1. Opinion

Landmark step toward universal coverage

Published Jun. 28, 2012

For more than a century, the nation's presidents have tried and failed to provide all Americans access to adequate health care. Thursday's historic U.S. Supreme Court opinion upholding President Barack Obama's signature achievement clears the path toward achieving that elusive goal. The Patient Protection and Affordable Care Act is far from perfect, and there is much work to be done to reduce the cost of health care. But rather than keep fighting the same political battles, it is time for Florida and the nation to move forward and embrace the landmark reforms that will improve the lives of millions of Americans.

Chief Justice John Roberts deserves the lion's share of the credit for finding a creative way to uphold the law and preserve the integrity of the court. The normally conservative Roberts sided with the four liberal justices and upheld the central provision of the law, the individual mandate that requires most every American to have health insurance or pay a penalty. When the law goes into full effect in 2014, health insurance will markedly improve for tens of millions of insured Americans and access to coverage will be dramatically expanded for the country's 50 million uninsured.

Roberts rejected the administration's primary argument that the individual mandate was constitutional under Congress' authority to regulate interstate commerce. Instead, he found it was constitutional to create the mandate by requiring those who refuse to buy insurance to pay a penalty, which Roberts defined as a tax. "The federal government does not have the power to order people to buy health insurance," he wrote. "The federal government does have the power to impose a tax on those without health insurance."

It was an artful, narrowly defined conclusion. But in practical terms it makes little difference how the act was upheld. The law gives Americans the greatest advance in health care security since Medicare. Now parents can still include children up to 26 on their health insurance, insurers still have to spend at least 80 percent of premium dollars on providing care, and senior citizens will continue reaping big savings on their Medicare prescriptions.

In 2014, the heart of universal coverage goes into effect. Americans without health insurance from their employer or from a government program such as Medicaid will be able to shop for comprehensive coverage on state health insurance exchanges, often with federal subsidies. Coverage will be available and affordable in spite of any pre-existing conditions. And because nearly everyone will be in the insurance pool — the young and old, the healthy and sick — the price of coverage should come down. They public too often fails to grasp that high premiums are partly due to hospitals shifting their uncompensated care costs to the insured.

Mitt Romney, the presumptive Republican nominee for president, and other opponents continue to vow to repeal the law. But they offer no reasonable alternative that would expand coverage to the nation's uninsured and bring down costs. Their "you're on your own" market-based approach is essentially the broken system that exists now. And while the Affordable Care Act doesn't do enough overall to address medical cost containment, at least it is expected to decrease the deficit in the short term.

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Gov. Rick Scott and Attorney General Pam Bondi, having lost the legal fight, were less than graceful in defeat Thursday. Florida already is far behind other states in moving to set up state insurance exchanges. Scott also has rejected millions of dollars in federal dollars flowing from the law, risking the health of Floridians to make a political point. It is time for the governor to stop stalling, recognize the authority of Congress and the Supreme Court, and carry out the law that will benefit millions of Floridians.

Florida will also have to decide whether to opt in to the expansion of Medicaid that is almost entirely paid for with federal dollars. The court modified the law to make the expansion voluntary, but it would be fiscally and morally irresponsible to refuse billions of dollars to provide health coverage to more low-income Floridians.

As Washington and the states move forward with the Affordable Care Act, there should be a serious conversation on how to reduce health care costs. That will require toning down the rhetoric on all sides — no more accusations from the right about death panels or warnings from the left about pushing Grandma over a cliff. Thursday's U.S. Supreme Court opinion was a monumental step forward, but equally serious challenges still need serious attention.


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