Wednesday, July 23, 2014


Keywords or Terms: Patients Protection and Affordable Care Act; OBAMACARE; US Court of Appeals, Washington DC; Richmond Virginia; Contradictory Rulings; Litigations and Suits; Americans For Prosperity; Heritage Foundation.

Probably no law in the history of US health policy has undergone more scrutiny than OBAMACARE. Part of the reasons for this has to do with politics; and, maybe on the substance or foundation of the reform: allowing federal funds to be used as subsidy for the millions of Americans without health care insurance.

What OBAMACARE afforded, first in US History, are opportunities for direct subsidy for the purchase of health insurance policy from state exchanges. The number of US citizens without health insurance had risen in the past few decades, so too had the number of emergency room visitation – something advocates of health care reform reminded congress during the long debate over the passing of the Patients Protection and Affordable Care Act.

Much of the current outrage from Republicans over OBAMACARE has centered on the use of federal dollars for financing health subsidy for the more than forty million Americans without healthcare. The passing of the Patients Protection and Affordable Care Act has been considered an affront to the Republican hegemony in Congress; and more than ever, Republican lawmakers have introduced bills to overturn, derail funding and implementation, or scrap the law in totality since its inception in 2010.

Recent effort at killing or undermining the law may be found in ongoing legal battle before the courts. In what would probably be considered another conflicting and misunderstood rulings, are two determinations yesterday before federal appeals court, where it seems the ruling of the courts are conflictual. The US Court of Appeals, Washington DC, struck down IRS rule providing tax subsidies to low income families purchasing healthcare insurance on federal exchanges, maintaining that as the law stands, subsidies are only due purchasers of health insurance policies on state exchanges. Contrarily, a panel of three judges in Richmond, Virginia, ruled that the spirit of the law encompasses subsidies for the same group, whether purchasing health insurance policies on state or federal exchanges.

While accepting the argument that the language of the Patient Protection and Affordable Care Act seems ambiguous, it is the opinion of the Virginia Court that the Internal Revenue Service has discretion of writing rules for OBAMACARE, with respect to award of subsidy write-offs. Now, if the ruling of the Washington DC Court stands, despite petition from OBAMA White House, the decision from the Washington DC Court of Appeal has the potential of crippling the implementation of the Patient Protection and Affordable Care Act. 

The Federal Exchange subsidy, just as the States Exchange subsidies, is crucial to the survivability of the law. The law articulates that there has to be a critical mass of participation, which could be ensured or guaranteed with more Americans carrying a health insurance policy. The thorny part of these contradictory decisions is simply this: there are dire consequences for lower participation of individual in the federal and state exchanges; and, since only fourteen states have exchanges, the remaining 36 states’ residents depend strictly on the use of the Federal Exchange. If participants obtaining their policy on the Federal Exchange cannot receive tax credits, ultimately, there are going to not only be a gap in number of participants, but also, a dithering health insurance market, due to this aspect of the Patient Protection and Affordable Care Act.

While still on these rulings and their implication for the Patient Protection and Affordable Care Act, it is important to take into consideration that the law was passed without a Republican vote of support in March, 2010. Further, the Supreme Court ruled in a June 2012 decision that the law is constitutional; yet acrimonious disastisfaction still persists among the far right. For example, Republicans have introduced over sixty bills in the US House of Representatives to kill the law. Part of the opposition to the passing of the law, emanating from conservative think tanks and work groups in Washington DC, including far right groups as the Americans for Prosperity and the Heritage Foundation, has been summed up as vindictive by many independent keen observers and elevators.

As of recent, the Conservative group Americans For Prosperity was running media advertisement in various US markets, spreading the message that the law is unworkable; that the technological failures that marred the roll-out of the law, is emblematic of the convolution of the provisions in the law; that current litigation challenges in the court are indication of why the law is better written off; and or, symbolic of the type of weaknesses in the law. In the past, just about the time of the debate over passing the health care law, the conservative group, Heritage Foundation, distributed a self-interest research finding listing the following as the case against OBAMACARE, among others: 1) advocating individual mandate; 2) it as a form of new taxes; 3) gutting or overloading the federal budgets; 4) putting a heavy burden on the employer through the employer mandate; 5) it is a form of healthcare subsidy or transfer payment that the nation can’t afford; 6) the federal health exchanges are additional federal bureaucracy; 7) the insurance benefits mandate is an unusual burden;  8) the law has greater implication for the CLASS Act; and 9) the law has possible provision for funding of abortion. There are likelihood that all these reservations and probably anomalies from conservative groups as the Heritage Foundation and American For Prosperity will surface in future litigation over the Patients Protection and Affordable Care Act. There are also the solid expectations that the White House and Democrats in Congress will fight tooth and nail to protect and preserve the law as passed.

There are current perceptions that the contradictory rulings from the two courts apply only to the issue of subsidies for income-qualified or low-income groups that depend on federal subsidies to be able to purchase health insurance. In other words, the fight for abrogation of the law has more to do with denying equality of opportunity for carrying health care insurance in America.  To put it crudely as one can, the fight is against people with low or middle incomes — up to $94,200 for a family of four, who benefit from tax credits to help pay for an health insurance policy through OBAMACARE. The Republicans want the free market system to adjudicate who carries health care insurance and who doesn't. They are hardly interested in the merits of the law and would continue to horn the flaws in the law. 
The former U.S. Health and Human Services Secretary Kathleen Sebelius, alluded to the intricate nature of OBAMACARE in front of 200 national leaders in mental health field, during the 29th Rosalynn Carter Symposium on Mental Health Policy, holding at Carter Center in Atlanta in November 2013. Discussing how mental health could improve with the implementation of OBAMACARE, how the law offers subsidies and opens up new avenue for expanding mental health care, the former Secretary insists that the Law has brought a new lease of life for health delivery to many who may be suffering from mental issues. The litigation battle cry against the law from the extreme right must now be seen as an affront, not only to low income groups in the country but also, to mental health counselors, physician and health providers, who have welcomed the law as another avenue for helping the mentally ill. Now, if you have been reading the newspapers or watching the news on the television or internet lately, you would have concluded that the number of gun related shootings have come from people with mental incapacity or illness, who truly need mental health care. The current legal ambushes or litigation coming upstream from those who could hardly careless about the health of anyone, is an eye-opener of what America has become. Imagine, if the law is gutted; and the third stool on which the law stands is derailed? Your guess is as good as mine regarding the future of healthcare, especially, mental health.

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