Archives June 28, 2012

The Roberts Legacy: ACA Upheld

by Barry P Chaiken, MD

Thirty-seven years after the Federal government first departed on a journey to guarantee healthcare coverage to its citizens through an amendment to the Hill-Burton Act of 1975, our great country now ensures that all its citizens can obtain affordable healthcare services for their entire lives. No American will ever again be denied coverage due to pre-existing conditions or inability to pay. The United States now joins the rest of the world’s rich nations with a healthcare social compact first forged among its citizens with the passage of Medicare and Medicaid almost five decades ago.

Good for Employers and Employees

Irrespective of the rhetoric coming out of Washington, this ruling by the Supreme Court of the United States is good for both employers and employees. Cherry picking of enrollees becomes more difficult for insurers as payors now must accept all persons irrespective of pre-existing conditions. This motivates insurers, as well as providers who carry risk contracts, to focus on keeping people well rather than looking to make access to care difficult in their effort to boost profits. No longer can costly enrollees with pre-existing conditions be dropped from coverage. Payors must now take a population health point of view maximizing health while efficiently providing resources to achieve the associated clinical outcomes.

Businesses can now adequately budget for healthcare costs for their employees. A larger number of relatively healthy individuals enrolled in plans will expand the risk pool available to fund care, the underpinnings of all insurance models. This should decrease healthcare costs for businesses and employees alike. No more free rides for those who refuse to pay for insurance yet seek free care when they get sick with a catastrophic illness that they cannot afford pay for.

Businesses will benefit from the enhanced job mobility now afforded to employees. No longer will employees be trapped in jobs to ensure healthcare insurance for a family member with a pre-existing condition. Employees can now seek positions offering the best opportunity while businesses can hire the best candidates. These shackles are gone forever.

The Roberts Court

Finally, Chief Justice Roberts made a bold statement today. Although there are nine justices on the Court all with just one vote, the Chief Justice’s vote and role transcend the other eight justices. Every Chief Justice deeply understands the role of the Court in the lives of its citizens. Every Chief Justice understands his role in protecting the Court and ensuring its high standing in the eyes of its citizens.

In recent years the Court’s decisions have appeared politically motivated rather than legally forged. Whether true or not, public perception weighs heavily and a recent 44% approval rating in a recent national poll, the lowest in decades, surely unsettles Chief Justice Roberts.

This decision, decided by a conservative Chief Justice appointed by a Republican president, clearly makes a statement that Chief Justice Roberts intends to demonstrate to the American people that His Court – the Roberts Court – exists to serve the people, and decisions made by the Roberts Court are not politically motivated. The Roberts Court intends to study the law and rule accordingly to the best of its ability. The ruling wisely sends back to the Congress and the President the responsibility of governing – deciding what rules our healthcare system should function under and how to pay for it.

Five decades hence, scholars will look back on this decision the way we look back on Brown v. Board of Education. It is momentous in scope and will forever change how Americans live.

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