23Nov2011
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SOA Blog
Category
Healthcare
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Healthcare reform goes to the high court

Last week, the U.S. Supreme Court announced that it would weigh the legality of President Barack Obama’s healthcare reform bill, the Patient Protection and Affordable Care Act (PPACA), in the first few months of 2012. Below you will find a summary of the issues at hand and thoughts on what needs to be discussed before the Supreme Court weighs in.

The bottom line is that the Supreme Court has agreed to hear oral arguments to decide the constitutionality of the healthcare law’s requirement for individuals to buy insurance. Conclusions by the high court will likely come down in late June — right before the Republican and Democratic conventions and smack dab in the middle of the 2012 presidential season.

Nicholas Pell, blogger at Credit Sesame, does a nice job of summarizing the most controversial provisions of the healthcare bill.

The main provisions relevant to consumers can be broken down into three basic categories:

  • All US citizens must have some form of insurance, and failure to do so will result in penalties that would likely exceed the cost of a bare bones plan
  • Insurance companies have to cover consumers
  • Certain procedures must be included in the cost of health
    insurance

Appeals courts have largely split on whether the mandate is constitutional.  Here’s a summary of what some of the courts are saying:

The U.S. Appeals Court for the DC Circuit upheld the mandate. Senior Circuit Judge Laurence Hirsch Silberman wrote: “Despite questions raised as to our subject matter jurisdiction, we conclude we have jurisdiction, and we affirm the district court’s conclusion that the Act is constitutional.”

As reported in a post from the Consumerist, “Panels in Virginia and Ohio sided with the White House and the Justice Department argued that the mandate is covered by the Commerce Clause because one’s decision to not purchase health insurance qualifies as an act that has a direct impact on interstate commerce, by shifting the cost of the uninsured person’s medical care on to others. The Atlanta-based 11th circuit ruled against the DOJ, saying that the mandatory coverage clause of the act does not fall under the umbrella of interstate commerce.”

So as we get ready for the “final” legal challenge to the PPACA, here are some questions related to risk management we should consider. All thoughts are welcome.

  • What should be the criteria for “essential” health care procedures?
  • What responsibilities should an individual have in regards to preventative care?
  • Regardless of the outcome of this challenge, do employers need to fundamentally re-think how they manage increasing health care costs?



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