The Affordable Care Act has lots of good things in it — and three really good things: It allows young people to be covered on parents’ policies until the age of 26, it prevents insurers from denying coverage to people with pre-exisiting conditions, and it would have allowed expansion of Medicaid coverage for state-based coverage of the poor.
Today’s Supreme Court ruling means the first two of those provisions will stand, but before the rejoicing starts, I see a few potential downsides:
Chief Justice Roberts’ opinion questions whether the federal government can require states to expand Medicaid coverage. This presents a question mark about whether the health care law will really give coverage to the poor. And Roberts' opinion is based not on what everyone expected -- the Commerce Clause -- but instead on Congress's power to levy taxes.
So, another question mark for me is this: Is it OK for the federal government — instead of providing insurance itself — to say that you, citizen Jane Doe, must pay a private company for insurance?
My fellow public health professionals will share my relief about the two plusses above, but some will continue to be disappointed that we don’t have some kind of federally organized single-payer coverage. I would like to see what my colleagues in the public health profession say about the late, lamented "public option." And what’s going to happen with Medicaid.
Philip Alcabes, PhD, is an epidemiologist, professor in the School of Nursing, and director of public health program at Adelphi University, Garden City.