After the Ruling on the Affordable Care Act: Can We Just Give it a Chance?

July 9, 2012

It is hard for me to understand why opponents of the Affordable Care Act (ACA) react so negatively to the law and use such vitriolic language in describing their views. There is a legitimate public policy debate about this law, but the policy debates have not been much in evidence in the aftermath of the June 28 Supreme Court ruling. More typical is this from House Speaker John Boehner, who said his caucus would “rip [the healthcare law] out by its roots.” What does that even mean?

Another example: the very well-off woman who preceded me at the beauty salon the day the decision came out, who said it was one of the darkest days of her life. She didn’t understand why the law was even needed, because “anyone can buy health insurance when they want it, even on the way to the emergency room.”

How is it possible to be that disconnected from the one million people in Michigan—more than 10% of our population—who cannot afford health insurance without help?

Why is there so much emotion around this law? The ACA is significant, but it is fundamentally a compromise—it doesn’t change the underlying structure of health care coverage in this country. Indeed, my personal critique of the law is it doesn’t go far enough to address the major flaws in Medicaid or our employment-based coverage system.

But isn’t that the kind of compromise our democracy is designed to produce—something not too far toward one political ideology or another?

The Affordable Care Act is not the law I would have written if I had a magic wand, but it is far better than what we have in place today. And for those who think this law wasn’t needed, I would point to an important example in the press, published just before the Supreme Court ruling, that we shouldn’t forget as the political process takes over.

In late June, the New York Times described the situation of a father, who after donating a kidney to his daughter, was denied health insurance:

“Like most other kidney donors, Mr. Royer, a retired teacher in Eveleth, Minn., was carefully screened and is in good health. But Blue Cross and Blue Shield of Minnesota rejected his application for coverage last year, as well as his appeals, on the grounds that he has chronic kidney disease, even though many people live with one kidney and his nephrologist testified that his kidney is healthy.”

While Blue Cross and Blue Shield of Minnesota would not say precisely why he was refused coverage it appears the father was considered to have a pre-existing condition.

When I read the article, I could not have been more surprised—not because this is unheard of in today’s market place, but because of what I know about the Minnesota Blue Cross and Blue Shield plan. Minnesota’s Blue Cross and Blue Shield is a non-profit plan that has long been known as one of the more consumer-oriented plans. I had always viewed Minnesota Blue Cross and Blue Shield as one of the “good guys” in the health insurance world.

If Minnesota’s plan is applying pre-existing condition clauses as restrictively as this story suggests, it can only mean one thing: the individual and small group insurance markets have become so unstable that more and more limits are being imposed to stave off the adverse selection spiral. If this is true, then there are few protections anywhere any more for those who are sick. And while many health insurers committed to continue some of the ACA’s reforms before the Supreme Court ruling, they made no commitments to address the kinds of issues this father faced.

The Supreme Court’s ruling means that people like the father in this story will have a shot at the equality of opportunity we so prize in this country. Perhaps now, a father like this one won’t face bankruptcy because he couldn’t afford health insurance. Perhaps now, this father’s own health won’t be compromised by delaying care for lack of health insurance.

So, I am OK with this compromise less-than-perfect law. Now let’s hope that the political process comes to its senses and doesn’t undo what the Supreme Court affirmed.