Health Care Reform on Trial: What's at Stake in the Upcoming Supreme Court Arguments

News | Health

Hearings on the Patient Protection and Affordable Care Act begin on March 26. The law has yet to take full force, and key aspects, health experts argue, remain fundamentally misunderstood by the public

By Katherine Harmon ?| March 23, 2012?|

Image: Flickr/kokopinto

The U.S. Supreme Court is a busy place this time of year. So when the justices announced that, starting March 26, they would hear six hours of arguments on the health care reform law?the most time it has dedicated to any one case in decades?the gravitas of the issue became clear to all.

The Patient Protection and Affordable Care Act (PPACA) is perhaps the most profound change to health care since Medicaid was instituted in 1965. "This case deserves the hype it's getting," says Gregory Magarian, a law professor at Washington University in Saint Louis School of Law.

The case is not just a political lightning rod?and whatever decisions emerge from the Court in the early summer will likely do little to diffuse the partisan tensions around the issue. What's really at stake in the case is individuals' access to health care.

Signed into law March 23, 2010, PPACA is expected to expand access to health care to an additional 32 million uninsured people in the U.S.?unless all or part of it is struck down by the Supreme Court.

"If this law's thrown out, I think we're resigned to the status quo, which is a lot of people without access to health care for a long time," says Larry Levitt, an expert at the Kaiser Family Foundation, a nonprofit, nonpartisan policy analysis organization. "I don't think there's any question about what lack of access to health care means: people get treated later, and some people die earlier as a result."

That also means continued health care cost increases, an expenditure that already eats up some $2.6 trillion a year?about a fifth of all U.S. spending.

At issue are two major provisions: the requirement that everyone have health insurance?the so-called individual mandate?and an expansion of Medicaid benefits, which would help more people afford insurance in the first place. "If the Court rejects either or both of those, it would have far-reaching implications for how health care reform would work?or even if the law would work at all," Levitt says. With fewer people insured, premiums would become even more expensive.

One of the unusual things about the legal challenge is that most of the law's big changes have not yet gone into effect, which has muddied the debate about how it will likely affect people's lives in practice. The individual mandate, for example, is not slated to begin until 2014. As more provisions are rolled out, Magarian notes, the law's benefits for individuals will likely become clearer to many. "For a lot of people this law is going to be a desirable thing on a personal level." he says.

From a public health perspective, the only argument against the law is that it should be even more aggressive in ensuring that people have access to affordable health care, says John McDonough, a professor at Harvard University's School of Public Health.

The Court will be hearing arguments about four segments of the law over the course of three days. What is at stake for each of these issues?

Individual health
Much of the outcry about the PPACA has centered on a need to preserve individual rights?that is, no law should require that people get health coverage. But the case before the court, Magarian explains, "isn't about that at all." The question in front of the Court pertains to state rights. "I think that would surprise a lot of people." This confusion, he posits, might be behind some of the recent polls that show about two thirds of Americans favor repealing the whole law part and parcel. As Levitt points out, if the Court overturns the PPACA, the states are well within their constitutional bounds to require their residents to purchase health insurance (as they already do with auto insurance).

Source: http://rss.sciam.com/click.phdo?i=44d0eb6956c6987e58ad5996b66490a7

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