With the U.S. Supreme Court expected to take up questions related to the Patient Protection and Affordable Care Act (PPACA) in the coming months, now seems to be a good time to discuss some of the news and developments related to the law.
First, let's look at the key issues the Supreme Court could consider if it chooses to hear any health care reform-related cases, courtesy of James Vicini of Reuters. The issue most likely to be considered by the Court is whether Congress overstepped its authority by mandating insurance purchasing or whether this mandate falls within Congressional authority to regulate interstate commerce. For its part, the Obama administration is arguing that lawsuits challenging the mandate should be barred because the mandate has not yet gone into effect and that the penalty assessed to those who do not obtain health insurance should be considered a tax, which opens up a host of new tax law questions if the Court agrees. Finally, several states are arguing that the PPACA represents an unlawful expansion of the Medicaid program because Congress could withhold funding for the program from states that do not cooperate with the law. If the Court does indeed decide to consider any of these issues, observers expect arguments to be held in the spring with a decision by June. SCOTUSblog has a rundown of the six key petitions that are or are expected to be considered by the Supreme Court.
What happens if the mandate is overturned? According to a new study conducted by John F. Sheils and Randall Haught, of the Lewin Group, a health care policy research and management consulting firm, in Falls Church, Va., concerns about a premium spiral caused by healthy individuals dropping unmandated coverage would cause premiums to spike and the ranks of the uninsured to swell may not materialize because of other mitigating elements of the law. The authors estimate that premiums in the individual market would increase by 12.6 percent, which is less than other estimates, and that 7.8 million people would lose health insurance coverage without a mandate, rather than more dire estimates of 16 to 24 million people. Overall, the authors argue that the mandate may not be as essential to the PPACA's success as many believe.
Finally, there is a bit of the PPACA that is unlikely to ever be implemented, at least not in its current form and in the current political and economic environment. The Obama Administration pulled the plug on the Community Living Assistance Services and Supports (CLASS) Act, which created a long-term care insurance program that employers would have been able to offer to their employees. The CLASS Act was included in the PPACA health care reform law and the government-provided program would have been funded entirely through premiums.
In many ways, the CLASS was doomed from the start. The main concern was that the program would not attract enough healthy individuals to create a premium base large enough to cover promised benefits. Indeed, when announcing the end of the program, Health and Human Services Secretary Kathleen Sebelius said that the program as currently structured would have to charge premiums that were too high to attract healthy individuals to the program.