As many of us know, the Supreme Court is set to issue its ruling on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), the federal health care reform law championed by President Obama, and passed in 2010. As we await the Court’s ruling, many people ask what will be the effect here in Maryland.
The premise behind the law is simple, even if the law itself is complicated. A healthy society, where everyone can get access to affordable medical services, is a society where people can obtain services when they first need them, not when the illness is the most expensive or most difficult to cure. It is a society where workers are more productive, students learn better, and dealing with financial hardship due to a significant illness is a thing of the past.
However, to achieve this type of society and maintain a consumer-based health care system, insurance companies that pay for most of these medical services need to balance the risks of ensuring the sick by also insuring the healthy. This notion gave birth to the concept of the individual mandate, a requirement that everyone should be required to have health insurance because everyone will eventually need access to medical care. The individual healthcare mandate is no different than car owners have car insurance, or homeowners have homeowner’s insurance. The irony is that the individual healthcare mandate was a Republican idea (credit where credit is due) conceived in the halls of the Heritage Foundation back in 1989. They called it a “free market approach to universal health care,” and it was championed by then-Senate Majority Leader Robert Dole and then-House Speaker Newt Gingrich, and ultimately enacted by Massachusetts Governor Mitt Romney.
Now, one portion of the PPACA is being challenged in the Supreme Court – that very same individual mandate. Most Americans love every other portion of the PPACA. Polls show overwhelming support for allowing children to stay on their parents insurance until age 26; allowing seniors to buy prescription drugs at negotiated, reduced rates; giving small businesses tax credits and direct assistance to purchase insurance for their employees if they can’t afford it; and eliminating health insurance practices like denial of coverage for pre-existing conditions and rescission. What about half of Americans do not like is being mandated to buy it. However, in a free market system where private companies (insurers) are the pay agents and still want to make a profit, you can’t actually have one without the other.
So, where do we go from here? The Supreme Court has basically three options. First, it can leave the law as it stands; it can rule that the individual mandate is unconstitutional, but leave the rest; or finally, it can overturn the whole law.
Maryland has been a “fast-tracked” State when it comes to implementing the PPACA. Upon passage of the PPACA, we converted the Maryland Health Insurance Program (MHIP) into a high risk pool, implemented series of code changes, and last session we put into place the basic structures of the Maryland Health Insurance Exchange, the insurance marketplace required by PPACA that will allow individuals and businesses to compare insurance plans and shop around for the best coverage and the best deals.
With that context in hand, where does Maryland stand? The Supreme Court is poised to issue its ruling on Thursday. Each option can pose specific challenges for our state, which the legislature has tried to prepare for in advance.
- If the Supreme Court leaves the law alone, then Maryland will move forward and implement PPACA as expected, being at the forefront of this historic reform.
- If the Supreme Court should only overturn the individual mandate, but leave the rest, insurance companies will likely start to clamor for Congress to overturn the rest of the law or put in place mechanisms to take the financial burdens off of them (many insurers will go bankrupt if they were required to cover pre-existing conditions but not have a requirement for healthy people to buy insurance). Ironically, the solution might actually end up being the “public option” (where government provides public health insurance as an alternative) that insurance companies and Republicans in Congress fought so mightily against. Maryland’s health insurance exchange will continue to remain in place and can continue to function, though I suspect legislative changes would be required if an individual mandate did not exist.
- And finally, the Court can overturn the whole law. With such a ruling, insurers will immediately start rescinding many of these benefits including kicking kids off of their parent’s insurance, senior’s prescription coverage costs will skyrocket, and pre-existing coverage denials and rescission practices will go back into effect (it’s true that some larger insurers have promised to retain a few of the benefits granted by PPACA). The truth is that most people, even the ones that hate the individual mandate, will not stand for this and demand some kind of reform. With the structures in place to enact the PPACA already, Maryland is in a good position to move forward, with or without Congress.
If reforms do not get implemented at the federal level, it is my belief, and my hope, that Maryland will move forward with an individual mandate, similar to what Massachusetts passed in 2006. Or Maryland can look to another option like single payer universal coverage akin to Vermont’s model.
Now, all we have to do is wait and see what happens on Thursday.