Jew World Order

FRIDAY, June 29 (HealthDay News) — The U.S. Supreme Court‘s
long-awaited ruling Thursday upholding the constitutionality of the
Affordable Care Act means that changes to the American health care system
will roll out largely as planned when the bill was signed into law two
years ago, experts say.

“The opinion cleared the way for implementation to proceed,” said Karen
Pollitz, senior fellow with the Kaiser Family Foundation in Washington,
D.C.

Perhaps the biggest impact of the law will be the decrease in the
number of people who are uninsured or underinsured. The U.S. Congressional
Budget Office estimates that the rolls of the uninsured will go down by 30
million to 33 million people by 2016, leaving 26 million or 27 million
people uninsured, a 50 percent reduction.

The increase in the number of people covered by health insurance comes
via several different provisions of the Affordable Care Act. The most
contested and controversial of those provisions is the so-called
individual mandate, which requires all adults to obtain health insurance
or face a penalty.

Surprising some legal scholars, the Supreme Court upheld this part of
the law, as a tax, and it will now go into effect in 2014.

That means the earliest the U.S. Internal Revenue Service could levy
fines would be in 2015, said Linda Fentiman, James D. Hopkins Professor at
Pace University Law School in White Plains, N.Y.

But in truth, 90 percent or more of Americans won’t ever feel the pinch
of the penalty either because they’re already covered or they’re exempt,
Pollitz said.

The Supreme Court decision also means that other provisions in the
law — the most significant legislative achievement of President Barack
Obama’s administration — will be allowed to remain in place.

For instance, young adults can still be covered under their parents’
insurance plans.

“[This allows] the 2.5 million young adults up to the age of 26 who
gained coverage under the law to stay on their parents’ health insurance
policies,” Dr. Jeremy Lazarus, president of the American Medical
Association, said in a statement.

Many other Americans will be able to get health coverage through
subsidized health insurance exchanges. And insurance companies can no
longer exclude people from plans because of preexisting conditions.

This provision is already in place for children and will be applicable
to adults starting in 2014, said Dr. Michelle Huckaby Lewis, a research
scholar with Johns Hopkins Berman Institute of Bioethics in Baltimore.

The law will also preserve discounts that Medicare recipients
(generally people over the age of 65) receive on prescription drugs, Joe
Baker, president of the Medicare Rights Center, said in a statement.

And, in general, the expanded health coverage will boost preventive
services such as mammograms and colonoscopies.

Insurance companies will now be required to provide “first dollar”
coverage for preventive and screening services, explained Dr. Glen Stream,
president of the American Academy of Family Physicians. Stream said he has
seen many patients decline a mammogram or a colonoscopy because the co-pay
or deductible was simply too expensive.

“It was not at all uncommon to decline important wellness and
preventive screening because they couldn’t afford the co-pay or the
deductible,” Stream said. “Now, the whole cost of a mammogram is covered
because it fits into this category of preventive screening services.”

The only part of the Affordable Care Act that the Supreme Court took
issue with was penalizing states that didn’t expand their Medicaid
programs.

“The court said the federal government does not have the power to
penalize states who decline to expand their Medicaid programs,” said Devon
Herrick, a health economist and senior fellow with the National Center for
Policy Analysis in Dallas.

It’s unclear whether states will decide to pursue Medicaid expansion or
not, but this part of the ruling could affect the poor.

Lewis explained that prior to the Supreme Court’s decision, “the
Affordable Care Act would have required that states expand Medicaid
programs by 2014 to cover all individuals under the age of 65 with incomes
below 133 percent of the federal poverty level.”

The federal government would pay 100 percent of the cost of expanded
coverage through 2016, with the states assuming a small portion after
that.

“This expansion of Medicaid would have done a great deal to eliminate
much of the state-by-state variation we currently see in [the coverage of
the] poor, but after [Thursday’s] ruling, states may decline to
participate in Medicaid expansion,” Lewis said. “This would no longer
eliminate disparities in coverage in the very poor from
state-to-state.”

On the other hand, Herrick noted, because Medicaid reimbursement rates
run an average of only 59 percent of what private insurers pay, doctors
may opt out of covering these people.

“If we have 16 or 17 million more people on Medicaid and doctors are
saying they don’t want to take Medicaid enrollees, that’s not good,”
Herrick said. “We’re afraid that could drive up emergency room visits.”

And requirements that employers with 50 or more employees provide
health benefits may mean a squashing of cash raises, he added.

Regardless of the perceived pluses and minuses, the Supreme Court’s
ruling does mean that many people are letting out a long sigh of
relief.

“At least now we have some certainty about how we’re going forward,”
said Stream. “We can work to implement those components of health care
reform that are already underway that we think are in the best interest of
patients… Even the strongest advocates wouldn’t claim it to be
perfect.”

Thomas Oliver, a professor of population health sciences at the
University of Wisconsin School of Medicine and Public Health, added: “This
gives us the chance to fight our way to the finish line, but it’s still a
tough several miles ahead. What we have now is a stronger set of
resources, and a set of guidelines and rules so that individuals and
companies and health care organizations and insurance companies are not
out there on their own.”

But a fight to the finish line may be inevitable. Republicans and
likely GOP presidential nominee Mitt Romney have vowed to repeal the
controversial law — when, and if, they get the necessary votes.

More information

Healthcare.gov has more on the Affordable
Care Act.