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Government class, summer 2013

Emily Hinds

on 23 July 2013

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Transcript of Obamacare

The Affordable Care Act (ACA)

The History of Health Care
Noticed as potential issue - early 1900s
Politicians including Theodore Roosevelt proposed a national health care system ~1912
Employers began sponsoring health insurance, and labor unions helped expand employer-provided insurance.
By 1951, 50% of Americans had some form of health insurance.
Lyndon B. Johnson and Congress created the Medicare and Medicaid programs in 1965
Current Debate
Do people have a right to health insurance?
Or is it a privilege?
The Patient Protection and Affordable Care Act
This highly controversial piece of legislation is the Obama administration's contribution to health care reform.
Partisan Participation
The response to the ACA was not split cleanly between parties.
My View
Something needed to be done with health care
The ACA is well-intentioned, logical
Covering as many people as possible is a good idea - disease does not care if you're insured or not.
The Individual Mandate is crucial to the ACA as a whole, and a constitutional provision.
The Supreme Court was right in limiting the Medicaid Expansion.
National health care means that federal funds (tax money) would be used to pay for the health expenses of citizens, without the middle-man of private insurance.
Opponents in the early 1900s argued that this would reduce the quality of care.
This type of system was never seriously considered.
Some attempts at reform have been made at the national level prior to the current administration, but none have been particularly successful.
Some state-level reforms have been made as well.

Notably, in 2006, Massachusetts Governor Mitt Romney signed a health care law requiring all citizens in the state to have a minimum amount of health insurance or pay a penalty.
Most agree that the current health care system is largely inefficient. The debate centers around how the system should be reformed and the role of the federal government in the process.
The United States is one of very few industrialized countries that delivers health care primarily through private health insurance.

The nation spends 20% of it's gross domestic product (GDP) on health care, and out-of-pocket costs for individuals are increasing.

In comparison, countries like the United Kingdom, Germany, and New Zealand spend 6-10% of their GDP on health care, and their citizens are healthier than those of the United States.
The 16% of Americans that remain uninsured are the targets of government health reform efforts.

In 2009, 30 million citizens did not have access to health insurance.
Preexisting Conditions
Dropped Coverage
Increasing Premiums
Universal Health Care - everybody has access to affodable care
National Health Care - the government owns the hospitals and employs the doctors
Premium - a consideration paid for the cost of insurance
Preexisting Condition - a chronic illness or another already existing illness
The Act was signed into legislation by President Barack Obama in 2010.
Main Elements of the ACA
Regulation of Insurance Companies
Expansion of Coverage
Guaranteed Issue - cannot be denied coverage
No Caps on Coverage - cannot limit coverage
Insurance will pay for annual check ups and individual care.
Young adults can stay on their parents' insurance policy until age 26.
Large Employer Mandate - companies with 50 or more employees must either offer health insurance to their employees or pay a fine to help cover insurance costs.
Expansion of Medicaid - people up to 133% of the poverty level can receive benefits ($15,282 for the individual, $31,322 for a family of four)
Health Insurance Exchanges - creates a marketplace for health insurance
INDIVIDUAL MANDATE - people not covered by their employer or the government must buy health insurance or pay a fine
After the Act squeezed through Congress with a 220-211 vote, many were disgruntled.

Florida sued, and many other states followed.
This case, among others, was taken to the Supreme Court.
No Republicans voted in favor of the ACA. After it passed, they asserted that it would bring upon the following consequences:
higher taxes
worse health care
higher health care costs
unaffordable expenses
tax-payer funded abortions
Democrats were less unified. While many supported the law, there were quite a few against it as well. The official stance is in favor of the ACA.
The Questions:
1) Is it constitutional for the government to require people to buy health insurance? (Individual Mandate)
2) Can the Individual Mandate be separated from the ACA?
3) Did Congress exceed its powers by pressuring states into compliance, threatening Medicaid funding?
4) Can the ACA even be argued before many of its provisions are in full effect?

Key Constitutional Provisions:
Article I, Section 8 (The Commerce Clause)
Tenth Amendment (State Powers)

The Court took on several ACA cases that all boiled down to the same few questions.
The main case was Florida v. Department of Health and Human Services, consolidated with the other cases.
They set aside five and a half hours for oral argument, dividing the time to address each questioned component.
Arguments of the Proponents
Claim that precedent cases confirm Congress' ability to regulate a national marketplace
"Once Congress has the power to do something under the Supremacy Clause, its laws are supreme to the laws of the states," meaning that the Tenth Amendment would not apply.
Arguments of the Opponents
Chances of compromise are unlikely at best.

Strong positions taken

Majority of provisions go hand-in-hand, cannot remove one without the other

Many citizens already do not understand the ACA very well, and if attempts at compromise do not undermine the law as a whole, it would only complicate it further and make it more difficult to enforce.

The Supreme Court's limitation of the expansion of Medicaid could technically be considered a compromise.
Believe Congress is asserted power it has never been entitled to before
Rather than regulating commerce, the government is ordering citizens into commerce
Congress can only regulate the commerce that already exists; they cannot create commerce.
The Verdict?
The majority conclusions reached were as follows:

1) The Individual Mandate is a tax and is therefore constitutional.
(Roberts, Ginsburg, Breyer, Sotomayor, and Kagan)

2) The justification of the Individual Mandate under Congress' ability to regulate commerce was invalid.
(Roberts, Scalia, Kennedy, Thomas, and Alito)

3) Severability of the Individual Mandate went relatively undiscussed after it was declared a constitutional tax.

4) Congress cannot threaten the states into compliance with removal of Medicaid funding.
(Roberts, Scalia, Kennedy, Thomas, Breyer, Alito, and Kagan)

5) However, without the threat to completely withdraw Medicaid funding, the rest of the Medicaid Expansion provision was valid.
(Roberts, Ginsburg, Breyer, Sotomayor, and Kagan)
What does this mean?

The Supreme Court ultimately upheld the ACA, limiting some of the Medicaid expansion but confirming the Individual Mandate constitutional as a tax.
C-SPAN Classroom Deliberations, "Health Care Reform." Last modified March 14, 2012. Accessed July 22, 2013. http://www.c-spanclassroomdeliberations.org/issues/health-care-reform-supreme-court-interactive.

Current Issues, 2012-2013 Edition - 36th edition. Close Up Foundation, 2012.

Democratic National Committee, "Health Care." Last modified July 13, 2013. Accessed July 22, 2013. http://www.democrats.org/issues/health_care.

Liptak, Adam. The New York Times, "Supreme Court Upholds Health Care Law, 5-4, in Victory for Obama." Last modified June 28, 2012. Accessed July 22, 2013. http://www.nytimes.com/2012/06/29/us/supreme-court-lets-health-law-largely-stand.html?pagewanted=all.

MaryBeth, Musumeci. Kaiser Family Foundation, "A Guide to the Supreme Court’s Affordable Care Act Decision." Last modified July 2012. Accessed July 23, 2013. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8332.pdf.

"THE AFFORDABLE CARE ACT CASES," The Oyez Project at IIT Chicago-Kent College of Law, accessed July 21, 2013, http://www.oyez.org/cases/2010-2019/2011/2011_11_400%23argument4.
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