The U.S. Supreme Court’s ruling on the 2010 Patient Protection and Affordable Care Act may put to rest key arguments opponents have made on legal and constitutional grounds.
But the high court’s decision isn’t likely to end the fractious national debate over the state of national healthcare or quiet the bipartisan political strafing in Congress over healthcare reform.
President Barack Obama and Democrats who championed the law say it is needed to expand coverage to more than 30 million uninsured Americans and guarantee insurance for all. The way to do that, they say, is to expand Medicaid, offer tax credits to businesses and the middle class, and require Americans to have insurance — through an employer, via government program, or by purchasing their own.
But GOP leaders, healthcare specialists, business execs, and Mitt Romney contend the two-year-old law is the wrong way to go. It’s too costly, they say, and will further strain the nation’s anemic economic recovery. It will kill job growth, balloon the federal government (and spending), and ultimately won’t fix what’s wrong with the U.S. healthcare system.
“I don’t think the Supreme Court ruling will be the end of it,” said Brendan Steinhauser, director of federal and state campaigns with FreedomWorks, in an interview with Newsmax. “The Democrats and Republicans will continue to make it a campaign issue, and I think the Republicans are going to have to be really good about articulating what free-market solutions make sense for healthcare.”
Ed Haislmaier, a senior research fellow with the Heritage Foundation Center for Health Policy, agreed, telling Newsmax the high court’s ruling marks the end of only one phase in the national debate over Obamacare.
“Does it end the debate on healthcare? No, regardless of what they do,” he said. “There’s a lot more on policy grounds that’s wrong in the legislation, beyond the constitutional issues.”
Here’s a closer look at the key arguments opponents have leveled at Obamacare and what’s likely to come next in the healthcare debate.
Number 1: The Individual Mandate
At the center of the new law – and the Supreme Court case – is a federal mandate requiring all Americans to have health insurance or pay a penalty. Because the law also requires companies to provide health coverage to employees, Obamacare supporters and some insurers have argued the individual mandate is needed to ensure healthy people sign up for coverage to help balance the insurance pool.
But soon after the law was signed in March 2010, challengers filed lawsuits, arguing Congress had exceeded its authority in mandating that Americans buy health insurance by 2014. Some federal judges ruled in favor of the law, and others ruled against it, kicking it up to the Supreme Court to decide.
Betsy McCaughey, former New York lieutenant governor and author of “The Obama Health Law: What It Says and How to Overturn It,” argued from the beginning that Congress has no right to make such a demand under the Constitution’s Commerce Clause.
That clause authorizes Congress “to regulate commerce with foreign Nations, and among the several States, and with the Indian Tribes.” But McCaughey and other constitutional scholars told Newsmax the individual mandate overreaches that authority and the matter should be viewed as a state issue versus interstate commerce.
“The Obama lawyers argue that all Americans need healthcare; therefore, all Americans are already engaged in healthcare commerce and therefore can be regulated under the Commerce Clause,” said McCaughey, a Newsmax contributor. “But . . . that’s wrong, because not all Americans are engaged in healthcare commerce. So while it may be possible to regulate people who have healthcare, Congress does not have the power to regulate those who don’t. That is a constitutional issue.”
Florida Attorney General Pam Bondi told Newsmax earlier this year the Supreme Court ruling is “one of the biggest cases of our lifetime.” Bondi, who has argued the law is unconstitutional, added: “If the federal government can do this, they can force us to do anything.”
Number 2: New Employer Requirements
The federal law seeks to drive reform by requiring employers with at least 50 fulltime workers either to provide coverage or to pay an annual penalty of $2,000 per employee.
Critics contend this provision goes beyond what the federal government can compel businesses to do. What’s more, it may have an unintended consequence: Many employers may consider it financially beneficial to drop coverage for their employees, forcing them to purchase insurance through government-run health exchanges Obamacare seeks to create. About 170 million Americans now receive health coverage through their employers.
The provision’s costs to some employers would be significant, McCaughey said, citing estimates that it would add the equivalent of $1.79 per hour, per employee, for providing company-based health insurance coverage.
“When you look at unemployment in this country, that unemployment rate is so high because employers have fear in their heart that Obamacare [could drive] the biggest increase in costs in labor history,” she said. “People are reluctant to hire new employees because they will have these big costs tied to Obamacare.”
Ironically, perhaps, if the Supreme Court strikes down the employer provision it would be bad for the healthcare law, but could actually boost President Obama’s re-election campaign — by driving an increase in employment, she added.
“If the law is overturned, it’s going to create a hiring surge,” McCaughey said. “So, bad news for Obamacare could be good news for Obama.”
Number 3: Medicaid "Coercion"
The 27 state attorneys general who brought the case to the Supreme Court have argued the vast expansion of Medicaid the states would have to shoulder under Obamacare amounts to “coercion” and violates states’ rights.
They maintain the choice given states by the federal government — to accept coverage of millions of newly eligible beneficiaries or withdraw from Medicaid and lose all federal Medicaid funds — undermines state autonomy guaranteed by the U.S. Constitution.
“This is the sleeper issue,” McCaughey said. “The Supreme Court clearly thinks that is worth taking up . . . the legal principle is coercion. Congress can’t order states what to do like that.”
Former Virginia governor and U.S. Sen. George Allen told Newsmax this month that the law is “an overreach” by the government that tramples state’s rights.
“I also don’t the like the way the federal government in Obamacare is commandeering the states and expanding the Medicaid roles, which will cause — obviously — a lot of budgetary harm in the states,” said Allen.
Number 4: Huge Federal Spending Costs
The actual costs of Obamacare have been hotly debated by congressional leaders on both sides of the aisle. But few have suggested it won’t be a costly initiative.
Perhaps the best estimate came from the Congressional Budget Office (CBO), which in March projected of the law’s total price tag would reach an estimated $1.76 trillion over 10 years — nearly twice the amount originally projected.
“Both fiscally and for the sake of our healthcare system, Americans cannot afford the president’s healthcare law,” Georgia Rep. Tom Price, chairman of the Republican Policy Committee, told Newsmax at the time. “The longer the president’s healthcare law remains on the books, the greater the threat it poses to our nation’s healthcare and our fiscal well-being,” said Price, an orthopedic surgeon.
U.S. House Speaker John Boehner also issued a press statement last year whose title spoke volumes about the costs of the new federal healthcare law: "Obamacare 'Will Increase Spending, Increase Taxes, & Destroy Jobs in America.'"
"The No. 1 concern for the American people is the cost of healthcare — and yet what we see with Obamacare is an increase in costs to the American people,” he said. “The Congress can do better in terms of replacing Obamacare with common-sense reforms that will bring down the cost of health insurance and expand access for more Americans.”
Number 5: Greatly Expanded Federal Government
Former GOP presidential candidate and House Speaker Newt Gingrich has called the healthcare law “really bad stuff” for consumers, but said it is a huge boon to the Washington bureaucracy.
“Remember, this bill creates 159 new agencies, commissions, and bureaus,” he said in a statement, shortly after it was signed into law. “Now, the idea that the Department of Health and Human Services can implement a bill that has 159 new offices is just a fantasy.”
GOP presidential candidate Ron Paul echoed Gingrich, saying the law will lead to an “explosive expansion of the reach of government, unprecedented corporate favoritism, and the impending end of quality healthcare as we know it.” But Paul underscored another key argument opponents have made: It undermines individual freedoms of choice in healthcare.
“[T]he most troubling aspect of this bill is that it is so blatantly unconstitutional and contrary to the ideals of liberty,” he said.
FreedomWorks’ Steinhauser agreed. “It takes away our liberty, so it’s bad for economic reasons and liberty reasons,” he told Newsmax. “Forcing people to buy a good or service against their will from on high in Washington is not the American way.”
Number 6: Obamacare Doesn’t Fix the Problem
Perhaps the strongest argument opponents have leveled against Obamacare is one that even some Democrats, doctors, and supporters acknowledge is true: It won’t fix many of the problems facing the U.S. healthcare system — including high drug and insurance costs, improving quality of care, giving patients better choices, controlling end-of-life medical expenditures, and promoting prevention and wellness.
“People all want more value in healthcare, better results at a better cost,” said the Heritage Foundation’s Haislmaier. “But the whole approach in the legislation is sort of a top-down, central-planning, standardizing-the- system approach as opposed to [the] consumer-centered reforms that we would like to see.”
Policymakers now need to make the push for competition and quality care the driving forces for change in the nation’s healthcare system, he said.
“We would move to a system where individuals have more choice of coverage and insurers would have more ability to compete,” he added. “And it would be up to the market to determine the best way to pay doctors and hospitals and show the consumer you’re providing better results at a better prices.”
On other side of the political spectrum, Physicians for a National Health Plan has also argued Obamacare is unworkable and little more than a Band-Aid solution.
"We take no comfort in seeing aspirin dispensed for the treatment of cancer,” the group said in a statement. “Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers' health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.”
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