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Supreme Court Hears Health Law Arguments

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By Chris Levister

When Dr. Temetry Lindsey, Inland Family Community Health Center's president and CEO marked the second anniversary of the historic Affordable Care Act in Washington D.C. this week, she and members of the National Association of Community Health Centers quietly bypassed the champagne and party favors.

Instead, says Lindsey, as the Supreme Court weighs the constitutionality of the law’s mandate that almost all Americans buy health insurance, an army of foot soldiers set out to methodically help a skeptical public navigate one of America’s most transformative periods.

In one of the most anticipated Supreme Court hearings in years, on March 26, the Supreme Court convened three days of hearings on challenges to the constitutionality of the Affordable Care Act; the health care reform bill pushed by President Barack Obama and passed by Congress over bitter Republican opposition. A ruling is expected in late June.

The legal question for the justices is whether Congress exceeded its constitutional authority in requiring most Americans to obtain insurance or pay a penalty.

The fate of the individual mandate provision -- may be in jeopardy, and perhaps with it the entire law's other 450 or so sections, based on tough questions of the government by the court's conservative majority.

The law’s challengers — 26 states led by Florida, the National Federation of Independent Business and several individuals — present the central question as one of individual liberty. The Obama administration urged the court to answer a different question. May Congress decide, in fashioning a comprehensive response to a national crisis in the health care market, to regulate how people pay for the health care they will inevitably need?

Lindsey says popular consumer benefits are already here, yet there are plenty of bitter pills waiting in the wings.

“Many of us on the delivery side of the law have mixed feelings,” she said. “On one hand we want people to become insured and gain access to care. On the other hand the law is complex, expensive and increasingly difficult to implement.”

She points to the federal government and the states weighing in with differing arguments.

“Then you have patients for and against the measure, many of whom are confused and afraid they will be forced to buy health coverage they don’t want or can’t afford. Unfortunately, it’s a mess we can’t afford not to have.”

Lindsey says despite widespread opposition and legal challenges health care in America is changing, no matter how the Supreme Court rules on Obama’s historic overhaul.

Health experts insist the unappreciated reality is there may be no going back to the world before March 23, 2010, when President Obama signed the law before a cheering, whistling crowd in the East Room of the White House.

The way millions of Americans receive and pay for medical services is going to be different, driven both by the new law, which goes by the acronym ACA, and industry responses to the escalating costs it was intended to curb.

According to the latest government figures, more than one of every four Americans last year received a free mammogram, colonoscopy, or flu shot, thanks to a federal law that many despise. Roughly 3.6 million Medicare recipients saved an average of $604 as the same law began closing a gap in their prescription drug coverage. And 2.5 million young adults were allowed to remain on their parents’ health insurance plans until their 26th birthday.

The Obama Administration argues health reform is already making a difference by: creating new coverage options for Americans with pre-existing conditions. Under the new law, insurance companies are already banned from denying coverage to children because of a pre-existing condition. In 2014, they are banned from discriminating against anyone with a pre-existing condition, such as cancer and having been pregnant. Today, the new Pre-Existing Condition Insurance Plan in every State offers an option to people who have been locked out of the insurance market because of a pre-existing condition like cancer or heart disease

Historically, African Americans and other underrepresented groups have faced significant barriers to accessing affordable health insurance and these barriers have contributed to significant health disparities.

Administration officials say under the new health law, care will be more proactive and patient centered. Medical providers have already begun revamping their operations. Hospitals and health care companies are collaborating to improve Medicare and chronically ill patient care.

The law encourages a move away from the traditional fee-for-service model in which doctors are paid for each test, X-ray or treatment they provide. Instead healthcare providers would be paid based on patient outcomes, offering higher payments for better quality care.

It is not just hospitals and doctors that are changing under the law, but also health plans, which are branching into new businesses as enrollment slows in their primary, and most profitable, market of providing employer-based health coverage. Health insurers are increasingly shifting their focus to managing the care of the poor and the elderly through contracts with Medicaid and Medicare, buying physician groups and urgent care clinics and offering consulting services to doctors and hospitals.

“Americans will have the security of knowing that they don't have to worry about losing coverage if they're laid off or change jobs. And insurance companies now have to cover preventive care like mammograms and other cancer screenings,” Lindsey said.

The new law also makes a significant investment in State and community-based efforts that promote public health prevent disease and protect against public health emergencies.

Lindsey says while a Supreme Court finding that the mandate, the law’s essential feature and most unpopular feature is unconstitutional would upend Obama’s signature achievement and roil the 2012 presidential campaign, even without the controversial mandate the law would likely survive its demise in part because as the old adage in politics goes: “Benefits once conferred are virtually impossible to take away.”

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