The U.S. Supreme Court's 5-4 decision Thursday upholding almost all of the key provisions of the Affordable Care Act, including the individual mandate to purchase health insurance at its core, is an epic victory not just for the Obama administration and its Democratic supporters. It is, more importantly, a long-sought and urgently needed victory for all Americans. It sets the course for secure, affordable, comprehensive and universal health care -- a level of care that cannot be capriciously denied by a callous health-care industry that has long elevated outsized profits over provision of adequate care for all Americans.
Surprisingly, the court's majority decision hinged on -- and was written by -- Chief Justice John G. Roberts Jr., and not Justice Anthony Kennedy, the usual swing vote between the court's conservative and liberal wings. More surprising was Chief Justice Robert's view that the constitutionality of the health-care reform act -- and, specifically, the individual mandate to purchase health insurance -- is rooted in the federal government's right to impose a tax in needed circumstances, and not in its authority to regulate interstate commerce. The administration had argued for the latter, which the federal government has used for more than 60 years to regulate economic activities that broadly impact Americans everywhere.
Either should be acceptable. The ACA's individual mandate, facilitated with the help of wage-based subsidies for most middle-class Americans, would necessarily function as a health care tax for a system that more fairly regulates and funds basic comprehensive universal health care.
Insurance exchanges upheld
Under the reform act, state governments are required by 2014 to establish insurance exchanges in which insurers must offer competitively priced health insurance under minimum comprehensive care standards for all comers at flat rates. With federal subsidies for most wage-earning Americans, that will enable the needed expansion of insurance pools for ordinary Americans in the gap between Medicaid for the truly poor and Medicare for seniors. That's especially needed in states like Tennessee, where less than 55 percent of employers sponsor employee health care insurance, which in many cases is skeletal at best.
If states fail to establish the exchanges (Tennessee has so far taken no steps to do so), the federal government will intervene and establish them. The standards for the exchanges, and for health insurance companies generally, will ban insurers' current use of pre-existing-condition clauses for adults; their use of annual and lifetime limits on needed care; and their common abuse of canceling customers' insurance for a range of technical, fine-print provisions when they become ill. Exchange policies will also require several levels of comprehensive care, including preventive care.
Beyond the exchanges, all health insurance companies will be required to meet ACA regulations instituted last year that require them to spend a minimum of 80-to-85 percent of their income from customers' premiums for their customers' health-care needs.
The ACA's reforms -- several of which are already in place -- will quickly prove to be a godsend for all Americans when the act is fully implemented in 2014. Americans then would no longer have to worry what would happen to themselves, or to their family members, or their savings, if one is stricken with cancer or a serious or chronic health problem. Nor would the absence of employer-provided insurance invite disaster. The availability of affordable, comprehensive insurance through state exchanges, moreover, would mitigate the dreaded plague of personal bankruptcy driven by medical-care costs, which now constitute the lion's share of Americans' personal bankruptcies, and which lead to many premature deaths.
The Supreme Court's ruling in favor of these sweeping changes does not mean, as its critics claim, that the nation's health care spending will rise precipitously. In fact, it should fall as a percentage of the nation's gross domestic product, even as the country moves toward universal health care.
All other advanced industrial nations, from Australia to Japan to virtually all of the European nations, provide universal health care and achieve wellness indices that commonly surpass those in the United States. And they do so while keeping health-care spending down to 8-to-13 percent of GDP.
In the United States, conversely, health care spending has zoomed to 19 percent of GDP, and continues to advance faster than the general rate of inflation, while leaving 50 million Americans uninsured. These Americans' incomes are above the poverty level for Medicaid, but they typically go without health insurance because it's unaffordable, or because insurers reject them for pre-existing conditions.
The utter moral failure to provide a fairer, universal health-care system is needlessly killing too many Americans, and bankrupting others, while insurance and pharmaceutical industry executives are paid lavish fortunes for minimizing their so-called "medical losses" -- the percentage of revenue spent to actually provide health care for their customers.
GOP still panders for repeal
Regardless, Republicans rose again in lockstep Thursday to denounce the court's ruling and to promise to repeal "Obamacare," a term that they have made an epithet without offering a hint of a viable alternative. Voters who follow their cruel propaganda would do themselves -- and their family members -- a certain injustice and invoke a bleak health-care future to support repeal of health-care reform.
Indeed, though many have been misled by partisan Republicans to object to "Obamacare," most Americans, polls repeatedly prove, support the reforms the ACA has already introduced. These include: banning insurers' exclusion for children for pre-existing conditions, extending family coverage to children up to the age of 26, requiring insurers to cover preventive care and to spend 80-to-85 percent of revenue from customers' premiums on actual care, banning insurers' annual limits on coverage, and narrowing the "donut" hole in Medicare for prescription drugs. These and other pending ACA reforms are all necessary to lower overall health care costs and to bring more American citizens under the umbrella of insurance.
Americans are now on a course that, in 2014, will assure affordable, accessible and comprehensive lifetime health care for most citizens. That's a milestone half a dozen presidents -- Democrats and Republicans -- have tried to reach, and failed. The debate now should be how to improve the ACA, not how to dismantle it for fleeting partisan gain.