Fate of the Affordable Care Act

Like many others, I spent a lot of time this week trying to follow the U.S. Supreme Court news about the Affordable Care Act. Starting early in the week, the Court spent three days on the Affordable Care Act, listening to arguments from the White House Administration lawyers in favor of preserving the law and from lawyers arguing against the constitutionality of the law. The case made it all of the way to the Supreme Court because different states around the country filed complaints against the "Insurance Mandate" within the law. The mandate requires that everyone in the United States purchase insurance. Opponents of the law attacked the mandate, arguing that the mandate infringes upon individual liberty. According to opponents of the Affordable Care Act, no one should be told they have to buy health insurance. I wonder if these people are also against seat belt laws, and laws that require car owners to buy insurance.

The Court Justices spent a day or so focused on the mandate. Based upon news stories from journalists who tried to read between the lines of the questions, the Justices are skeptical of the mandate's constitutionality. After examining the question of constitutionality, the Justices then spent a good deal of time on the remainder of the law, exploring whether or not the entire law should be stricken with the insurance mandate or if pieces of the law could remain. Again, based upon media stories, many people seem to believe that when the Court publishes its ruling, in June, the entire law will be abolished.

For the dwarfism community, and for other people with disabilities, this is bad news. Passage of the Affordable Care Act in 2010 was a monumental occasion. For the first time ever, people with dwarfism, and other pre-existing conditions, were protected from insurance companies. Prior to the law, insurance companies could deny coverage simply based upon a person's dwarfism. The law makes it illegal for companies to deny coverage based upon dwarfism, or any other pre-existing condition.

The arguments people use to justify denying insurance to individuals have been kind of ridiculous, from Mike Hukabee who said no one would buy a lemon from a used car salesman, to a guy earlier this week on a show called "Chicago Tonight" who said insurance companies shouldn't have to provide insurance to some people just like a bank shouldn't have to provide a mortgage on a house that fails inspection. While I wouldn't want to be sold a lemon, the comparisons don't make sense. The point of health care is to provide health services. Everyone, whether or a dwarf or not, will need health care coverage at some point in their lives. Insurance companies don't want to take the risk of insuring someone who may be more vulnerable. But in terms of cost, it's more risky if a person doesn't have coverage. If a person doesn't have coverage, again whether that person is a dwarf or not, then when that person gets sick, emergency room costs and other crisis measures will end up costing society more money in the long run.

While following the Supreme Court this week, I learned that if the Insurance Mandate is repealed, but part of the Affordable Care Act is retained, the pre-existing conditions protections are not likely to survive. The lawyers for the administration, who are defending the law, told the Supreme Court Justices that if the mandate is struck down, the pre-existing conditions protections would no longer be affordable. So for people with dwarfism and other disabilities, if the entire law isn't preserved, we lose.

I am not sure what to do at this point. The Justices probably have made their decision. We just have to wait a few months before we learn what the decision is. While we wait, I am comforted by a quote from a recent issue of The Nation Magazine. The quote gets at the fact that the health care industry in this country isn't really about protecting people and ensuring that people have access to resources that support their health. Instead, like some many other things, it's about business and money. If it were about health and humanity, everybody would be on the same page, working to ensure that all of us had access to affordable, quality care. The Nation quote is, "The challengers (to the Affordable Care Act) maintain that the case is about fundamental liberty, specifically our freedom not to be compelled to purchase things we don't want. But that frame, while undoubtedly appealing to the radical libertarian strain of the Tea Party, is misleading. In fact, the only 'liberty' that would be protected by a victory for challengers is the freedom of insurance companies to discriminate against sick people, (The Nation, p. 5, March 26, 2012)