U.S. District Judge Roger Vinson in Pensacola went too far Monday by declaring the entire health care reform law unconstitutional, and it is clearer than ever that the U.S. Supreme Court will decide the issue. A federal judge in Virginia ruled more narrowly that the insurance requirement is unconstitutional, and two other federal judges have upheld the law. The law remains in effect while the appeals continue, and instead of celebrating Gov. Rick Scott and other Florida officials should focus on making health care more accessible and affordable.
President Barack Obama signaled a positive way forward last week in the debate over health care reform. The president said in his State of the Union address that he is open to improving the law and offered several suggestions.
Republicans in Congress should embrace the opportunity rather than insisting on a complete repeal of reforms. While the House has voted to repeal, that is going nowhere in the Senate, and Obama would veto any repeal that reached his desk.
No one ever claimed the health care legislation is perfect. Among the positive changes that Congress could explore:
Repeal a new tax form requirement. A well-intended effort to collect $2 billion a year in taxes that go unpaid places too much of a burden on businesses. Starting in 2012, a provision requires companies to file a tax form for payments of more than $600 for goods or services to any vendor. That hurts small businesses as well as large corporations, and the threshold needs to be raised. Obama embraced the change, citing this "flaw in the legislation."
Allow health insurance to be purchased across state lines. It sounds simple, but there are complicated issues are involved. States regulate health insurance, and they have wildly different requirements about what treatments insurers have to cover. For example, a 2008 survey showed Florida was one of 45 states requiring coverage of alcoholism; Arizona was not. Florida was one of 10 states that required coverage of a second surgical opinion, but Alabama was not.
The last thing that should happen is for insurers to be able to cluster in a state that requires few coverages and then sell those bare-bones policies nationwide. But there should be a way to negotiate minimum levels of coverage that could be sold across state lines along with other health care policies that offered more coverage at higher cost.
Explore tort reform. This is a favorite Republican topic, and Obama signaled a willingness to discuss medical malpractice reform. Florida tackled this years ago, and the health care reform legislation did not address this issue in any meaningful way. Perhaps there is more that can be done that could provide some reassurance to health care providers without jeopardizing the fundamental rights of injured patients to be fairly compensated.
Despite Vinson's ruling, the Obama administration has a strong argument that the federal government can require citizens to purchase health insurance or pay a penalty under the commerce clause in the Constitution.
An individual decision not to buy health insurance affects health care availability and affordability for all. Two federal judges have bought that argument, and two have not. The final word, of course, will come from the U.S. Supreme Court.