What's next for the healthcare law?

WASHINGTON Wed Mar 23, 2011 2:58pm EDT

Discovery Communications Wellness Center Medical Director Liz Sequeira confers with a patient at the clinic in Silver Spring, Maryland December 3, 2009. REUTERS/Jim Bourg

Discovery Communications Wellness Center Medical Director Liz Sequeira confers with a patient at the clinic in Silver Spring, Maryland December 3, 2009.

Credit: Reuters/Jim Bourg

WASHINGTON (Reuters) - One year ago, President Barack Obama signed into law a sweeping healthcare overhaul to fulfill a long-standing Democratic pledge to ensure healthcare coverage for all Americans.

Passage of the law was a major legislative victory for Obama and helped change the political landscape, but not always in the way Democrats had hoped. Republicans strongly opposed the law and successfully worked public skepticism about it into sweeping election victories in November.

Here's a look at the uncertain future of the reform law.

REPEAL, DEFUND AND TAKE APART

Republicans, who say the law gives the federal government too much control and does little to reduce costs, have pushed a repeal bill through the U.S. House of Representatives after they took control in January. Full repeal, however, is unlikely unless Republicans successfully take control of the Senate and the White House in next year's presidential elections.

The Democratic-led Senate will not go along with repeal and Obama would veto any such bill. Democrats argue the law's reforms will slow the growth of healthcare costs while improving care and reducing the ranks of the uninsured.

A Republican move to withhold funds to stop implementation of the law will meet similar resistance from Senate Democrats.

That leaves Republicans the option of picking apart the law regulation by regulation. This strategy could be more successful.

Already, a revenue raising provision requiring businesses to file Internal Revenue Service forms on purchases and service totaling more than $600 a year is likely to be repealed with support from both parties.

The bill passed the House, and the Senate is expected to follow. The bill adjusts insurance purchase subsidies for middle income people as a way to cover the $22 billion cost of rescinding the so-called 1099 reporting provision.

COURT CHALLENGES

A number of states have challenged the constitutionality of the law's requirement that most Americans obtain health insurance or pay a penalty. The rulings have been divided, and the issue is certain to end up before the U.S. Supreme Court.

A U.S. District Court judge in Florida ruled the entire law unconstitutional, while a U.S. judge in Virginia ruled the insurance mandate unconstitutional and upheld the rest of the law. Other courts have dismissed cases or have found the law's mandate to purchase insurance constitutional.

The U.S. Supreme Court could decide as early as next year. Senate Finance Committee Chairman Max Baucus, who played a leading role in writing the healthcare law, and other healthcare advocates believe the law will be upheld.

Conservative critics give better than even odds that the Supreme Court will overturn the law.

If the court does decide that the coverage mandate violates the Constitution, many experts believe the judges would most likely strike down just that provision and leave the rest of the law intact.

A decision striking down the purchase mandate but leaving intact provisions requiring insurers to cover everyone regardless of medical history would wreak havoc on the insurance industry and send premiums soaring.

The law's major provisions establishing state insurance exchanges, imposing coverage mandates and requirements that insurers can no longer exclude or charge more for preexisting conditions take effect in 2014. That would give lawmakers time to act on any court decision.

STATE ISSUES

Despite the court challenges and stiff Republican opposition, the federal government is moving ahead with implementation that mostly falls on the states.

A number of state governors, primarily Republicans, have balked at the added cost of the law to already tight budgets. States must set up insurance exchanges to help consumers and small businesses purchase insurance. States also have to maintain their Medicaid coverage for the poor until the program is expanded in 2014 to cover millions more low income people.

The Medicaid healthcare program is run by the states with federal financial aid, and many governors are looking to cut Medicaid spending to help balance budgets that took a huge hit during the economic recession.

The federal government will pick up the cost of expanded Medicaid coverage for three years, but many states worry about future added costs.

Some states are dragging their feet on establishing the insurance exchanges that are to go into effect in 2014, leaving it to the federal government to step in and operate them.

SAVING THE HEALTHCARE LAW

Democrats note the popular Social Security retirement and Medicare healthcare programs for the elderly also faced stiff political opposition from conservative Republicans and survived legal challenges.

If the healthcare law survives the constitutional challenge, most likely the current political opposition will begin to subside and the law will remain on the books.

Most Americans did not think the costly U.S. healthcare system was working well before the new law. Costs were soaring and millions were going without coverage.

Polling data show that while people are skeptical about the law, most do not want to see it scrapped entirely.

Republicans have yet to put forward a proposal to replace the current law and are not likely to take a comprehensive approach. Instead they most likely would take it step-by-step, starting with limits on medical malpractice lawsuits. They also would push to allow insurers, who are regulated at the state level, to sell policies across state lines.

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Comments (15)
Sensibility wrote:
A citizenry is never truly free unless it has economic freedom. The health care reform act passed in 2010 takes away that freedom by forcing all citizens to buy health insurance. This requirement makes us beholden to the health insurance companies and their wards. We the people must stand up to injustice in all its forms. And this law is a great cause to stand against.

Mar 23, 2011 12:18pm EDT  --  Report as abuse
@Sensibility

Freedom from health insurance is not a good thing. The insurance industry is now under heavier scrutiny due to this law, which means the money we give them will be better spent. That means better and more available care for the insured. Follow that out. Health insurance isn’t something we want freedom FROM, it’s something we want the freedom to USE! Obama’s health care reform is good for the people. You might not like the taste of the medicine, but it’ll save your life.

Mar 23, 2011 1:10pm EDT  --  Report as abuse
CensibleSol wrote:
Yea right, try to buy a house without insurance, try to drive a car without insurance, try to ride a motorcycle without a helmet.

Forcing people to protect themselves is one of the things government needs to do because the average american is clueless and only thinks about saving money (aka cheap,thanks Walmart, and don’t worry about exporting jobs), period!

When I no longer have to pay for a person’s health care because they don’t carry it and just go to the ER for care, I will consider your proposal, until then, here is an idea, try gathering some facts before a knee jerk reaction. Read “Deadly Spin”, I dare you, then see what you think once you have some facts.

This lame concept that government is bad, doesn’t do a single good thing for us and should be cut, cut, cut is crazy. Don’t like government, let big business run your life. Enjoy the lead in your toys, carcinogens in your water and air, but hey, we have to maintain profits right?

Mar 23, 2011 1:25pm EDT  --  Report as abuse
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