The fate of the Obama administration’s health care reform law appears uncertain after the Supreme Court conducted three days of hearings in late March.

Health care reform, health care reform law, Obama administration, Supreme Court, Affordable Care Act, ACA, health insurance, Greg Jacobson, Charles Blahous, individual mandate, health insurance coverage, pre-existing condition, Mark Bertolini, Aetna, Glen Stream, American Academy of Family Physicians

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Inside This Issue - News

Health care reform case a cliff-hanger

April 23rd, 2012

WASHINGTON – The fate of the Obama administration’s health care reform law appears uncertain after the Supreme Court conducted three days of hearings in late March.

Although the president expressed confidence after the hearings that the Court would uphold the Affordable Care Act (ACA) of 2010, many Americans apparently have a more cynical opinion and expect the justices to rule based on their partisan political views.

According to a Washington Post-ABC News poll of 1,103 adults, only 40% of respondents expect the justices to base their rulings “on the basis of law,” while half expect decisions based on partisanship. However, the poll found little enthusiasm for the law itself: 38% of participants want the ACA to be struck down in entirety, while 29% want the Court to eliminate the individual mandate that requires most individuals to obtain health insurance. Only about 25% want health care reform to be upheld in full.

Even among Democrats polled, support was tepid, with about half wanting the entire law to be upheld. Among Republicans, nearly two-thirds want the law to be overturned in entirety.

Nevertheless, the debate over the ACA continues to be framed along partisan and party lines. A Republican member of the board that oversees Medicare financing has issued a study that contends the ACA will add more than $340 billion to the deficit.

Charles Blahous, a Republican trustee for Medicare and Social Security and a former domestic policy adviser to President George W. Bush, argues that much of the money generated as revenue and savings through the law will wind up in the Medicare hospitalization trust fund and therefore will not be available to pay for expanded coverage for the u­ninsured.

Blahous, along with other conservative critics of health care reform, contends that the standard bipartisan budget rules used for the past 40 years allow a double counting of projected Medicare savings. The Congressional Budget Office (CBO) and Medicare actuaries have acknowledged the issue, and a 2010 CBO report stated that without Medicare savings the ACA will increase deficits by $226 billion by 2019.

However, last month the CBO published updated cost estimates for certain parts of the ACA and projected that net spending on several parts of the law through 2021 will be about $50 billion less than projected last year due to slower growth in health insurance premiums.

Two major provisions of the ACA are under review by the Court: the individual mandate requiring most people to obtain health insurance coverage and the expansion of Medicaid coverage. If the Court rules that the individual mandate is unconstitutional, it will have to decide whether it can be overturned in isolation or whether all or part of the rest of the law must be scrapped.

For its part, the federal government maintains that if the individual mandate is judged unconstitutional, only two provisions of the law should be invalidated: one that prevents insurers from refusing to offer coverage due to a pre-existing condition and one that bars insurers from charging higher premiums based on a person’s medical history.

The government further maintains that the other provisions of the law are entirely unrelated to the individual ­mandate.

Recent media reports find little enthusiasm for repeal of the ACA among insurers, who have already begun implementing many of the provisions of the law. Mark Bertolini, chief executive officer of Aetna Inc., told The New York Times that although the law was imperfect in a number of ways, it was a step forward.

Glen Stream, president of the American Academy of Family Physicians, warned that dismantling two years of implementation will produce tremendous uncertainty that will directly affect patients.

With the possibility of the law’s repeal looming, a few states are planning to act on their own to implement a key part of the law, a requirement that all states have a new insurance exchange where consumers can compare and shop for health coverage, much like travel websites. The exchanges are one of the most popular parts of the ACA, which allows the states to run their own exchanges or have the federal government do it for them.

If the law is overturned, the states will be denied federal funds to run the exchanges. Among states planning to proceed with exchanges even if the ACA is repealed are Rhode Island, California and Colorado.