The age-old question, does the end justify the means? When this question pertains to the recently passed United States health care reform, signed into law by President Obama on March 23, 2010, the answers may be difficult to ascertain.
The End: 2.7 million New Yorkers and 32 million Americans, who are currently uninsured, will be able to obtain more affordable coverage. Insurance companies will no longer be able to impose lifetime limits on coverage or arbitrarily drop coverage. In other words, insurance companies will not be able to deny coverage to individuals with preexisting medical conditions. The Reform will require insurance companies to cover many free preventative care services without requiring copayment or deductibles, such as cancer screenings and mammograms. Seniors Citizens, who are Medicare beneficiaries, will receive free recommended preventative services, pay lower premiums, and receive discounts for prescription drugs if they fall into the gap in Part D drug coverage, known as the “doughnut hole”[1]. For a complete list of changes to insurance coverage visit www.healthreform.gov
The Means: Controversy surrounding the means can be broken into two parts. (a) Expediting the legislative process by using a budget reconciliation bill and (b) the mandate requiring individuals to purchase health insurance, in order to bring the public the benefits mentioned above.
(a) Use of the Budget reconciliation Bill[2]
The process by which the White House and Congressional Democrats passed the recent health care legislation, or specifically, the procedural shortcuts that allowed the Bill to bypass strong Republic opposition, has raised significant concern among those in opposition to the health care reform. Indeed, President Obama signed the final health care legislation that included the budget reconciliation after it was passed by the Senate and the House. The ”simplified” formula is as follows: take the Bill passed by Senate on December 24, 2010, add a Budget Reconciliation Bill, used to rectify certain provisions in the senate bill related to fiscal objectives that are disapproved by Congress, and hold a single vote for the Amended Bill . This particular budget reconciliation addresses issues such as Medicare payroll taxes, changes that allow insurance coverage to close the “doughnut hole” in Medicare, and provisions that extended the time young adults are able to stay covered by their parents’ insurance policies. Implementation of a budget reconciliation bill is favorable to Democrats, the majority party, who sought to streamline the process by treating every senate vote equally and allowing the health care legislation to be passed using a simple majority vote instead of affording the minority Republicans an opportunity to stop the bill. Although similar reconciliation measures were widely used throughout policy-making history, some remain skeptical due to the high profile nature of such a major legislative effort.
(b) The constitutional soundness of Federal Mandates set forth by the health care reform
Another source of controversy surrounding the “means” has been raised by way of two lawsuits brought to federal Courts by 14, predominantly Republican, state attorneys generals[3]. The leader is Republican Bill McCollum, state attorneys general from Florida, and the leading issue is twofold; first, the right to requiring Americans to purchase health insurance or else pay a penalty in the form of a tax, and second, the inherent infringement upon state sovereignty that arises when the federal government obligates state governments to expand Medicaid Programs, thereby increasing their costs.
The attorneys generals filing this suit maintain that federal authority cannot mandate individuals to purchase a good or service. In response, the Bill’s supporters note that consumers are not specifically required to [4]purchase health insurance from private enterprises. Instead individuals can choose to forgo the purchase and instead pay a tax to a health insurance subsidy program (what some deem a “penalty”). Supporters of implementing a tax on those who refuse to purchase health coverage reference Article 1 Section 8 of U.S. Constitutional Law which states that Congress has the power to collect taxes that promote the general welfare of society and those that are “necessary and proper” for the implementation of legislation. Since the health coverage of millions of Americans aims to promote general welfare, the Bill’s supporters consider it within the realm of Constitutional Law and rights of Congress. The tax is also said to be necessary in order for insurance companies to guarantee the issuance of health insurance coverage to those with preexisting medical conditions. According to this reasoning, insurance companies must exist in a market where some individuals pay premiums and don’t use their benefits. In other words, insurers need a mechanism to acquire funds to provide such costly services by preventing consumers from seeking treatment last minute and thus causing significant increases in premiums to be paid by consumers.
The claim concerning the constitution right of the federal government to require States to increase Medicare programs is rebutted by referring to the nature of Medicare as voluntary by nature. The State government can technically withhold participation.[5] Kathleen Sebelius Secretary of the Department of Health and Human Services has said “there are some new costs in insurance expansion borne by the state. But I would argue that those costs are far balanced by new benefits to states.”[6] Examples include less on compensated care and increased federal resources for covering children. The debate of “ends” and “means” will continue to be debated as news of the lawsuit continues to emerge. For now, Ms. Sebelius remains steadfast in maintaining the legality of the health care reform. She states: “in consultation with our legal team and their consultation with the Justice Department, first of all, we are confident that the law is on solid constitutional ground, on firm grounds.”[7]
[1] Doughnut hole is a gap in insurance coverage of prescription drugs to Medicare beneficiaries under Medicare Part D, a Federal Subsidy program enacted in 2006. According the plan beneficiaries pay a 25% coinsurance until drug cost amount to $2,700 after which coverage is ceased until consumer expensed have reached $4350 resulting the spending gap. (www.healthreform.gov)
[3] The Legal Assault on Health Reforms, New York Times 3/10/2010
[5] Is Health Care Reform Unconstitutional, New York Times 3/28/2010