the 3-day oral argument scheduled in late March, the core question of the case is simple: does the US Congress have the power to enact a law requiring all citizens to carry health insurance? The means by which our modern Congress has authority to enact most federal law comes from the "commerce clause" of the Constitution, allowing it to regulate economic activity among the states. With few exceptions, the Court has interpreted the commerce clause very broadly, allowing Congress to regulate an activity as long as it "substantially affects" interstate commerce. For example, the Court interpreted the commerce clause to allow Congress to pass the Civil Rights Act of 1964.
Many believe, and some of our panelists will likely argue, however, that the individual mandate in the ACA regulates"inactivity", that requiring people to purchase a product is different than previous cases that regulated an "activity". In other words, although there is neither constitutional text nor case law to support this argument, opponents of the mandate suggest there is a legal distinction between activty and inactivity. Unfortunately, there are direct economic consequences for all of us when a person chooses to forego (or isn't able to afford) health insurance. Because we all engage in health care services at some point in our lives and getting that care is becoming increasingly expensive, buying insurance is clearly an economic activity and therefore within Congress' power to regulate. That's the practical, economic argument that forms the basis of the supporters' case for the ACA.
Perhaps most important, for those who believe health care is a human right, is how the ACA aspires to achieve health equity and justice. The ACA bans gender discrimination so that being a woman is no longer a pre-existing condition; prohibits insurance companies from harmful practices like dropping coverage when you get sick; and expands coverage options to millions of Americans who have previously been uninsured. Expanding access to health care is critical to correct longstanding disparities in the health care system.
Domestic crises require big ideas and aggressive solutions. Historically, Social Security, Medicaid, Medicare, and other government programs were created at times of economic hardship to provide a critical safety net to seniors, people living in poverty, and people with disabilities. Given today's economic climate, the safety nets need to be strengthened, requiring us to be more efficient than ever before. The ACA's promise lies in its breadth and depth; we need the Medicaid expansion, the consumer protections, state Exchanges and premium subsidies, and quality improvement initiatives, among many others, to overhaul a very broken "system."
For info about tomorrow's forum including the full list of presenters and sponsors click here.
Want to delve a little more deeply? Check out this issue brief put out by Kaiser. Stay tuned for a future post on reading the tea leaves and predicting potential outcomes of the case and what it will mean for Maine.