KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Perspectives On Health Law Challenge: Does Court Recognize Its Own Limits?; A Dubious Link To Civil Rights Act; The Burden On Young People

The New York Times: The Supreme Court's Momentous Test
In ruling on the constitutionality of requiring most Americans to obtain health insurance, the Supreme Court faces a central test: whether it will recognize limits on its own authority to overturn well-founded acts of Congress (3/27).

The New York Times: Could Defeat In Court Help Obama Win?
If the Supreme Court decides to strike down the new health care law's individual mandate to purchase insurance, it will represent a remarkable election-year rebuke for President Obama – the rejection, by the nation's highest court, of a central provision of his main domestic policy accomplishment. It might also help him win re-election (Ross Douthat, 3/27).

The Washington Post: The Supreme Court Takes On Medicaid
On the third and last day of oral arguments on President Obama's landmark health-care law, the Supreme Court will grapple with a couple more issues, including whether the law's expansion of Medicaid unlawfully coerces states to participate (3/27).

The Washington Post: Obamacare Is Not A Civil Rights Issue
By now you've heard it plenty: The Affordable Care Act (ACA), a.k.a. "Obamacare," is like the Civil Rights Act of 1964. This creative bit of dot-connecting began with President Obama and has been perpetuated by countless talk-show hosts and their guests. ... This would be a dandy argument if the two issues were remotely related (Kathleen Parker, 3/27).

The Wall Street Journal: A Constitutional Awakening
Tuesday's two hours of Supreme Court oral arguments on ObamaCare's individual mandate were rough-going for the government and its assertions of unlimited federal power. Several Justices are clearly taking seriously the Constitution's structural checks and balances that are intended to protect individual liberty (3/27).

The Wall Street Journal: Insurers And The Supremes
Insurers were never the enemy of ObamaCare that it suited President Obama to pretend. That much is clear from their stance in this week's Supreme Court case. In a brief filed by America's Health Insurance Plans, the industry's main trade group, along with the Blue Cross Blue Shield Association, insurers conspicuously fail to take issue with the individual mandate or any feature of ObamaCare. Their sole concern is a question that will animate Wednesday morning's oral argument—"severability," or whether the individual mandate can be struck down without invalidating the rest of the law (Holman W. Jenkins Jr., 3/27).

USA Today: Editorial: Health Care, Yes. Broccoli, No.
Skeptics of the mandate suggested a range of possibilities. Cars? (Justice Antonin Scalia) Cellphones to dial 911? (Chief Justice John Roberts) Burial insurance? (Justice Samuel Alito) Broccoli? (Roberts and Scalia). Amid the metaphorical overload, it fell to Justice Ruth Bader Ginsburg to point out the rationale behind the individual mandate: "The people who don't participate in (the health insurance) market are making it much more expensive for the people who do," she observed about 20 minutes into the two-hour debate. Indeed. It's hard to make that case about consumers, and non-consumers, of any other product (3/28). 

USA Today: Opposing View: Individual Mandate Masks An Ugly Deal
After all, a Congress that can force you to buy health insurance can also force you to buy solar panels, newspaper subscriptions and gym memberships. But let's be real. The reason the ACA forces every American to buy health insurance is that the law makes it a raw deal for people to buy it on their own. Of the 50 million people in America without health insurance, according to the U.S. Census, 55% — nearly 28 million — are under the age of 35. Thanks to decades of unwise government subsidies, regulations and mandates, these young Americans are forced to pay far more for health insurance than they consume in health care (Avik Roy, 3/28).

Roll Call: Millennials – Much Is At Stake With Health Care
Let's assume the mandate is upheld. Young people will feel an immediate effect because they are the primary target of the law's linchpin mandate. According to the Census Bureau, young adults (ages 19 to 29) are more likely to be uninsured than other age groups and to report being in good health. Beginning in 2014, this group will be required to buy government-approved insurance. That means they’ll face a monthly bill for something they do not want, covering services they probably won’t use. The cost will be higher than it would be absent the law because the measure limits insurers’ ability to offer different prices based on factors such as health and age. Effectively, millennials will pay to support other, older people’s health care needs (Hadley Heath, 3/28).

The Baltimore Sun: Health Care Jujitsu
(T)he only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance -- including young and healthier people who are unlikely to rack up large health care costs. This dilemma is the product of political compromise. The administration couldn't get the votes for a single-payer system such as Medicare for all. Not a single Republican would even agree to a bill giving Americans the option of buying into it. But don't expect the Supreme Court to address this dilemma (Robert B. Reich, 3/28).

The Fiscal Times: How Obamacare Derailed The Economic Recovery
[M]any Americans think Obamacare failed to tackle many of the actual causes of excess healthcare spending – the lawsuits that mandate unnecessary procedures by vulnerable doctors (the CBO estimates capping malpractice awards would save taxpayers $54 billion over ten years), the fact that so many patients have "no skin in the game" and therefore undertake treatments oblivious to any reasonable cost/benefit analysis, and often wasteful reimbursement procedures (Liz Peek, 3/28).

Politico: Health Law A Leap Forward For Women's Health Care
Before health care reform, insurance companies could legally deny women coverage because they had been diagnosed with breast cancer. ... It isn't just breast cancer. In 2011, at least 19 million American women between the ages of 18 and 64 were uninsured and 129 million non-elderly Americans had some type of pre-existing condition. ... The new health care law guarantees coverage for every American — regardless of whether they have a pre-existing condition (Cate Edwards, 3/27). 

Bloomberg: Broccoli-Bungling Defense Hurts Health Care
What, (Justice Anthony) Kennedy wanted to know, is the limiting principle on the government’s ability to regulate? ... The answer is that health care insurance is different because if the healthy people fail to get themselves coverage, it becomes extremely difficult -- under some conditions, impossible -- for the insurance market to operate…. If I choose not to buy broccoli, others can still buy it at a market price. If I choose not to buy health insurance, universal coverage becomes impossible (Noah Feldman, 3/27).

Houston Chronicle: Seniors Are Already Benefitting From The Affordable Care Act
As the law continues to be debated, we're likely to hear more of the same "government takeover" rhetoric. But ask a senior who's gotten a free checkup or a break on the cost of prescription drugs and you're likely to hear another story: about how the health reform law brings with it a sigh of relief (Betty Lee Streckfuss, 3/27).

The Seattle Times: Health-Care Freedom Can Be Costly
Then Paul Clement, the gifted lawyer for the states against Obamacare, made this suggestion: "The most straightforward one would be to figure out what amount of subsidy to the insurance industry is necessary. ... And once we calculate the amount of that subsidy, we could have a tax that's spread generally through everybody to raise the revenue to pay for that subsidy." Uh ... our unpaid hospital bills for one year, in this one state, now amount to two billion dollars! Instead of asking the free riders to pay, the constitutional solution apparently is to tax all of us into the poorhouse. The good news is we'll still be free. Broke but free (Danny Westneat, 3/27).

Politico: Obama's Disregard For The Constitution
By seeking to compel individuals to enter into specific commercial activity in the first place, the president and the Democratic Congress disregarded any semblance of congressional restraint. They recklessly exceeded federal constitutional authority and attempted to exercise a power the Constitution reserves to the states. As inconvenient as constitutional limits may seem, individual liberty requires that they be respected (Sen. Mike Lee, R-Utah, 3/27).

Arizona Republic: How 'Obamacare' Could Be Reformed
This week, the question is whether "Obamacare" is constitutional. That's a monumental legal issue. If Congress can require every person in the United States to purchase health insurance, there's nothing left of the Founders' concept of a federal government with enumerated, limited powers. Of course, there's not much left of that concept anyway. In some respects, this is a battle for the last bridge in a war that's already been lost (Robert Robb, 3/28).

Des Moines Register: Whether Obamacare Wins Or Loses, Obama Triumphs
Small wonder President Obama chose not to delay the U.S. Supreme Court case on his health care reforms until after the election. His advisers are transforming the president’s signature legislation into a potent election issue — whether the justices leave it intact or rip it apart (Froma Harrop, 3/27).

Fox News: What Happens If "ObamaCare's" Individual Mandate Is Thrown Out?
Requiring health insurance companies to cover all comers without price discrimination would accelerate health insurance inflation and the exit of millions more Americans from the health insurance system—simply more small businesses and individuals would find coverage prohibitively expensive (Peter Morici, 3/27).

JAMA: Listening To History In The Making
Those who listen to the audio recordings of the Supreme Court debate taking place this week in Washington will not have the benefit of Howard Cosell’s blow-by-blow commentary to help them know who is winning, but they will be witness to a heavyweight debate that, like the Liston-Clay fight, has the potential to change the course of history (Andrew Bindman, 3/27).

JAMA: The Other Important Issue Before The Supreme Court—Medicaid Expansion
So much attention has been paid to the individual mandate that relatively few have bothered to focus on the other questions that will be debated tomorrow in front of the Supreme Court. One involves the expansion of Medicaid, and it is absolutely worth some time (Aaron E. Carroll, 3/27).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.