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SUMMARY AND BACKGROUND
"It’s a mistake to believe the debate is over." 2
- Robert Blendon
"...people say, Is it a penalty, or is it a tax? Let’s just be clear -- it’s a tax-penalty." 13
- John McDonough
"I worry, particularly about discussions with the deficit and the costs of implementing this act, that what they will chop off will be a great deal of these innovative programs, and especially public health, which is always last at the table." 15
- Wendy Mariner
"We’ve got to get serious about cost control." 6
- Regina Herzlinger
The U.S. Supreme Court has upheld the Patient Protection and Affordable Care Act, including the individual mandate that requires most Americans to have health insurance. This Forum at HSPH event, which took place the morning after the ruling, explored the implications of the decision for Americans. Where do we go from here? Presented in collaboration with Reuters.
Background
- The Patient Protection and Affordable Care Act
- HealthCare.gov
- The Case Against Obamacare: Health Care Policy Series for the 112th Congress
- The Heritage Foundation
- Health Care Reform and the Supreme Court (Affordable Care Act)
- The New York Times
Photo © Getty Images/Richard Seagraves/Photonica Collection
What about the Medicaid expansion?
I have one thing to say about this country. We are supposed to be a democratic country where everyone gets a say in what happens to them. BUT, the Supreme Court is the BIGGEST JOKE in our country on democracy. There are 9, APPOINTED FOR LIFE PEOPLE, who can, and do, tell MILLIONS of people how they MUST live. We not only don't have any say, but we don't have any say as to who will be in the Supreme Court. Our stupid presidents choose the ones they want that will help their agenda. If that's democracy you can keep it!
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
Please discuss the issue of physician shortages when many more people are insured.
Marcia S. Taylor
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
In addressing the costs, please address the cost elements, especially the cost of administration that would be greatly reduced with universal health coverage.
Janine M. H. Selendy
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
Given the annual federal deficit, serially over one trillion in recent years, and a protracted weakness in the overall economy (still with no signs of significantly improved job creation) how do you envision the increased funneling of federal dollars to the states as impacting the federal debt in the near term and in out-years?
Thomas Jamieson
Washington, DC
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
How does an individual with preexisting conditions find affordable health care before the legislation begins in 2014?
Margaret
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
How do you think this decision will affect temporary and contract workers, most especially those who own temporary employment and recruiting agencies.
Derek Filkins
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
Thank you for your offering this panel and considering my two related questions. These two questions are directed primarily to those on the panel of HBS Professor Regina Herzlinger's mindset:
1) Now that the legality of the individual healthcare participation mandate has been clarified and endorsed by yesterday's US Supreme court ruling, who on your panel agrees with HBS Prof. Herzlinger and her extensive research and case studies, and would like to see the United States design and adopt a healthcare insurance and delivery system that emulates the effective Swiss health care system and insurance model, with its attributes of high customer choice/ consumer driven alternatives, high quality patient care, intelligent managerial and control systems, and different patient/consumer alternatives in healthcare insurance and healthcare delivery systems--that is, a well designed, effective, non-federal governmentally controlled, comprehensive, consumer choice driven, fiscally sound, US healthcare system, that offers a variety of alternative patient care delivery systems--that would be designed and implemented on a larger scale here in the US to emulate the effective Swiss national system?
2) Although the Supreme Court has supported the "individual mandate" sections of the existing healthcare system passed by Congress, what yet must be done politically and legally to substantially change the flawed, existing US healthcare law passed by Congress a few years ago and signed by the President to redesign and restructure the ill-conceived, ineffective, unpopular United States health care insurance system on the books (currently, scheduled to be implemented in 2014), so that our US national healthcare choices and alternatives will emulate the more effective, fiscally sound, consumer driven, Swiss federal healthcare system model-- and what necessary education of the media and the public and political conscious raising must begin to achieve these necessary political and legal changes ?Thank you for your consideration of these interrelated, important questions on an issue that will effect our economy, businesses, nonprofit and religious organizations, and every US citizen radically.
A. John Maragos
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
I am elated by this landmark decision that puts patients before politics.
My questions can be answered by any of the participants:
1. What is the percentage breakdown of those additional 32 million Americans who will receive health coverage under the ACA? In other words, who are they? Are they Americans who use the emergency department inappropriately for primary care services, thereby inadvertently, utilizing the most expensive and ineffective way of delivering those services? Or are they Americans who present with end stage disease because financial considerations prevent them from seeking care earlier, thereby, incurring heavy financial risk and, also inadvertently, increasing the cost of health care?
2. Of the 20+ million Americans who will not be covered by the ACA, what percentage of those are undocumented? What percentage of those are exempt for religious or tribal beliefs? And what percentage of that 20+ million will decide to pay a penalty rather than buy health insurance?
3. What are the next steps in addressing other issues such as tort reform that are not part of the ACA but are big drivers of health care cost?
Angela Crane, MD
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
What is the implications of the ruling regarding states and medicaid?
Jan Goldberg, New York City Administration for Children’s Services
Thank you very much for this interesting panel discussion and for making it available live online! Looking forward to the next session, best regards from Germany!
Can states use the new federal funds tied to Medicaid expansion to also pay for people using the current Medicaid system? I know my state is seriously behind in making payments and could use that money to catch up.
Now that U.S. citizens with pre-existing conditions can plan to retire with health insurance, they may do so at 65 or earlier. Their employers will then hire replacements. Do you expect this hiring to benefit the U.S. economy? (I'm thinking of conditions like diabetes that require treatment but are not necessarily disabling.)
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
Thank you for putting on this forum. My question is about the Medicaid expansion. Given that states have the option to opt out of the expansion without losing federal money, do you foresee that this will create a hole in coverage for those who are above the individual state's eligibility requirements but below 133% of the FPL (when the subsidies kick in?). I'm so happy about the decision, but feel that we have once again let the most vulnerable members of society slip through the cracks.
Thanks and I look forward to your response,
Colleen Vessell
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
Thank you for hosting this! Here are a couple of my questions:
1. Could you discuss the shift from fee-for-service to a more quality
based payment plan, and how you think this will influence medical
practices?
2. There's been a lot of talk about how this bill will hinder small
business creation and growth, but are there any ways that small
business can benefit from the reforms?
Brendan Burke, University of Michigan
EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER
John Boehner is saying once again that Obamacare is taking $500 billion away from Medicare (over 10 years). But this is a conservative argument: to reduce Medicare Advantage premiums, which were "overpaying" recipients about 15% of the average Medicare costs in their area. What was the continued purpose of that? This comes under the area of fraud, waste and abuse, which should be applauded by Republicans and fiscal conservatives.
George Fulmore, Concord, CA
Is it not the case that, while "polls show that Obama care is unpopular", the elements of the Affordable Care Act are very popular with the American people when those elements are described to them?
I am very happy at the decision made by the Supreme Court on the issue of healthcare today. To uphold the health care law is a decision on a right direction. Although the cost to maintain health cost may be enormous, the benefits are many. Lots of lives would be saved given this new law and decision.
I would like to be informed about any updated issue on the topc of health care.
@kajal: Would you like to join our enews alert? I'd be happy to add you.
Thank you for holding these forums and making them accessible to all. Looking forward to the Supreme Court's ruling and your analysis.