The U.S. Supreme Court upheld virtually all of the federal Affordable Care Act – a decision that affects millions of people and clears the way for the greatest overhaul of the health-care system in half a century. What does the ruling mean? Experts from the UW School of Public Health offered reaction, commentary and analysis to local media.
"Washington families won in the Supreme Court," Bob Crittenden, adjunct professor of Health Services, wrote in an op-ed for The Seattle Times. "We all need government working for us, not against us – making sure our kids are healthy, setting rules so insurance companies do the right thing, and ensuring that losing a job or starting a business are not grounds for losing health coverage or bankruptcy."
Crittenden noted several key points of the law (some of which won't take effect until 2014):
- insurance companies cannot deny coverage due to pre-existing conditions
- lifetime caps on care for sick people are eliminated
- new health-insurance marketplaces, known as exchanges, will be created so small-business owners and individuals can shop for competitively priced health-care plans.
Crittenden also said the law makes prevention a key part of the health system. "Our soaring health-care costs are caused by obesity, tobacco use and unhealthy behaviors that all start in childhood," he wrote. "These epidemics affect lower-income people more than anyone and they have few tools to combat them."
About 800,000 uninsured people in Washington state now will begin to move onto insurance plans, according to Sallie Sanford, adjunct assistant professor of health services and assistant professor of law. Nationwide, she added, 30 million uninsured people will be covered either through an expansion of Medicaid or through subsidized insurance. "The point of the law was to have affordable insurance and get more people insured," Sanford said. A family of four earning up to $92,000 will be eligible for subsidies, she told KING-5 TV. The Congressional Budget Office estimates the typical subsidy will amount to about $6,000.
But adding so many people to the health-care system could strain the capacity of primary care providers and organizations such as community and migrant health centers, said Aaron Katz, principal lecturer in Health Services. "A fair number of people will face a struggle getting access to primary care for a few years while the system adjusts to the 'new normal,'" Katz told The Seattle Times. He added that community clinics "have a strong track record at providing high quality, efficient basic health services."
Both Sanford and Katz appeared on a KUOW talk show with Ross Reynolds to explain the ruling. Sanford said she wasn't surprised the Court decided to uphold the mandate for individuals to carry insurance. But she was surprised by the reasoning behind it. In a 5-4 ruling, justices said the requirement to buy insurance or pay a penalty amounted to a tax and therefore was constitutional. The Court also struck down a provision that would have allowed the federal government to withhold Medicaid allotments to uncooperative states. "States that don't want to expand their Medicaid population cannot then lose all of their Medicaid support," Sanford said.
Katz said he was skeptical the Act would keep health-care costs down. "We haven't been very successful in the past," he said. But he stressed, "It will likely make insurance affordable for a fairly large group of people."
Katz told the Public News Service the court's decision is not the final word. He predicts it will heat up the political rhetoric even more, and thinks it's important for voters to speak up. "It's made a decision based on the constitutionality of the law," Katz said. "But ultimately, whether the law is wise or not, is not up to the court. It's up to the citizens and our representatives."