The Supreme Court decision on the Affordable Healthcare Act threw us a curve ball. Many people who predicted the outcome of the ruling swung and missed – including me.
The Court agreed with the government’s argument that the individual mandate contained in the Affordable Care Act was not a tax … for purposes of the Anti-Injunction Act (which would have prevented a lawsuit regarding assessment or collection of the mandate and forced those bringing suit to sue for a refund after paying it).
At the same time, the Court declared that the individual mandate contained in the Act was a tax … for purposes of validating and enforcing the mandate.
To me that’s a stretch. That’s like legal argument defending a dog bite lawsuit by simultaneously alleging that (1) I don’t have a dog, (2) you weren’t bitten, and (3) my dog didn’t bite you.
The Supreme Court’s decision will become a rally cry for the 41% of Americans who believe the law should be overturned and the 27% of Americans who believe the mandate should be overturned. Romney’s campaign will emphasize Romney’s commitment to repeal the law – whether or not he truly intends to do so. While some argue that “President Romney” wouldn’t have the ability to repeal the law, President Obama’s decision not to enforce our country’s immigration laws shows that an executive order refusing to enforce laws can have the same effect as repealing a law. A dog with no teeth can’t bite you.
In addition, President Obama and all the legislators who supported the ACA have essentially approved the largest tax increase in US history … in an election year. How many voters will be happy at the thought of a new and expanding tax that coerces us to purchase a commercial product which we may not even be able to use? The growing public backlash in this regard is probably the reason that the White House is backpedaling and stating that the mandate really isn’t a tax … even though the same White House stated that the mandate was a tax in the media and during oral arguments on the issue. The mandate stands because it is a tax and now President Obama and our legislators have to live with the consequences of their decision. In case you were wondering, here are how each of the House members and the Senators voted on ACA.
But many people will think that the tax … er, um … penalty is OK because our government is going to provide us with insurance. Millions of more patients will be INSURED! If you’ve read WhiteCoat’s Call Room on a regular basis, you know why this is such a false and empty promise. Insurance amounts to a series of promises. First there is a promise that, in exchange for a premium payment, someone else will pay for your medical care. Then there is a promise that someone else will provide your medical care. Finally, there is a promise that you will be provided with the medical care you need when you need it.
While the government wishes to expand the number of patients who receive our government-mandated “insurance”, many states are planning to restrict the eligibility for the “insurance” that our government wishes to provide to us. In other words, states don’t want to pay for your insurance. A House Ways and Means survey showed that 71 of the Forbes 100 companies could save a total of $28.6 billion in 2014 by dropping health care coverage for their employees. The Affordable Care Act creates a financial incentive for your employer not to pay for your insurance. It shouldn’t be surprising that thirty percent of employers are planning to drop health care insurance for their employees when the Affordable Healthcare Act is implemented.
Now think about the effects of just these few fact patterns. When those employees lose coverage, what will happen? Perhaps the employees will be able to afford to purchase a private insurance plan. Even if they did, it is likely that the plan would be high-deductible so that the employees could save money on premiums. Perhaps the employees earn so little that they will be eligible for government “insurance” – if the states don’t cut the eligibility. That leaves a large group of people who earn too much to get Medicaid but who don’t earn enough to purchase decent “insurance.” What will happen to them? They will pay the tax … er, um … penalty and end up with no insurance. When employers drop the insurance benefits for their employees … and they will … their employees will receive less coverage because less coverage will probably be all that they can afford. Sure, the Affordable Care Act will provide “insurance” to an additional 30 million indigent patients, but the Affordable Care Act will also create more uninsured and underinsured patients from the group of people upon whom our country depends the most – our work force.
Medical insurance is only as good as the health care professionals who are willing to provide care under the terms of the insurance policy. accept the insurance as payment. Suppose you had a million dollars worth of Japanese yen in your pocket and you were in a rural Kansas coffee shop trying to buy lunch. You may be rich, but no one accepts your money. Similarly, if a doctor that you need to see using your new government mandated magical insurance plan doesn’t accept your insurance, then you either pay out of pocket for your medical care or you find someone else who accepts your insurance as payment. If few doctors take your insurance, you wait for an open appointment. It’s that whole fast care/free care/quality care triangle. Pick any two.
By now you should know that many doctors refuse to provide care to patients who are on government insurance. In Texas, one third of all the physicians don’t take Medicaid “insurance” due to low reimbursements and governmental red tape. Mayo Clinic in Arizona stopped accepting Medicare patients in 2010 after losing $840 million in 2009 due to low reimbursement rates. Patients with Medicare in the Raleigh, North Carolina area are finding that physicians who accept Medicare patients are “scarce.” All of these people have the magical medical insurance plan that so many more people will be receiving, yet many of the “insured” patients still cannot find medical care. Even though you will coerced by the IRS to buy into the concept that health insurance and health care are synonymous, they aren’t and they never will be.
The health care that you are able to obtain with your “insurance” may less than adequate, as well. Walter Reed Army Medical Center was just one of the government hospitals plagued by allegations of patient neglect and shoddy medical care. And you won’t find any government hospitals on the government’s own Hospital Compare web site. Ever wonder why?
Finally, keep in mind that medical insurance is also only as good as its covered benefits. Your medical problems just might not be a covered benefit on your insurance plan. Even though you have paid into the insurance plan for dozens of years, your covered benefits can change at any moment. Ask patients who have had to depend on their government “insurance” for care of their cancer or injuries, or asthma.
So our elected officials have foisted what amounts to a medical Ponzi scheme upon us and most of them will be long out of office before the medical insurance house of cards collapses. Tough luck, suckers.
Perhaps the thing that concerns me the most about the Supreme Court’s decision is the precedent that the ruling sets. Our highest court has now held that it is permissible for the federal government to impose a tax … er, um … penalty upon citizens in order to force citizens to purchase a private commercial product. In oral arguments, Justice Scalia joked about next creating a mandate that everyone purchase gym memberships to make sure that people stay healthy. Wasn’t funny. His point was spot on. Where do the new taxing … er, um … penalizing powers of our government end? I fear that we will only learn the answer to this question after the election.
The Supreme Court’s ruling and the implementation of this law are another example of how the Court and our legislature are hopelessly out of touch with the needs of the people and how to meet those needs. If President Obama’s actions and the Supreme Court’s decision don’t make our citizens realize that we need a profound change in the governance of our country, then woe to us all.
What a disappointment we will have been to our forefathers.