“We all need affordable health care, and we need protection from abuses that have been inflicted by insurance companies for many, many years,” said Dell Erwin.
Erwin, a Charlottesville resident whose grandson suffers from a heart condition, was one of several supporters to gather outside the Federal Courthouse March 26 to recognize the two-year anniversary of the Affordable Care Act, the health care reform law that was President Obama’s legislative centerpiece. People talked about how their lives have been affected, and passed around a petition asking Attorney General Cuccinelli and Governor McDonnell to stop blocking the law.
Even as they rallied, attorneys were readying arguments in the case Virginia’s leaders helped push to the Supreme Court. The court set aside an almost unprecedented three days last week to hear oral arguments for and against the Affordable Care Act, which has been the source of heated partisan debate. Central to the case of the opponents—a list that includes 26 state attorneys general—is the assertion that the mandate requiring all Americans to buy health insurance is a government overreach. Whether the law remains intact is now in the hands of the justices, and local experts reiterated the view shared around the country: Its future, and its legal and economic ramifications, are uncertain.
Thomas Hafemeister, associate professor of both law and medical education at UVA, said last week marked the longest oral arguments ever made before the Supreme Court. “It’s going to be a close vote,” he said. “But if it’s a five to four vote, it doesn’t resolve a whole lot.”
Elizabeth Teisberg, Darden School professor and co-author of Redefining Health Care, has built a career on outlining how the U.S. can reform health care. In her eyes, the mandate is a good way to get everybody in the system, “not only for equity, but for efficiency.” Until everybody is in, she said, too many efforts go into cost shifting, wasting money rather than creating better value for patients.
“If we don’t do a mandate,” she said, “we raise the chance that we will end up with a single-payer system.”
A key factor in understanding the Act is the fact that, according to Teisberg, it’s more a law about payment reform than about care delivery. “And we need payment reform,” she said, due to the competitive nature of the current system. The death of the mandate might not mean the death of a sytem that includes everyone, though. “The notion of having universal coverage is also separable from the question of how you do it,” she said.
But if the mandate is struck down, it could take the entire act with it. It’s that question of severability—can the entire law live on without the component that dictates all Americans jump in the insurance pool? —that helps elevate the case to one of unusual importance.
“It’s a potentially landmark case if the court wants to set limits on what the federal government can do,” Hafemeister said.