Affordable Care Act (Obama Care)

A friend of mine from home came in to Boston today and it was great to see a familiar face!  We went to a panel discussion on the Supreme Court decision on the Affordable Care Act (Obamacare) hosted by the BU Law School.

We arrived a little late so I missed some of the presentation but it was still quite interesting. Some of it had too much legaleeze for me to follow but there were a couple of interesting points.

1) Expansion of medicare.  One of the things that the bill does is expand the people who are covered by medicare.  It has always covered certain categories (six, I believe) that were defined back in British Common Law ('elderly, widows, orphans, extremely poor people, etc).  The speaker defined them as the people who are generally recognized as  'the deserving poor'.  This bill added a new category: those who make up to 130% of the federal poverty level.  This expansion was one of the things that the opponents found most objectionable.

The speaker seemed to feel that the expansion was a legislative issue - not a judicial issue.  And thus should not have been relevant to the legal case.

2) Funding for the expansion of medicare.  Medicare is provided by the states but (most ? all? ) funding is provided by the federal government.  The bill makes federal funding for medicare contingent on a state's acceptance of the affordable care act.  There was a lot of discussion about whether this was 'coercion' - which would make the law unconstitutional (if I got it right).

Interesting discussion about the legal basis of federal funding for state programs. Some conservatives are happy to have federal funding flow to the state's as long as the federal government doesn't dictate how the money is spent (i.e. block grants).  In my mind, this brings up thoughts about federally funded but locally administered programs in the South during the Jim Crow period.

3) Impact on Massachusetts.  Someone asked the question that I wanted to know.  "What impact does this have on Massachusetts?"  But the answer didn't get to the point I wanted to know.  The answer was that we need to adjust some of our categories and other relatively minor procedural matters. (Massachusetts care is more generous than the Affordable Care Act). But what I wanted to know was - if Obamacare had been determined unconstitutional, would that also make the MA program unconstitutional ? I didn't have the guts to pose the question (this was an event for BU law students, after all).  It's also moot since the law wasn't overturned.

4) Health Care vs Health Insurance.  Someone asked if this created a right to health care.  Answer: no constitutional right.  Legislative right to purchase health insurance.  Interesting discussion about the difference in the right to 'health care' and the right to 'purchase health insurance'.

The panel felt that this decision is quite murky in that it is hard to know what other existing laws would be impacted by the reasoning in this decision.  There is likely to be many more court cases flowing out of this case.