Alex Henderson

The Political Zone

Health Insurance Reform and the U.S. Supreme Court



By Alex Henderson
RealmNoir, March 26, 2012

This week, the United States Supreme Court is evaluating the constitutionality of the Patient Protection and Affordable Care Act (PPAACA), which President Barack Obama signed into law in 2010.  The High Court will not announce its decision until June, and it remains to be seen whether the justices will (1) strike down the “individual mandate” portion of the PPAACA but uphold other parts of the PPAACA, (2) strike down the PPAACA in its entirety, or (3) uphold the PPAACA in its entirety.  And considering that more than 50 million Americans presently lack health insurance, it is no exaggeration to say that the health of millions of Americans hangs in the balance.

When Obama signed so-called “Obamacare” into law two years ago, he accomplished something that a long list of presidents—from Teddy Roosevelt to Richard Nixon to Harry S. Truman to Bill Clinton—wanted to accomplish but were unable to: he moved the U.S. a bit closer to universal health care. The PPAACA, although deeply flawed in some respects, does have some positive attributes and addresses some of the more egregious practices of the health insurance industry—for example, it outlaws rescission (health insurance companies dropping customers when they suffer a major illness) and says that U.S. citizens with “pre-existing conditions” such as diabetes, cancer or heart disease cannot be denied health insurance. “Obamacare” also mandates that 80% of a health insurance company’s profits must actually be spent on health care.

But despite those badly needed reforms, the PPAACA still leaves the foxes (companies like Blue Cross, Aetna, Kaiser Permanente and United Health Care) in charge of the henhouse—and it isn’t hard to understand why the “individual mandate” is so controversial. The “individual mandate” forces Americans to purchase what is still a defective and overpriced product. Had the Democrats who controlled both houses of Congress been able to create a public option back in 2010, the PPAACA would have been a much stronger piece of legislation. Forced to compete with a robust public option, health insurance companies would have had a lot more incentive to clean up their act. But as Wendell Potter (a former health insurance executive turned outspoken health insurance reform activist) has pointed out, “Obamacare” minus a public option has some gaping holes in it—and health care-related bankruptcies will continue to be a tragic fact of life in the United States. Even if the Supreme Court upholds “Obamacare,” companies like Blue Cross and Aetna will continue to cause extreme misery and suffering for millions of Americans.

Indeed, the fact that 50 million Americans lack health insurance is only part of the problem. Millions of insured Americans have major gaps in their coverage that could easily result in bankruptcy if they suffer a major illness.

Republican politicians will be cheering if the Supreme Court strikes down “Obamacare,” but not because they give a damn about the health of their fellow Americans; their opposition to “Obamacare” is entirely political. And if Republican opponents of “Obamacare” had an ounce of intellectual honesty, they would admit that “Obamacare” is actually “Romneycare.” The “individual mandate” element of the PPAACA was inspired by the “individual mandate” that Mitt Romney favored when he was governor of Massachusetts. Other GOP proponents of the “individual mandate” have ranged from the Heritage Foundation to 1996 presidential hopeful Bob Dole. So “Obamacare/ Romneycare” is actually a very Republican-inspired piece of legislation whether Romney and House Speaker John Boehner want to admit it or not.

It should be noted that Republican President Richard Nixon, who was considered an arch-conservative in his day, was a major proponent of universal health care. Back in the early 1970s, the Nixon Administration and Democratic Sen. Ted Kennedy offered different proposals; Kennedy wanted a government-run single payer system along the lines of the U.K., while Nixon’s approach was closer to what we now call “Obamacare/Romneycare” but was more generous in some respects. Nixon and Kennedy reached a compromise in 1974—one that combined Nixon’s ideas and Kennedy’s ideas—but “Nixoncare/Kennedycare” was derailed by the Watergate scandal.

Health insurance reform is not only a health care issue—it is also a business issue. Many smaller businesses simply cannot afford the sky-high premiums that Blue Cross, Aetna and United Healthcare get away with charging; so they are unable to offer employees health insurance, and that makes those companies less competitive.

Further, the U.S.’ health insurance nightmare discourages Americans from starting their own businesses; countless Americans would like to start their own businesses but are reluctant to do so because of the exorbitant health insurance premiums. Other developed countries, from France to Holland to Italy to Australia, are smart enough to realize that universal health coverage is highly beneficial for the business world, but in the U.S., businesses continue to be at the mercy of unscrupulous companies like Aetna, Kaiser Permanente, Blue Cross and United Healthcare. 

If the Patient Protection and Affordable Care Act of 2010 is upheld by the Supreme Court, it needs to be greatly expanded. The public option idea must be revisited, which is unlikely to happen as long as the GOP maintains a majority in the House of Representatives—and even if the Democrats do, at some point, retake the House and increase their majority in the Senate, they will need to grow a spine in order for a robust public option to be a possibility. However, if all elements of the PPAACA are overturned, it’s back to square one for health insurance reform activists.

The future looks grim for millions of Americans who continue to be victimized by the most cruel, barbaric and anti-business health insurance system in the developed world.

   Alex Henderson is a veteran journalist whose work has appeared in The L.A. Weekly, AlterNet, Billboard, Spin, XBIZ, Creem, The Pasadena Weekly and a long list of other well-known publications.  He can be followed on Twitter @alexvhenderson.

Supreme Court Justice Antonin Scalia, a Reagan apointee, is among the justices who is likely to vote in favor of overturning the Patient Protection and Affordable Care Act.