Monday, April 9, 2012

Uncertainty About U.S. Health Care Prevails


The future of Health Care in the United States is more uncertain than at any other time in the past fifty years. This new uncertainty was created by the U.S.Supreme Court’s decision to receive a challenge to the Affordable Care Act (ACA), known by most as Obamacare. If you missed it, the oral arguments on the case were presented before the Court in an historic three days of hearings March 26-28. These were preceded by many briefs submitted to the Court from a broad spectrum of organizations. All of this information is available in the public domain. A detailed analysis of each day of the hearings may be found at A decision from the Court is expected in late June.

There is no certainty about how the Court will rule in the case before it. There are widely divergent speculations which are interesting to read, for sure. This is usual and customary. On the other hand, there is a difference this time. The entire healthcare system is likely to be impacted, many millions of citizens will feel it, and the political races from coast to coast are expected to react regardless of the outcome.

There is one certainty. The Justices of the Supreme Court have more power to influence the direction and content of how health care is provided and paid for than at any time in contemporary history with the possible exception of the era when Medicare and Medicaid were enacted in the mid 1960s. The Court’s decision will likely have substantial impact regardless of the decision. Here’s a summary of the major options under consideration.

The Court can conclude that comprehensive health care reform, as prescribed in the Act, is constitutional and should  proceed. It would be a green light for substantial change for many.Or, the Court would post a red light and repeal the entire Act. That would return us to pre-2010 health care policy. Or, the Court could post a caution light with some parts of the Act approved and others repealed. Right now, this is very murky. These are vastly different options. There may be other options which the Court could consider.

The contents of the Affordable Care Act are contained in a comprehensive and lengthy document in excess of 2000 pages. There are many, many parts to it An analysis of these parts is beyond the scope of this posting but some of them will be the focus of future postings.Suffice it to say the Act is complex and controversial. Some believe it is long overdue and is the right direction to improve health care in the U.S. Others believe it would be the wrong direction and an inappropriate role of the federal government. Nevertheless, the Act was passed by Congress and signed by the President two years ago. Parts have been implemented already. For example, people can not be rejected for health insurance due to pre-existing conditions, children under the age of 26 can be included in their family’s health insurance plan, and preventive health care benefits must be included in health insurance plans. Most of the parts of the Act will be implemented in 2014 and after, provided it is sustained by the Court.

The stakes for the future of health care policy at the federal and state levels as well as the arrangements for personal health care for many could not be higher. A total repeal of the Act will make a big difference for many right away. For example, seniors would likely pay more for health care out of pocket, Medicaid expansion would not proceed and those without insurance would increase. Those with health insurance, especially comprehensive insurance, would probably not notice much change in the short run. In effect, the Congress and the President would need to return to ground zero if they want to. If the Act is sustained, changes already in place will continue and additional reforms will be organized for implementation.. There will be much anxiety about the meaning of the changes. There will likely be challenges in implementation and concerns about public understanding. Our nation had a similar experience in the several years after Medicare and Medicaid were started.

This is an extraordinary time for health care in the U.S. Until the Justices announce their decision, a high level of uncertainty will prevail. It will not end with the decision, regardless of its direction. Future postings on this blog will be designed to help readers improve understanding of the complexities of health care in the U.S. and the depths of the uncertainties which prevail.  



Wednesday, March 21, 2012


The purpose of this blog is to examine and discuss health policy issues with the facts as a platform. It does not have a political bias but approaches relevant topics on health care with balance.