US Supreme Court Upholds Affordable Health Care Act

[kandrathe]

I think the real surprise in all of this is that Roberts was the deciding vote instead of Kennedy (the one that always seems to break the ties). Outside of those two, I'm not surprised on how everyone else made their decisions.

While establishing the limits of the commerce clause was important, the lesser publicized but more important part of why the 26 States signed on to the challenge was the drastic increase in the size of Medicaid. What is unclear still is how the already revenue strapped States will come up with their portion of the requirement for funding Medicaid (or risk losing their federal portion).

The justices said the Constitution allows the states to have a choice on whether to expand the group of people who are eligible for Medicaid coverage, but if they decline, they cannot be penalized.

Pushing more people into Medicaid was the biggest portion of closing the gap on the uninsured. Now it is unclear if the uninsured gap will be closed, since this ruling will allow the States to determine Medicaid eligibility.

For example, "The Medicaid expansion portion of the Affordable Care Act was of major concern in Alabama, where nearly 1 million people get their health care through Medicaid and the expansion could increase that by more than 500,000 people. In other words, the state would go from 21 percent of its state population eligible for Medicaid to about 40 percent."

Where will those 500,000 Alabamians get insurance now -- or face possibly being taxed by the Federal government for not having insurance.

I liked the public option. I think it would have saved money over what happens now with the government picking up uninsured emergency room visits already.

First, I think the subject often convolute health care with health insurance, so I'm glad you are focusing on health insurance. In talking about insurance then, we also convolute the insurance costs of preventative maintenance with that needed for treating acute or chronic illness or injury. From the government concerns perspective (e.g. misusing the emergency room or hit by a car lying in the street), it would be best if every citizen had an insurance covering both the times when you've got the bad cough (and want to make sure it's not tuberculosis), and to prevent uninsured people dying in the streets from lack of anyone willing to care for another potential non-payer.

But... If those costs are hidden, either by having an employer, or the government pay the bulk of them, then there is not much consumer decision making that will help to drive the costs lower. What happens then when costs need to be controlled, is that either corporations, or governments will end up deciding what procedures, or health care is warranted based on age, based on quality of life, based on morbidity. I don't believe we have the capability of giving everyone 100% of the health care they might need to have their longest possible life span with the highest possible quality of life. The limitation is cost. I think I would rather choose how my portion is used, rather than a bureaucrat in a corporate insurance company, or a bureaucrat in some part of government.

For me, I think it is clear that we need to decouple insurance (or at least the basics) from employment, and we need to put people in charge of making more of their own health care purchase decisions. I think the method, and level of government subsidy is a secondary concern to establishing a system for a health care economy that isn't either heavily rationed or subject to runaway inflation.