At 10:30 a.m. on Thursday, June 28 everyone in my office let out a collective gasp. The SCOTUS blog live feed had just updated, informing the hundreds of thousands of hyperventilating policy wonks and political junkies following the site’s posts that the Supreme Court had just released its ruling on the Patient Protection and Affordable Care Act. I had to run back and forth between my desk to refresh my Twitter and another room to watch MSNBC.
I’m just one hapless writer among many attempting to weigh in on what this ruling means for voters, insurance companies, small businesses, students, politicians, media outlets, America, Earth, the Milky Way, etc. I am not Ezra Klein or Dahlia Lithwick, two of my most favorite observers of the Court … but that is OK. I’m a student (maybe you are too) and a woman (also entirely possible) and the Court’s ruling will affect us all.
Before oral arguments began in March, many legal scholars and former court clerks believed that the mandate would be upheld. After picking over the questions asked by all the justices in the courtroom save Thomas (he doesn’t speak all that often), experts thought that under the commerce clause the penalty for not purchasing health insurance would be found constitutional.
The continued outrage from pundits and congressional Republicans has been unbelievable given that the idea for the individual mandate originated at the conservative Heritage Foundation think tank and was supposed to represent the concept of personal responsibility, often espoused by Republicans under different circumstances.
Experts found it impossible to predict what would happen if the mandate were to be sequestered. As Duke Law professor and health policy expert Barak Richman explained in an email, “The health insurance industry is deep in the throws of adjusting to the [health care reform rules]. But those rules remain a moving target, all the more so with the courts ruling. So this is a work in progress.”
Yet insurance companies, students, women, the uninsured and many other constituencies could breathe a sigh of relief on Thursday, as Chief Justice John Roberts joined the Court’s four more liberal justices in upholding the Act. Though they did read the Medicaid expansion narrowly, potentially increasing the likelihood of states refusing federal Medicaid funds to expand insurance coverage, the majority did rule the mandate as constitutional—in Roberts’ case, viewing it as a tax.
I received an email from Duke Student Health insurance on June 14, which we now can now officially affirm and celebrate.
“Good news!” The email proclaimed. “Preventive care services will be available to Duke Student Medical Insurance Plan subscribers at 100 percent coverage.”
The email continued to explain that the Student Health Insurance plan, administered by Blue Cross Blue Shield of North Carolina, also will be offering “benefit enhancements” for the upcoming year, including “STI screening … covered at 100 percent (there will be a limit on the number of annual screenings)” and “[g]eneric oral contraceptives … covered at 100 percent.”
Needless to say, this was a very exciting email for a woman who will have paid $360 in copays for birth control from the Duke Outpatient Pharmacy come August. Now that we have some more closure from this ruling, these benefit enhancements will go into effect when we get back to Durham.
Americans didn’t like the Act because they didn’t understand what it actually contains. Hopefully, after this ruling, more will comprehend the positive provisions under the poorly sold original packaging. A telling Reuters poll released June 24 had the best headline: “Most Americans oppose health law but like provisions.” Majorities of respondents expressed support for allowing children to stay on their parents’ insurance until 26, preventing insurance companies from discriminating based on pre-existing conditions, and requiring companies with more than 50 employees to provide insurance. Another recent poll from the National Women’s Law Center and Planned Parenthood found that 73 percent of Americans support access to affordable contraception.
Those unhappy with the Supreme Court’s ruling will do their best to spin the PPACA’s effect on Americans. They have already promised to repeal it if they get the electoral approval from voters in November. Without sustained support for the legislators who voted for these provisions, say goodbye to a world in which sick people can find an insurer to cover them and women aren’t charged higher premiums simply because they’re women.
We need to let our legislators know that we like and want to keep the provisions in the Affordable Care Act. Otherwise, we might not be able to have our copay free birth control and eat it, too.
Samantha Lachman is a Trinity senior.
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