All eyes are on the U.S. Supreme Court, which just ruled today on the Patient Protection and Affordable Care Act.
Everyone's talking about this, and it's apparently the most widely anticipated Court decision in memory, according to those in the know.
This is about insurance and our society's desire to pay for well-being. Just one example of why this is so important comes from a study released in mid-June stating more than 26,000 working-age adults die every year because they don't have health insurance. That's 72 deaths per day and three per hour!
We've been watching for that court decision here at the 'Mine, and I like to think my six years of legal reporting before starting here helps me interpret what this may mean for those of us living with diabetes.
You know, beyond the general media headlines and legalese that are all basically saying the same thing but not telling us People With Diabetes what this really means for us.
Besides, why should YOU have to read through almost 200 pages of boring legal documents when that's what I'm here for, right?
And as I'm sure everyone who's been watching any form of news know the court upheld the healthcare law, something I'm very pleased about (I actually did a little dance in my living room once I heard it was confirmed!)
An initial snapshot of the 193-page ruling:
Essentially, the justices were ruling on whether it's unconstitutional for Congress to require all Americans to obtain health insurance by 2014 or pay a penalty?
Most folks thought and expected the court to decide whether the controversial individual mandate was allowed under the U.S. Constitution's Commerce Clause, but the court majority actually went a different way.
By a close vote of 5-4, the court upheld the constitutionality of the act and ruled that Americans must buy health insurance or be taxed if they don't.
The 9-member court voted that the law could be sustained because Congress has the power to tax individuals. A deciding vote came from Chief Justice John Roberts, Jr., who's a more conservative voice on the court but in this case sided with the liberal wing — Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan, and Sotomayor. The four dissenting justices opposing the mandate in any form were Samuel Alito, Antonin Scalia, Anthony Kennedy and Clarence Thomas.
With that aspect upheld, this means popular provisions that have already taken effect — such as stopping insurers from denying coverage to those people who get "sick" and allowing parents to keep their children on family policies to the age of 26 — can stand.
(As a PWD, I'm again dancing because of this great news!!)
A quick search of the ruling found that "diabetes" wasn't specifically mentioned once, nor was the term "chronic condition." And I was a little bummed that Justice Sonia Sotomayor, a fellow PWD diagnosed with type 1 at age 7, didn't specifically write anything herself. Still, as a person with a "pre-existing condition," she's one of "our" voices on the court and voted to uphold the law!! (smile)
While most are still processing the decision and gaining an understanding of what it means, the initial reaction from some legal beagles in the D-Community was extremely positive:
Donna Hill, VP of legal for Siemens Healthcare Diagnostics and the new chair of the Diabetes Hands Foundation, summed up her feelings with a quick exclamation-point heavy email: "UPHELD!!!!" Describing herself as a moderate, Donna said she's thrilled. The law isn't perfect, but it keeps affordable healthcare out there and can be tinkered with and made better over time.
"Had they ruled any part of it to be invalid, we would have been so far back in the need for healthcare reform in this country," she said.
In California, Kriss Halpern, an attorney who's a fellow type 1 and specializes in D-related legal issues, was pretty happy about the way the decision came out.
"The nation is going forward with the law and those of us with diabetes can plan on being covered in ways never before possible for us," he wrote in an email. "It will take time to see if my options are as good as I think they are, but I am very, very pleased and believe they can only be far better than they are now and that this is true for all of us."
Kriss also mentioned another issue that isn't being highlighted in the mainstream media just yet: What this opinion means in terms of the U.S. expanding healthcare more in line with what most other advanced economies have done worldwide? He isn't sure yet if this ruling moves us closer to one day having a nationalized healthcare plan, which many of us PWDs said they'd prefer when this issue was being debated in the DOC several years ago.
"It will take years for this to be clear...but I am wondering what I can learn and predict from reading this ruling," Kriss wrote.
For those PWDs without insurance currently? This means you have to buy it (at least in theory) or face a tax: $95 in the first year 2014; $325 for 2015; and $695 in 2016. Kriss notes that the tax is "pretty small" in comparison to other taxes and it's not nearly as readily-enforceable as those now in place.
So, the government can't do things like put you in jail or put a lien on your income or garnish wages. He says: "Some people will be pleased to hear that, but it also carries some concerns. Will it make the ACA harder to enforce and pay for over time? I have no idea, I only know that it is an issue that will become clearer over the next five years or so."
Interestingly, a footnote on Page 44 of the ruling mentions how people can't legally avoid paying taxes...
Aside from the big "mandate" issue, there was also the matter of the federal government being able to withhold Medicaid funding (for low-income folks) from states that refused to set up new programs expanding access to Medicaid. That's where the states won.
Justice Roberts wrote that Congress cannot "penalize states that choose not to participate in that new program by taking away their existing Medicaid funding."
At the American Diabetes Association, the lawyers and advocates were closely watching the ruling and began analyzing it as soon as the court handed it down. CEO Larry Hausner had a prepared statement, and we got a few minutes by phone with the ADA's managing director of public policy, LaShawn McIver. She said everyone there was on the edge of their seats in anticipation, and as soon as word went out officially about the court's ruling cheers went up in the office.
"This is monumental," she said. "From the ADA perspective, today was a great win for people with diabetes. Who's it going to benefit most? People with chronic conditions, as far as how much these conditions play into your life and what that means when you're determining if you get to have insurance or not."
States are at various stages of implementing insurance exchanges, which LaShawn said will provide more options for people trying to find affordable insurance. That creates a market place for insurance options and will have minimum standards on what essentially must be covered, and hopefully that will motivate private insurers to offer more competitive and affordable healthcare coverage, she said.
The ADA has an online Q&A that's been updated to provide information on the court's ruling and what this means for PWDs and the D-Community.
Obviously, not everyone in the diabetes or broader community of those with chronic conditions will be happy with this ruling, but it seems at least these voices advocating for PWDs are pleased.Interestingly, a survey published just before the court's decision showed most Americans oppose the overall health care law but strongly support some provisions of it.Is any of this set in stone? Absolutely not. Besides unraveling the legalese of this court ruling, the upcoming election means the end-result is up in the air; a Republican victory and potential for repeal means nothing is certain right now. And really, it's (not surprisingly) going to be a hot political campaign issue.
So, it continues.
We're reaching out to more legal experts in the Diabetes Community to get their thoughts on what this means for us PWDs. We'll provide more updates at the 'Mine and on our twitter feed and Facebook page as warranted, once we hear more.
Being the nerd that I am, as the court decision was being handed down, I did a blood glucose test - to mark history. The result? 235 mg/dL, likely haywire because of the anticipation ...
What about you? Does this court ruling make your blood sugar rise or fall in happiness or worry? What impact do you see this having on the D-Community and overall on the healthcare system we have in this country?