The Supreme Court on Thursday, by a vote of 6-3, ruled that President Obama’s health care reform law – the Affordable Care Act (ACA) – can provide subsidies known as tax credits to help poor and middle-income people buy health insurance whether the state runs its own health insurance exchange or if it is run by the federal government. Challengers to the ACA have argued that based on a specific provision in the law, individuals who reside in states that run their own insurance marketplaces (16 states) are only eligible for subsidies.
Over 30 states are allowing the federal government to run their exchanges, so people in those states will continue to be eligible for subsidies to help pay their health insurance premiums. Nearly 7 million (2 million people with a mental illness) would have lost their coverage if the Supreme Court had ruled against the availability of subsidies in the 34 states that do not run their exchanges. In addition, a ruling against nationwide subsidies would have thrown the health insurance markets into a tailspin affecting millions of people who are not eligible for subsidies, as they would have seen their premiums rise significantly (read our report "Pulling the Rug Out from Under").
With all the angst surrounding the upcoming SCOTUS decision over the last six months on whether it is constitutional for people who are currently receiving health insurance with the assistance of subsidies in the 34 states –that do not have their own health insurance marketplaces or exchanges – is there anything left to be said on the matter of King v. Burwell?
Yes, although we have seen Guinness record-book-like articles and reports by those arguing for or against the legality of those subsidies, and the moral issues involved if those Americans lose their coverage over a 4-word provision in a 1900-page law known as the ACA.
So what else could be possibly said at this juncture?
Well I am going to take a crack it. How about our values as a nation? They must count for something like:
- Every person enjoys an inalienable dignity to basic, continuing, and comprehensive health care. Only health insurance coverage can get us to the goal.
- Health insurance is an element of the common good.
- Health insurance is a service to people – health care is an essential social good.
- We have a special duty to care for the poor – the well and wealthy should care for the poor and sick (I don’t get it for those among us who want to punish poor people more by taking their health insurance away. Do you think that poor people like being poor and have trouble accessing needed care?)
I am sure with those 4 bullet points – especially the last one – I have raised the collective blood pressure of a nation – and many readers.
I could argue all day about the benefits on many levels that the country would be much better off if more people had health insurance, and save money and lives at the same time (the proponents and opponents of the ACA have heard it all ad nauseam).
When it gets down to it, I believe it is all about values and the character of a nation that matter when talking about health insurance and health care.
The ACA is here and it is likely too late to have a national conversation as a starting point to discuss values surrounding health insurance.
But let’s talk about that among the human rights we should hold dear is health care, without which human potential is seriously impeded, if not denied. And shouldn’t there be an obligation to contribute to the health of the individual, which by its very nature helps society?
Of course I recognize the American passion for independence – political and personal. But in this day and age let’s get real. We as individuals are dependent on health insurance to help us thrive – and survive – in today’s environment (how about just sleeping better at night as a starting point).
How many people can really say that they do not care about having health insurance coverage, or for their families? You would be deemed irresponsible by your friends, peers, colleagues at work and by your family if you did not have health insurance (affordable, of course, and that is where subsidies come into play).
Ah, but those opposed to the ACA and would like to see subsidies disappear for 7-8 million people (the vast majority who work) are likely from the camp promoting enlightened self-interest and for that matter – survival of the fittest. Many would say that it is just too darn bad – or tough luck or they lack will power -- if those Americans do not have insurance coverage because they can’t afford coverage, or if they have a medical condition that at one time basically excluded an individual from buying coverage (that was the case until the ACA became law in 2010 and now it is illegal for health plans to deny coverage if you have a pre-existing illness).
But I am wasting time because the conversation I want to have which I believe are our most salient values and defines us a nation, above and beyond personal freedom, is our belief in the importance of fairness and equality of opportunity.
We Americans, I thought, support the “underdog” and more important, commitment to providing the opportunity to succeed to all. If we deny subsidies and coverage to people who really need those things to thrive, then we have fallen way too short of that standard. Health insurance is all about fairness and equality of opportunity reflecting a common good.
Health insurance is an essential building block in today’s society like universal education whose purpose is to preserve fairness and equality of opportunity by breaking down all kinds of barriers. Prior to the ACA, even those with health insurance, knew we were still at risk not only for the possibility of independence-threatening ill health, but the loss of coverage which is the principal protection against the worse effects of sickness.
If Americans had no protection against illness or injury, the situation was even worse still. So instead of double indemnity, they faced double uncertainty. Under those circumstances, it seems that our commitment to the notions of independence, fairness and equality were compromised. The ACA has addressed those issues. Do we want to go back to those days and place a key building block in grave jeopardy?
Health insurance and health care are felt at every stage of one’s life. Lack of access at any stage, is a potential threat to independence and the pursuit of opportunity. It is a building block like universal education, police and fire protection, roads and running water.
Recognizing health insurance and care as essential building block offers a framework rooted in the American opportunity ethic:
- It provides individuals with a critical tool for taking advantage of their opportunities.
- It provides individuals and families greater opportunities to participate in and contribute to the fabric of their communities through religious, social, and voluntary institutions.
This is not all a one-way street. There is a reciprocal obligation on the part of citizens to respect and care for their own health. But by making health insurance an essential building block, it serves society’s legitimate self-interest in promoting a healthy, productive citizenry.
To say it another way: The provision of health insurance and health care through consistent coverage should be essential to an authentic realization of the American values of independence, fairness and opportunity.
More importantly, it is an opportunity to stand up for opportunity.