Affordable Care Act

I initially thought the Patient Protection and Affordable Care Act (PPACA, or just ACA; watch this video from the Kaiser Foundation for a great overview of the law) was going to be ruled unconstitutional by the Supreme Court. It doesn’t seem constitutional to force everyone to get health care, and this is exactly what Chief Justice John Roberts said. We don’t force everyone to eat healthy. We don’t force everyone to exercise. However, Roberts argued that the mandate is actually a tax levied by Congress on a citizen’s decision to forgo insurance. This logic seems to follow, as we tax other decisions that people make, such as smoking. Also, our government taxes people to pay for health care for people over 65 (Medicare), so why would it not be allowed to do the same for those under 65? Regardless, I am thrilled that the ACA will be carried out. Everyone should have access to health care. Health care should be treated as a basic right; this is the way it is viewed in most other Western countries. Indeed, one of the reasons I have chosen to become a doctor is to provide health care for as many people as I can.

As an aside, I have a newfound respect for Chief Justice Roberts. He was not afraid to rule against his fellow conservative colleagues. I’ve always had a lot of respect for Justice Anthony Kennedy, typically known as the “swing vote” because he sometimes sides with the conservative justices and other times with his liberal colleagues. He doesn’t let politics get in the way of his decision-making, and this time I am glad that Roberts did the same. I commend him for the courage it took to make this decision.

So what does this mean for us as medical students and future health care providers? My first thought is that we are going to be busier and have more patients to see. On the plus side, we won’t be dealing with the issue of having to provide care for the uninsured, and I would imagine it is currently very hard for doctors to prevent giving care to patients that lack insurance. Therefore, the ACA will decrease the burden of uncompensated care on doctors and hospitals. In addition, there should be less insurance company bureaucracy to deal with, so we will have more time to care for our patients. Lastly, the ACA will give states and local governments more resources for preventative care, which will help our population become healthier. After all, this will be our goal as doctors.

My only real concern is the cost. The Congressional Budget Office estimates that the ACA measures will cost us $938 billion over 10 years. However, the ACA also includes provisions for cost reduction (mostly from health care providers and insurers, which will be paid less, mostly in the Medicare department), and the country will actually be saving money. This seems amazing, and I am curious to see if this will actually happen.

Lastly, what does this Supreme Court ruling mean for our country’s imminent presidential election? I personally don’t think it will have too much of an effect because the bigger issue for the election will be the economy. However, according to a June Ipsos poll, 73% of independent voters oppose the ACA, which favors Romney, who has said he would work to repeal the ACA on his first day as President. This is rather interesting when you consider the Massachusetts health care law enacted during Romney's tenure as governor, which mandated that nearly every Massachusetts resident obtain health insurance. The smart move might have been to accept the ruling on the ACA and focus on other issues, like the economy. It will definitely be an interesting presidential election, but for now, it looks like many more millions of Americans will gain health insurance. This is definitely a reason to be happy.