RSSLive - Sioux City Journal

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WASHINGTON (AP) — The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.

The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

Benzoni:

Ms. Moser: Legally, what is the difference between using the commerce clause to support the mandate and using taxing authority to support the mandate? Or is that understanding of the decision inaccurate? Thank you.

Ms. Moser: Can you, as you said earlier in plain English, describe for our readers what the Commerce Clause of the Constitution is and how the Obama administration was trying to apply it in this case?

Dr. Benzoni: Obviously those in the health care field were watching this case closely. Does today’s decision at all clarify the future of health care in America?

Dr. Benzoni, how will this affect my visits to the doctor’s office or hospital?

Benzoni: Knowing little about you personally, this will (or should) assure your doctor that he/she will be paid for the work they want to do for you. This should increase their willingness to see you. (To state the obvious, getting paid for your work increases the likelihood you will do that work.) In short, access should increase. We have seen that already in states that have piloted this idea.

Dr. Benzoni: What are the biggest challenges and opportunities for the health care industry moving forward, assuming the law stands as is?

Moser: one of the major challenges I see is how our health care system will be able accomodate what is likely to be a huge influx of patients who, once they have health coverage, will seek health care sooner. The Act also requires more preventative and wellness services be covered, so I think we will see an increased emphasis on those types of programs.

Ms. Moser: Are Supreme Court decisions typically this complex and, frankly, dense? Or is this decision more of a reflection of the complexity of the issue itself?

Moser: The answer to both your questions is "yes". The United States Supreme Court is very selective in the cases it chooses to hear and decide and those cases, by their nature, typically involve very complicated and contentious issues. That said, the opinion rendered today (which runs 193 pages) is particularly complicated because of the number of concurring and dissenting opinions issued by the justices.

Can you explain what the court’s move to limit the states’ power to terminate Medicaid funds means? Does this allow states that oppose the law to opt out?

Moser: One of the key provisions of the Accountable Care Act is the provision that requires insurance companies to provide coverage, regardless of any pre-existing conditions. Because the Act has been upheld, pre-existing conditions will be covered.

Reader Jill's question about cost is one we hear a lot. What more can be done to better control health care costs in this country? And this question is for either Dr. Benzoni or Ms. Moser or both.

Benzoni: Jill: You raise a very interesting concept: Will costs continue to rise? See our current state: we're spending, as an industry, more and more of your paycheck (notice how it hasn't gone up? guess why...) We have not been returning to you value for money received. (Please. I recognize I am over generalizing. You in Iowa re really badly spoiled. REally bad. I just got back from National Disaster Life Support.) What if I could make for you a system that helped you improve your own health and that of your family, and you could have confidence it wouldn't hurt you? That is the future we can create.

Benzoni: The thought/concept of rationing is one worth addressing. I prefer the word Rationalizing. Currently, there is very little rational thought in interventions. Take, for example, someone with a terminal disease within 2 years (except life, which is terminal). Why, oh why, do we have that person taking a cholesterol drug that won't give benefit for 5 years (and then only to 1 out of 10 who take it) but will give harm fro the first week to 1 of 20? That is a human and financial cost currently routine but ineffective.

For both: The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension. What could this mean for states who do not want to participate and could it eventually undermine the entire law?

Moser: If I can weigh in on the question about what the repeal of the Act would mean under a Romney administration, I think it would have a significant impact on hospitals. The hospital industry reluctantly agreed to sign on in support of the Act and accept a reduction in Medicare payments, based on the assurance that hospitals would be providing care to a fully-insured population. Right now the amount of totally unfunded care (that is, charity care for patients who do not qualify for Medicare, Medicaid or other government programs) is a huge financial burden for many hospitals.

Moser: Today's ruling is now the law. Whether a future court could reconsider the ruling depends upon whether another case makes its way through the federal court system and is accepted by the Court for consideration. But yes, it could happen.

Benzoni: Exchanges continued. Another facet of exchanges is the ability to assemble the coverage you need. I don't need OB coverage but I need old knee coverage. So I can assemble a coverage for me and my family and pe priced accordingly.

Benzoni: The question of the uninsured and the ER is important. Currently, folks use the ER for a number of reasons, nearly all very rational from their standpoint. The uninsured can't access the systems available to the rest of us, like a doctor's office. So they come to the ER; what do you expect them to do? People with insurance also use the ER because they are getting value for their policy dollar. (Think this through; ER use is rising, but out of proportion to the increase in uninsured. It's because people with options are following the consumer model: 24/7/365 access, be it ER or QuikTrip.) Oh, and the ER is VERY efficient. Know what % of the US healthcare dollar goes to ER (including ambulances)? 2%. And we see nearly 30% of acute care visits using 4% of the healthcare workforce. (All figures from sources without a dog in the fight, like the CDC. No industry generated figures here!

Benzoni: It is a common and convenient misunderstanding that care is cheaper elsewhere. Effective care is cheaper elsewhere, but ineffective care is expensive everywhere. Take, for example, antibiotics for uncomplicated sinusitis. Most of the visits take place in primary care offices, most result in an antibiotic prescription, and there is no positive value in this transaction. However, there are a lot of negatives!! Cost, effect on the microbial community, patient perception of illness and thus drive to repeat care-seeking with subsequent self limited illnesses, etc.-

Benzoni: Increasing the population on Medicaid has an interesting effect. Medicaid usually pays the physician well below the cost to provide the care. The business loss, though, can't be used as a deduction against taxes.