Three days in the U.S. Supreme Court. Momentous. Supreme Court hearings on the Affordable Care Act, although now I hear it is ok to call it Obamacare. Obamacare is no longer a pejorative term since President Obama started using it himself.
While I have many thoughts about what I heard on the audio tapes, I am focusing today on the Court’s interest in the economic impact the uninsured have on commerce. I am certainly not a constitutional lawyer but I am told that the justices likely are interested in what will be the impact on the health of the American workforce and the economic impact on commerce if the Affordable Care Act is struck down.
From what I heard, I am not sure that the justices got a complete picture of the impact that the uninsured have on commerce across this country. The justices heard about the uninsured but they did not hear about the underinsured. They heard about the almost 50 million Americans who are uninsured. 18.5% of the non-elderly were uninsured in 2010 across the country. In Delaware 14% were uninsured and that rate ranged by county from 10% in New Castle County, 13.5% in Kent County and 17.6% in Sussex County. (Statistics from Kaiser Family Foundation www.kff.org and The News Journal 7/28/10 and are based on 2010 Census.)
The justices did not hear about the underinsured. While the uninsured are most at risk, researchers estimate that about a fifth of insured individuals are underinsured, meaning that their health insurance limits coverage. For example, their policy may not pay for prescription medicines or mental health services, so they face substantial financial costs if they get sick.
The uninsured paid out-of-pocket for their health care $30 billion in 2008 and left $57 billion in unpaid bills. This is called uncompensated care. It is a significant financial burden on hospitals as well as the federal, state and local governments.
The economic impact on families is significant. In 2010, 27% of uninsured adults used up all or most of their savings paying medical bills. Medical bills are the second most frequently cited reason for bankruptcy in the nation.
The American Journal of Public Health in December 2009 reported that lack of insurance can be linked to about 45,000 deaths a year in the U.S.
I spoke to a woman from Clayton who was diagnosed with multiple myeloma and found out her insurance would not pay for the chemotherapy that her oncologist at Christiana prescribed. She was self-employed and had an individual insurance policy. Her policy did not cover specialty drugs such as chemotherapy. She was underinsured. This is the kind of bad insurance policy that Paul Ryan, Mitch McConnell and Mitt Romney want you to be able to buy across state lines from some shyster a thousand miles away operating in an unregulated insurance market. So this woman had to quit work, go on disability, beg the pharmaceutical company to give her the medicine for free until she could get Medicare. That is an expense to taxpayers for the disability payments and it is an additional expense to the pharmaceutical company during a time when pharmaceutical companies, even in Delaware, are laying off workers.
The Supreme Court justices heard that the uninsured are young people who never go to the doctor and who have willingly made the decision not to buy health insurance because they need to spend their money on other things but they will buy insurance when they need it. The lawyers made it sound like this is liberty! This is freedom! Don’t tread on me!
But the uninsured are not all young. They are not all healthy. And many of them feel shackled, not free. They feel shackled by the worries of being sick and disabled by disease which has become a pre-existing condition for which they are denied health insurance.
I met a father whose son has hemophilia. The out of pocket cost of the medicine his 14 year old son needs to stay alive is $15,000 a year. When the boy becomes a young adult, he is not going to have the freedom to choose not to buy health insurance. The only way he will be able to get health insurance is if he works for the government or a large corporation that offers good group health insurance. He will never have the freedom to start his own business or be self-employed because his illness will be a denied, pre-existing condition on the individual and small group markets. Our economy will never benefit from his potential to be an entrepreneur and to create jobs.
Early retirees, defined as retirees aged 50 to 64, are often uninsured. They retire before age 65, maybe voluntarily, maybe not so voluntarily. They may be victims of age discrimination in the workplace. They may be victims of downsizing in corporations that want to be rid of retiree pension and health care costs. They may be sick and disabled after years of hard, physical labor. They are too young for Medicare and they cannot afford COBRA coverage from a former employer. They just pray that they do not get too sick before they get Medicare at age 65. But sometimes they do get sick and then they use the emergency room and get admitted to the hospital and the cost becomes uncompensated care which the hospitals and the taxpayers have to pay.
The uninsured and underinsured bring uncertainty and disorder to commerce and to the labor market. They significantly impact the health and productivity of the labor force. This is happening in the health care industry which is 18% of the U.S. GDP. They represent at least 18% of the non-elderly population, more if you count the underinsured. They shift costs unto the rest of us. They account for many personal bankruptcies. The Affordable Care Act can help to solve the problems of uninsurance, underinsurance, and uncompensated care. So striking down the Act would have a significant impact on commerce and on the labor force.
So the Supreme Court justices will weigh and balance the relevant issues – impact on commerce, individual mandate, and probably others. The problem is the strength of the law is dependent on the individual mandate. If the individual mandate falls, the law will be crippled.
The individual mandate raises concerns about government intrusion into our lives. I share those concerns. We live in a society where government puts up cameras on public streets to watch who goes where. Where the GPS on your cell phone can be used to track you down. Where the internet is keeping track of every website you go to and every thought you email or tweet. Where there is a mandate to buy car insurance. Where you have to get a permit 15 days ahead of time to hold a demonstration on The Green in downtown Dover to exercise your right to assemble and to express your free speech. Where cameras look at your belongings and your body parts at airports. Where important IV medicines are not available due to shortages. Where counterfeit medicines are coming into our country. Where cardiac stents and orthopedic devices are approved for use before they have been thoroughly tested. Where young women’s access to family planning services is being threatened. And you are worried about a mandate – with many exceptions – to buy health insurance? I think we have bigger things to worry about.
I have learned something from opponents of Obamacare. I do understand their concern about government intrusion into our lives. I never thought the case against the individual mandate would go this far or come so close to overturning the law. Conservatives have arrested Obamacare, taken it to the United States Supreme Court and left it stranded on a cliff. The Supreme Court will either kill it, cripple it or let it live. Liberals and progressives – I am one – be on guard. This is what conservatives are capable of doing to the country we love so dearly.
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