The US Supreme Court this week will take on one of the most significant issues in recent history: a challenge to the healthcare overhaul central to US President Barack Obama’s legacy and hated by opposition Republicans. What it decides will affect nearly every American and could have a huge impact on the November US presidential election.
Obama staked the first years of his presidency getting the overhaul passed by Congress, then fully controlled by his fellow Democrats. Every Republican voted against it and the party’s presidential and congressional candidates have pledged to repeal it if they prevail in November.
The court has acknowledged the importance of the healthcare law by scheduling more time for arguments than on any case in more than 45 years. Government lawyers and those representing the 26 states and private parties opposing the law will have six hours over three days beginning on Monday to hear arguments. A ruling is expected later this year.
The biggest issue before the nine justices is whether the government can require Americans to acquire health insurance.
The US is the only major industrialized and developed country that does not provide citizens with healthcare, instead relying on the market place of private insurance companies. Americans spend far more per capita on healthcare, and — most studies show — the outcome falls short of that in countries with national healthcare programs.
A national healthcare program has been on the US agenda for decades, in particular under the administration of former US president Richard Nixon in the late 1960s and early 1970s. However, changes such as those achieved under Obama had always been beaten back by opponents to government involvement.
The healthcare overhaul, denigrated as “Obamacare” by its detractors, is vastly complicated and most provisions of the law will not take effect until 2014. Polls consistently show that at least two-thirds of Americans do not support the changes, particularly a provision that forces everyone to purchase health insurance or be subject to a federal fine. Business could also face a fine if they fail to provide employees with insurance.
Supporters of the law contend that requirements would expand the market for private insurers to include healthy young people who often forgo buying coverage. That would help compensate insurers for provisions barring them from denying coverage to would-be customers with existing health problems. The new law would also ban insurers from canceling coverage to customers after they become seriously ill. Both practices are now widely used by health insurance companies to prevent losses.
The White House says it has little doubt the high court will uphold the law, and that even its opponents will eventually change their tune.
“One thing I’m confident of is, by the end of this decade, we’re going to be very glad the Republicans termed this ‘Obamacare,’ because when the reality of healthcare is in place, it’s going to be nothing like the kind of fear-mongering that was done,” David Plouffe, a senior adviser to the president, said on Sunday in an interview on ABC television’s This Week with George Stephanopoulos.
The Obama administration argues that the insurance requirements, known as the individual mandate, are permissible because the US Constitution gives Congress the right to regulate interstate commerce. It notes that healthcare costs consume 17 percent of the US economy. Opponents argue that the mandate unconstitutionally requires Americans to buy a product and interferes with the rights of the 50 states to set their own insurance rules.
Federal judges in lower courts have come down on both sides of the question, forcing the issue onto the Supreme Court docket.
The suits challenging the law could result in the court and its five-justice conservative majority ruling the entire law unconstitutional or conversely leaving it stand as is. The court could also strike down individual portions of the overhaul or delay a ruling for at least two years until the law goes fully into effect.
The four liberal-leaning justices on the court are seen as certain to vote to uphold the law, which means it will be left standing if only one of the five conservative justices breaks ranks.
The law, as passed, is designed to make sure that most of the estimated 50 million uninsured Americans obtain coverage. Congress has found that when the uninsured go to clinics and hospital emergency rooms, the care they can’t pay for costs nearly US$75 billion a year. Much of that cost is passed along and ends up adding US$1,000 a year to the average family’s insurance premium. The law provides federal government stipends to those without coverage and least able to pay health insurance premiums.
The Obama administration insists the overhaul will bring down healthcare spending nationally. The cost of treatment for health problems and the insurance to help pay for that has been skyrocketing and far outpacing the rate of inflation.
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