(click on the picture of the chart for a better view)
A Quick Introduction to Health Reform. PPACA = Patient Protection and Affordable Care Act
Why I’m Sharing This
So, this isn’t exactly timely and I said that I was going to present this information on my blog months and months ago (when I posted about how people who disagree with PPACA are more likely to not even know what’s in the law; hopefully my chart will help at least one person out there to realize they either do or do not like parts of PPACA based on what’s actually in there). But, I finally had the opportunity to make this chart for a school event and thought I’d share it. I wanted to find a way to present health reform, what it does, and why we need it as simply as I could. This was the best way I felt I could present this information.
Gaining a Comprehensive Understandingof Health Reform Issues Takes A Lot of Time and Study
The learning curve is steep for gaining a comprehensive understanding of the theories and arguments for why we have those striking statistics under the “what’s at stake” column of the chart. So too is the learning curve for understanding in-depth what types of reforms states have attempted in the past and why PPACA implements the “steps” that it does to achieve its objectives. This chart in no way answers these “why” questions, but it at least should serve as a brief factual overview of what’s going on. It has taken me months of study to understand this stuff and I finally just now feel confident enough with my grasp of the material to share my opinions about it.
The Constitutionality of the Individual Mandate and of the Entire Bill
The individual mandate is of course the most controversial part of PPACA. The issue of the constitutionality of both the individual mandate and the entire bill have reached several circuit courts. The 6th Cir. held that both the individual mandate and the entire bill itself is constitutional. The 11th Cir. ruled that while the individual mandate is unconstitutional, the rest of the bill passes constitutional muster. And finally, the 4th Cir. dismissed the case and did not even rule on the bill’s constitutionality because they stated that the plaintiffs did not have “standing” to challenge the bill (I defined standing in an earlier blog post). Now that two circuits have produced holdings that are in conflict with one another, we have a “circuit split” and the Supreme Court of the United States will likely rule on the issue to settle the matter. The sentiment among legal scholars is that the Supreme Court of the United States will likely uphold the individual mandate.
Why is the Individual Mandate So Important?
While it’s true that the Court could simply strike down the individual mandate as unconstitutional and leave the rest of the bill intact, this would effectively destroy the program that health reform doles out. Some call this the “keystone” piece of the legislation. And think about it - the individual mandate provides funding (both directly and indirectly) for many of the other reforms that need to be implemented. In the past, insurance companies stayed competitive and profitable by engaging in underwriting - kicking out those who were too high risk health-wise and thus “too expensive” to insure (this is a topic worthy of lengthy discussion as well). Without some sort of overhaul of who is insured and a larger focus on allowing for the healthy to subsidize for the care of the sick, insurers would never agree to the “guaranteed issue” and “guaranteed renewal” pieces (see chart) of reform due to the adverse selection death spiral.
What Are Our Choices?
Some people loathe the individual mandate, but it was THE alternative to having a public plan. It is a very capitalistic solution - it keeps private insurers intact. There are thus four positions: (1) some don’t like health reform at all and want to keep the system the way it is, (2) some want health reform and like the individual mandate, (3) some want health reform but prefer the public plan over the individual mandate, and (4) some want health reform but don’t like both the public plan and the individual mandate. Those in the last group need to understand that health reform is going to be messy, difficult, and invasive. No one has come out with an alternative to these two methods of reform that will achieve the level of reform that we are striving for.