The Supreme Court's ruling on the Affordable Care Act Thursday was destined to be controversial, regardless of the outcome. But few observers expected the Court to uphold the individual mandate. Chief Justice John Roberts sided with the majority -- basing that decision on Congress' power to levy taxes, rather than the Commerce Act.
Immediately after the ruling, Republicans declared their intention to overturn the Affordable Care Act should they retake the White House and Senate in November. GOP Presidential nominee Mitt Romney reiterated his pledge to repeal the legislation "on my first day as president."
President Obama, not surprisingly, praised the Court's ruling, calling it "a victory for people all over this country whose lives are more secure because of this law."
Lost in the partisan bickering and often hyperbolic coverage is what the Court's ruling really means for ordinary Americans.
The "vast majority" of Americans will not be affected by the Court's ruling, says Dr. Jonathan Gruber, a professor of economics at MIT and director of the Health Care Program at the National Bureau of Economic Research. "If you have health insurance you're unaffected. If you can't afford insurance you're unaffected. It's only for those who can afford healthcare and choose to free ride on the system instead; they will now have to pay a penalty."
Starting in 2014, Americans without health insurance will be required to get covered or pay a fine (1% of income in 2014 and increasing to 2.5% in 2016). Subsidies will be provided for those who can't afford it and businesses with over 50 employees will face fines if they don't offer their workers' coverage.
Gruber, who helped design both the Affordable Care Act and the Massachusetts health care reform Romney signed as Governor in 2006, agreed with President Obama's analysis of the Court's ruling.
"It's a victory because we essentially have a system in America where if you don't have healthcare from your employer or the government, you're pretty screwed," he says.
Once the Affordable Care Act is implemented, Americans can no longer be denied insurance because of preexisting conditions or have their insurance revoked or their premiums jump because they get sick. "This law will...end discrimination in the insurance market and we'll do that through the individual mandate, which will bring everyone into the health insurance market," Gruber says.
As for Romney, Gruber, said he is "disappointed" with his fierce opposition to Obama's Affordable Care Act.
Healthcare reform has been "an outstanding success in Massachusetts," he says, calling it a "template" for the nation. Since 2006, the ranks of the states' uninsured have fallen by two-thirds, private health insurance coverage has risen even as it's fallen nationwide, and premiums have fallen by 50% relative to the rest of the country.
"I'm disappointed both at [Romney] and his party," Gruber says. "Republicans have been completely nihilistic on this topic saying 'they don't like it, they don't like, they don't like it' and never offering an alternative that will help the 50 million Americans who don't have health insurance and the millions more who lose it every year."
Since the recession of 2008, 5 million Americans have lost their employee-sponsored insurance, according to Gruber. "These are people who'd be left in the cold if this law is not passed and implemented."
Finally, Gruber argues the Affordable Care Act is not a tax -- despite Justice Roberts' ruling -- but "a modest charge relative to the cost [the uninsured] impose on the rest of us by waiting until they get sick and going to the emergency room."
Regardless of what you think of the Court's ruling - or the Affordable Care Act itself -- it's pretty clear America cannot continue on its present course. Consider the following statistics, as reported by Reuters:
- At $2.6 trillion, health care spending accounts for nearly 18% of U.S. GDP, a figure is expected to rise to nearly 20% in the coming decade.
- The U.S. spends the most on healthcare and yet ranks 31st in quality of coverage among the 34 members of the Paris-based Organization for Economic Cooperation and Development (OECD).
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- Jonathan Gruber
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