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What health reform means for the people of Illinois

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Tuesday, March 27, 2012

The Supreme Court Challenge to the ACA

From March 26 to 28, 2012, the United States Supreme Court will hear arguments in Florida, et al., v. Department of Health and Human Services, et al., the historic challenge to the constitutionality of the Affordable Care Act brought by the attorneys general of 26 states and the National Federation of Independent Businesses. No case has been allotted this much time for argument since the 19th century.

Since the Affordable Care Act was enacted in March 2010, dozens of legal cases have been filed against the law. Most cases have been dismissed on procedural grounds. Of the small number of cases that have gotten past procedural hurdles, four cases have reached the Courts of Appeals.

Of those cases, three courts have rejected challenges to the law (the Sixth Circuit and the DC Circuit upheld the law entirely, and the Fourth Circuit found the challenge to be premature under the Anti-Injunction Act). However, in the Eleventh Circuit, in a case brought by the attorneys general of 26 states and the National Federation of Independent Businesses, the court found the personal responsibility provision to be unconstitutional. However, that court left the rest of the law in place and specifically found the Medicaid expansion constitutional.

The federal government has appealed the decision striking down the personal responsibility provision. The states and National Federation of Independent Businesses have appealed the parts of the decision that upheld the Medicaid expansion and that left the rest of the law in place. No party is arguing that the case against the personal responsibility provision is premature under the Anti-Injunction Act—the Supreme Court has decided on its own to consider that question.

The Campaign for Better Health Care hopes that the justices fully consider the legal precedents that have already been set in similar cases and find that the law is constitutional. We want to see this law given the full stamp of approval of the highest court in the land so that instead of wasting time playing politics around the Affordable Care Act, lawmakers move ahead to implement it.

The central questions here are: What kind of a country do we want to live in? What values do we have as Americans? This isn't a policy debate, it is a philosophical one. The arguments at the core of it are "you're on your own" versus "taking personal responsibility for the common good of your family and America." Our nation was built on the ideals of personal responsibility and working for the common good of our country. Those are the ideals that Obamacare promotes.

The Affordable Care Act protects and offers all Americans the opportunity to obtain quality, affordable health care. People like the consumer protections in the law. They do not want to give up the vital protections that the Affordable Care Act provides them and go back to being at the mercy of insurance companies. Striking down the Affordable Care Act would take away protections that Americans already have or are about to gain, including:

* rules already prohibiting insurers from denying coverage to people, including children, with pre-existing conditions

* tax credits that are already helping small businesses provide coverage to their employees

* rules prohibiting insurers from canceling coverage when people get sick

* rules prohibiting insurers from dropping young adults from their parents’ coverage

* rules prohibiting insurers from imposing annual or lifetime caps on coverage

* improved prescription drug coverage and preventive benefits for seniors and people with disabilities who rely on Medicare

The Affordable Care Act is constitutional, having already been upheld by multiple courts, including by leading conservative judges. If the Supreme Court follows existing precedent, it will uphold the law. Three separate Circuit Courts of Appeal have rejected challenges to the law, with two of these decisions including opinions written by leading conservative judges.

The law is constitutional because Congress has broad authority to regulate interstate commerce. This authority comes from the Constitution’s commerce clause and necessary and proper clause and has been undisputed in Supreme Court rulings dating back at least 75 years. Legal precedent has been well established in this case, so let's move on already.

The Affordable Care Act is fair. The personal responsibility provision is a common-sense rule that will ultimately affect about 1 percent of Americans, and the 83 percent of Americans who already have health insurance (for example, through their jobs or through Medicare) will not be affected by it. Most people without health insurance want coverage but cannot get it, either because they cannot afford it or they are denied it due to their pre-existing conditions. The Affordable Care Act makes coverage affordable and eliminates exclusions for pre-existing conditions. When these people get coverage, they will not be subject to the penalty either.

It is estimated that, at most, 1 percent of the population will refuse to buy coverage and will not qualify for an exemption (for example, for religious reasons or economic hardship). These people should pay their fair share and get coverage before they get sick; waiting until they get sick to get coverage only shifts the cost of their care onto everyone else.

All big changes to our national priorities and policies generate opposition. The Social Security Act in the 1930s and Medicare and the Civil Rights Act in the 1960s were bitterly attacked at the time they were passed. The Social Security Act and Civil Rights Act were even declared unconstitutional by lower courts before the Supreme Court upheld them. Now these laws are part of the fabric of American society. The same will happen with the Affordable Care Act.

Jim Duffett
CBHC Executive Director

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About the Campaign for Better Health Care

We believe that accessible, affordable, quality health care is a basic human right for ALL people. The Campaign for Better Health Care is the state’s largest coalition representing over 300 diverse organizations, organizing to help create and advocate for an accessible, quality health care system for all. For more information, visit www.cbhconline.org.

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