Health Care Symposium

  • March 24, 2011
    Guest Post

    By Ian Bartrum, assistant professor of law, Drake University Law School. Professor Bartrum teaches constitutional law, law and religion, and constitutional theory. He has also taught at Vermont Law School, and has served as the Irving Ribicoff Fellow at Yale Law School. This post is part of an ACSblog symposium marking the one-year anniversary of the Affordable Care Act.
    On the first anniversary of the Patient Protection and Affordable Care Act, Republicans continue to push the judiciary to intervene and revisit a debate they lost in the political branches. At this writing, five District Court judges have weighed in on the constitutionality of the Act: three have found it constitutional and two have not. In the meantime, the argument rages in state legislatures, policy think tanks, and the legal academy. The majority of legal experts, including as esteemed and nonpartisan a scholar as Yale's Akhil Amar, have concluded that the law passes constitutional muster. But other more conservative scholars have disagreed.

    The primary constitutional question centers on the provision known as the "individual mandate." That provision requires those without health coverage through their jobs, who are above the federal poverty line, either to buy a minimum level of health insurance -- at a rate not more than 8 percent of their monthly income -- or to pay a penalty of either $695 or 2.5 percent of income (whichever is higher). So in practical terms, the mandate is not all that onerous; but it is critically important. Because the law prevents insurers from discriminating against people based on preexisting conditions, it must ensure that people do not simply wait until they get sick to buy coverage -- if everyone did that, insurance would be impossible. But it's clearly not the practical effect that matters to health care opponents; it's the principle at stake. The Constitution, they say, does not allow the federal government to intrude this far into our lives.

    In particular, opponents say the mandate exceeds Congress's authority to regulate interstate commerce. The objections are of two kinds. First, scholars such as Georgetown's Randy Barnett argue that what Congress is regulating is not commerce. Second, pundits like the Cato Institute's Timothy Sandefur have argued that the mandate is not a regulation of commerce. Neither position stands up to serious scrutiny.

  • March 23, 2011

    This post is part of an ACSblog symposium marking the one-year anniversary of the Affordable Care Act.
    The legal challenges to the health care law represent "a radical attempt to turn back the clock on democracy," American Constitution Society Executive Director writes in The Hill's Congress blog.

    She warns of the danger to Congress's power to regulate important issues of national concern if the "radical and rejected conception of the Constitution" is accepted by the Supreme Court.

    She writes:

    The two recent federal court decisions invalidating the health care law represent a new and dangerous movement - both in the judiciary and in the political sphere - to push an outcome-driven approach to judicial decision-making and call it a valid theory of constitutional interpretation.

    Read the full article here.

  • March 23, 2011
    Guest Post

    By Sara Rosenbaum, Hirsh Professor of Health Law and Policy and chair of the Department of Health Policy at The George Washington University School of Public Health and Health Service. This post is part of an ACSblog symposium marking the one-year anniversary of the Affordable Care Act.   
    Viewed in its broadest perspective, the Affordable Care Act (ACA) represents two landmark achievements in U.S. health policy: a sweeping reform of the private market for health insurance; and a decisive shift of national resources toward families and individuals who, by virtue of poverty, illness, or both, historically have been barred from health care.

    Through a series of bold adjustments in existing policies, the ACA essentially reinvents the private health insurance market, transforming it over time into a social good whose regulation is essential to the public's health and the means by which a nation assures that its population can obtain necessary health care. The principal elements of this transformation consist of a ban on exclusion and discrimination based on health status or pre-existing health condition, the obligation to adhere to principles of guaranteed issue and renewal, and the insertion of safeguards that will ensure that, once covered, individuals will have access to necessary care without regard to artificial annual or lifetime expenditure caps.

    In the individual and small group markets, the historic epicenter of discrimination against the sick, the Act redefines coverage itself to encompass "essential health benefits" expressed in terms of both covered benefit classes and limits on cost-sharing. Most remarkably, perhaps, where the content of coverage is concerned, the Act defines essential health benefits to include habilitative treatments for persons with developmental disabilities. It is this benefit, whose traditional exclusion from private insurance products, represents the central means by which the market has denied beneficial care to a patient population that counts among the nation's most vulnerable.

    The Act's provisions addressing health care for low-income, medically vulnerable and medically underserved Americans are no less seminal. Health reform remakes Medicaid, perhaps the single most important conceptual and operational pillar of the American health care system, because of its historic role in absorbing health care costs shunned by the private market and even by Medicare itself. Medicaid's achievements in this regard can fairly be said to be virtually immeasurable. For nearly 50 years, Medicaid has been the primary source of investments that markets traditionally seek to avoid: in the poor, in populations that carry high social and health risks; and both directly and indirectly, in a primary care and hospital infrastructure for medically underserved communities and populations.

  • March 23, 2011
    This post is part of an ACSblog symposium marking the one-year anniversary of the Affordable Care Act.

    The opponents of reform are still feverishly working to defeat the Affordable Care Act (ACA), a year after its enactment, and their efforts echo unsuccessful actions of the past to scuttle significant civil and social laws, Drake University Law School Professor Ian Bartrum writes in a column for the Des Moines Register.

    "But just as some obstructionists challenged the constitutionality of the Civil Rights Act in the 1960s, there are those today who hope they can get the courts to revisit an argument that they lost in the political branches," Bartrum writes.

    One of the reform opponents' favorite targets of the ACA is the provision set to take effect in 2014 that requires certain Americans to maintain health care insurance or pay a small tax. The opponents, such as the law professor Randy Barnett, loudly warn that if the federal government can require individuals to maintain health insurance then there will be no limits to its power. We'll all be faced with an out-of-control federal government issuing mandates forcing people to eat healthy foods, purchase gym memberships and limit television and Internet usage to a few hours a year, the opponents declare.

    Bartrum, however, says the scare tactics failed in the past, and they'll likely meet the same fate today.

    He notes:

    The ‘individual mandate' requires those without health coverage through their jobs, who are above the federal poverty line, either to buy a minimum level of health insurance - at a rate not more than 8 percent of their monthly income - or to pay a fairly small tax. So in practical terms, the mandate is not all that onerous; but it is critically important. Because the law prevents insurers from discriminating against people based on pre-existing conditions, it must ensure that people do not simply wait until they get sick to buy coverage. But it's clearly not practical effects that matter to health care opponents; they see this as a political opportunity to revive a battle over the scope of congressional power that ended nearly a century ago.

  • March 23, 2011

    This post is part of an ACSblog symposium marking the one-year anniversary of the Affordable Care Act.
    On the one-year anniversary of the Affordable Care Act, it's worth revisiting commentary from an event on challenges to the health care law held earlier this month.

    Former Senator Tom Daschle keynoted the ACS event, calling the battle against legal and other challenges to the health care law "a fight for the equality and the liberty of all Americans and their moral right to health security at long last."

    Former acting Solicitor General Walter Dellinger, who also discussed the law's constitutionality during an ACS phone briefing yesterday, predicted that Chief Justice John Roberts would author the majority opinion upholding the health care law when the challenge reaches the Supreme Court.

    And National Senior Citizens Law Center Public Policy Counsel Simon Lazarus questioned whether the Constitution puts Congress in a "straightjacket" the way opponents of the law have contended.

    Watch the videos after the jump to hear George Mason University School of Law professor Ilya Somin challenge Dellinger and Lazarus, and Center for American Progress Chief Operating Officer Neera Tanden discuss obstacles to implementation.