Health Care for More

On Thursday, July 28, the Supreme Court of the United States voted 5-4 to uphold the Affordable Care Act (a.k.a. Obamacare).  After the three days of oral arguments back in March, pundits right and left had opined that SCOTUS would strike the act down, in part or in full.  However, when Chief Justice John Roberts read the decision, two "wild cards" on the court did not play their expected roles.  Justice Anthony Kennedy sided with the four usual conservative members and voted to strike down the act, on the reasoning that the U.S. Congress had overreached in applying the Commerce Clause.  The chief agreed with those five justices that the Congress' power to regulate commerce does not give lawmakers the authority to force people to buy insurance. 


But in what may become known as a Solomon-like decision, Chief Justice Roberts ruled that the law's individual mandate represents a tax on people who do not choose to get health insurance--a tax the Constitution gives Congress the power to impose.


Even today, five days after the decision, there are reports from behind the Kremlin-like walls of the Supreme Court that Roberts at first sided with the conservatives, then changed his mind.  However Roberts' decision-making played out, the Affordable Care Act will now continue its march toward near-universal coverage of health care for most Americans.  


This decision is good news for the approximate 50 million Americans who today are without health insurance, as well as for other groups.  Under-26-year-olds can continue to be covered by their parents' insurance.  There will be no lifetime caps on the amount of dollars spent on an individual who needs health care.  Pre-existing conditions will not prevent health insurance companies from accepting people for coverage.  And, with the expansion of Medicaid and the still-to-be written health insurance exchanges, somewhere between 30 and 45 million Americans by 2014 will receive at least a modicum of basic health care. 

From a political standpoint, Republicans are aghast, grasping at straws regarding the agreement by five justices that the Congress has to rein in its application of the Commerce Clause.  Democrats are giddy, receiving the unexpected boost to President Obama's reelection effort through an unexpected route--a penalty that Obama (and former Massachusetts governor Mitt Romney) was at pains not to call a tax which Roberts called a Constitutional tax.


But from my perspective, this decision is not about politics, it is about human rights.  Finally our country can take a big step toward establishing in law what has been recognized around the world and by our church as a human right--health care.  Health care is already a right for over-65-year-olds (Medicare), for veterans of military service, for under-7-year-olds, and for some poor people (Medicaid).  But the link between employment and health care benefits is eroding, down to perhaps 40% of all full time workers, and costs of health care continue to spiral upward.  With the Affordable Care Act working to include as many "free-riders" as possible within the unwieldy patchwork of  current U.S. health care system, it may be possible for insurance companies, hospital systems, and doctors to work on moving from the super-expensive (and often wasteful) fee-for-service mentality towards a preventative care model of patient care.

Among my three or four loyal readers (thank you!) there are probably gasps!  Almade will be thrown out of the Catholic Church for his heretical view agreeing with the Supreme Court decision.  But read closely the one page statement of the U.S. Conference of Catholic  Bishops, issued on June 28 ( www.usccb.org/news/2012/12-119.cfm ) in the wake of the Supreme Court decision.


First, the bishops affirm the need of health care for all:  "For nearly a century, the Catholic bishops of the United States have been and continue to be consistent advocates for comprehensive health care reform to ensure access to life-affirming health care for all, especially the poorest and the most vulnerable."  There.  In what has been missed over the heated controversy over the religious employer definition, the Health and Human Services administrative ruling, and the possibility of the church funding contraceptives and sterilization procedures, the basic principle is still there.  Health care is a human right, for all human beings.  (See  the encyclical of Blessed Pope John XXIII, Pacem in Terris, paragraph 22.)  


Then the bishops argue against Obamacare for three reasons:  the potential of federal funds being made available for abortions; failure to provide statutory conscience protection in the HHS mandate: and ... the ACA does not go far enough.  What?!  Yes, the ACA does not go far enough.  It "fails to treat immigrant workers and their families fairly."  In the words of the bishops, "life-affirming health care" is held back from immigrants, legal (and presumably illegal).  In other words, some people in this country will still be left out and unable to access health care (except through  a hospital's emergency room doors).


Now we will see how seriously HHS Secretary Kathleen Sebelius and the Obama administration are in wanting to revise their wrong-headed regulations of last September, and return to the decades long expansive view in law allowing religious bodies to employ members outside their religion and to serve persons not of their religion.   Now is the time for the bishops (and us citizens) to push not against some vague watering down of religious liberty, but for practical political and legal acceptance of what the Catholic Church's health care institutions, colleges,  universities, and social service organizations do:  serve the poor and all comers with respect, competence, dignity and love, in the name of Jesus Christ.