Duke’s health care policies may see changes after the Supreme Court passes jurisdiction on ObamaCare this week.
In hearings taking place between March 26 and 28, the Supreme Court will examine evidence regarding the constitutionality of President Barack Obama’s Patient Protection and Affordable Care Act, signed into law March 2010. The act, which some call ObamaCare, would require all Americans to purchase health insurance or pay a fine beginning in 2014. But the law can be stopped if the court deems it unconstitutional. The court’s ruling, projected to be released in June, is expected to greatly influence both voters in the presidential elections this coming November, as well as Duke employees’ health care benefits.
“If deemed unconstitutional, it will be a real blow to the act because the whole notion of [the act] was to increase insurance coverage,” said Frank Sloan, J. Alexander McMahon professor of health policy and management and professor of economics at Duke.
Sloan added that an unconstitutional ruling by the court would be a setback for the country’s goal to provide health insurance to a wider population of Americans.
Duke and the community
Regarding Duke’s health care policies, the University is functioning under the assumption that ObamaCare will be approved by the justices, said Kyle Cavanaugh, vice president for administration. If the act is deemed unconstitutional, the University will assess and adjust its policies accordingly, he added.
Duke currently spends $200 million on health care coverage for University employees and their dependents, Cavanaugh said. If the act is approved by the Supreme Court, state-based health exchanges will be enacted in 2014, which would provide employers the option to offer either private or state insurance for employees. Whether Duke maintains its current private policies or opts into public state insurance hinges on North Carolina’s health policies.
If the act is found constitutional, adults will be penalized $95 if uninsured, and they will incur an additional fine for uninsured children. It will also expand Medicaid to an additional 16 million Americans. These measures are projected to help an additional 32 million Americans become insured by 2020, though 3 to 4 percent of Americans will remain uninsured, Sloan said.
The act will benefit those who do not have insurance by providing subsidies to help pay for health care, Sloan said. But many Americans already insured are unhappy with the act.
“The advantage is that we improve the health of the population that doesn’t have insurance,” he said. “The disadvantage is that someone has to pay.”
Under the health care reform, individuals are insured under their parents’ plans until age 26. Sloan said if the act is repealed, many college students and other young Americans may not have access to health coverage.
Not having access to health insurance may not affect most young Americans because they are healthy, he noted. Repealing health care reform will have a greater impact on those who suffer from chronic diseases but cannot afford health care and do not qualify for Medicaid.
“Most Americans will just go along their merry way,” he said. “[But] the people who are disadvantaged will become more disadvantaged.”
Duke collaborated with members of Congress and the White House in the developmental and legislative stages of the act, said Paul Vick, associate vice president for government relations at Duke Medicine. He added that members of the University involved in the discussions agreed with lawmakers to cut $155 billion in hospital-based reimbursements over a 10-year period to fund the reforms.
Vick said Duke will continue to participate in the health care policy debate regardless of the court’s ruling come June.
Lasting implications
In considering the act, the Supreme Court will deliberate several important legal questions regarding the constitutionality of the legislation.
The justices will review all of the mandates of the health care reform, but will pay particular attention to the “individual mandate” provision, which requires all Americans to purchase health insurance before 2015 or pay a fine. Deliberations Monday determined whether the individual mandate falls under the Anti-Injunction Act—a statute established in 1867 stating that tax laws must be enacted before federal courts can determine constitutionality. If the act was deemed applicable, then the court would not be able to issue a ruling on the individual mandate until it took effect in 2014.
Separability—allowing certain provisions of a law to still take effect even if other components are deemed unconstitutional—was also in question.
Neil Siegel, professor of law and political science, emphasized the importance of the questions facing the court, adding that the judges’ decision could set legal precedent for many diverse issues.
“These questions are not just for the present, but for the future,” Siegel said. “Justices will try to discipline themselves to focus on very important legal questions with potential implications way beyond health care reform.”
The Supreme Court’s ruling will influence voter opinion and turnout in the upcoming presidential elections, but the exact outcomes remain uncertain, said David Rohde, Ernestine Friedl professor of political science.
Some voters feel the need to vote Republican in opposition of the act, Rohde noted. But if the court deems the law unconstitutional, those voters’ sense of urgency will be reduced, decreasing Republican support at the polls come November. But an unconstitutional ruling could also increase motivation to vote Republican in order to prevent an alternative policy from being enacted.
For Democrats who support the health care law, an unconstitutional ruling could motivate voters to reinforce their efforts to win the elections, Rohde said. He added that five of the nine Supreme Court justices were nominated by Republican presidents.
“At the very least, Obama and his campaign will say, ‘Look at what the Supreme Court did—it shows why it is so important that the Republicans don’t get to select any more Supreme Court justices,’” Rohde said.
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