Experts split on effects of Affordable Care Act
Thursday's Supreme Court ruling upholding President Obama's Affordable Care Act has raised a lot of questions on how the decision will change health care going forward. Bioethicist Ezekiel Emanuel, conservative economist Mark Pauly and Grace-Marie Turner, co-author of "Why ObamaCare is Wrong for America," have a few concerns.
Thursday's Supreme Court decision ruling President Obama's Affordable Care Act constitutional is expected to have an unprecedented impact in the long term for the physical health of the nation.
However, experts cannot seem to agree whether this impact will be largely beneficial or harmful.
From its inception, the Affordable Care Act has been surrounded by a great deal of controversy and strong opinions. The Supreme Court's decision has further split Americans and political leaders in their views on the mandate.
Conservative economist Mark Pauly is considered the father of the individual mandate idea. In 1991, he pushed former President George H.W. Bush to adopt a somewhat different mandate than Obama's. He agreed with some of the ACA, but said there are some features of the legislation he found worrisome.
For Pauly, one of the major concerns is the exclusive nature of the exchange markets.
"I personally think it's appropriate to offer fairly generous subsidies to lower or middle-income people to help them afford health insurance," the economist said.
"But the way the law works, you only get that subsidy if you get your insurance through the exchange, whereas [if] you take a lousy job at a good company to get health insurance, you don't get any help at all. You're on your own."
Bioethicist Ezekiel Emanuel was a special health care advisor to President Obama. He now serves as chair of University of Pennsylvania's Medical Ethics and Health Policy Department.
Emanuel believes the mandate will make Americans healthier.
"By 2020, because of this law, we will have a much better healthcare system and all Americans will benefit from it," Emanuel said.
Supporters of the mandate say it has many advantages. They count cost reduction, better access to preventative care and overall better health coverage for Americans as benefits.
With the mandate, every American will have the opportunity and choice to have health insurance.
According to Emanuel, by the end of the decade, every American will also have an electronic health record. He noted that individuals will be able to decide who their health insurer is, who their doctor is, and which hospital they want to go to.
"We've actually reduced the financial barrier for them," Emanuel said.
Opponents of the bill have also criticized it as just another regulation for insurance. They've said that it doesn’t actually impact health care.
"One of the issues is that the bill sets up quite an elaborate regulatory and control apparatus over health insurance. This is really health insurance reform, not health care reform," Pauly said.
The ACA includes a Medicare program that gives incentives for doctors to create accountable care organizations, networks of doctors and hospitals that share responsibility for providing care to patients.
Emanuel said this is just one way that the mandate would help doctors and patients.
We're reducing hospital infections. We're reducing readmissions, and we're giving electronic health records. That has nothing to do with insurers," he said.
Grace-Marie Turner, president and founder of the Galen Institute, a public policy research group that aims to promote free-market solutions for health reform, co-authored "Why Obamacare is Wrong for America."
She said the Affordable Care Act will only raise taxes and increase the deficit, an opinion shared by former Congressional Budget Office director Douglas Holtz-Eakin, who said that the ruling could sharply raise the cost of the law. In 2011, the Congressional Budget Office projected lower Federal budget deficits as a result of the law, but after Thursday's ruling, it said the calculations are complex and it will need some time to review the changes.
According to Turner, there are still a lot of other challenges to the law.
"For example, the Bishops are challenging the HHS mandate. You have the Goldwater Institute in Arizona, that's challenging the mandate," she said.
In 2010, Goldwater Institute filed a lawsuit accusing Congress of violating the separation of powers after it set up an independent advisory board to set Medicare policy and payment rates as part of healthcare reform. The case was put on hold pending the Supreme Court's decision, but will now resume.
Turner pointed out yet another possible stumbling block for the Act's policies: the states themselves, which now face a deadline to set up the prescribed healthcare exchanges.
Turner said it's important to note that there were only two provisions on the legislation before the court. The first was the individual mandate, the core of the ACA. The other provision mandated the states to expand their Medicaid budgets. According to Turner, the provisions said that because it found ways for both of the mandates to be legal that therefore, the question of whether or not the whole law was in question, was thrown aside.
The author also points out that the Supreme Court's ruling does not render the entire law constitutional. She said that a plan relying on incentives rather than mandates would be more effective.
"Given the proper incentives and the proper health plan, people will voluntarily get the preventive care they need," Turner said. "They're healthier and they actually wind up spending less on healthcare because they actually have more control over their personal resources and the kind of policy they have"
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