After a historic three days of oral arguments before the U.S. Supreme Court, the fate of the federal Patient Protection and Affordable Care Act known as ObamaCare lies in the hands of nine justices. Until the expected high court ruling in June, pundits and policy wonks will pick apart the questions and answers in the oral arguments. But Americans know that whether the law stands, crumbles or collapses, health care policy in these United States needs a fix.
Voters in the states know the answer is not in this federal, top-down health law, in essence cracking a nut with a sledgehammer. Just 37 percent of likely voters want the federal law upheld while 50 percent want it overturned, according to a Rasmussen poll conducted March 27-28, even as the court sat in session. In Georgia, which is party to the 26-state challenge to the law, Attorney General Sam Olens warned: “If the individual mandate, the linchpin of the law, is not stricken, there are no conceivable limits on federal power. The idea that the federal government can compel individuals to purchase a product is a radical one and is completely at odds with the Constitution and principle of federalism.”
Workers know the federal law is hurting their chances at private insurance: While President Obama promised nobody would lose their current insurance, it appears companies are increasingly weighing whether it’s cheaper to leave insurance to the individual or the government. An analysis by the Congressional Budget Office (CBO) released this month projected that 3 million to 5 million fewer people will have employer-sponsored insurance by 2016 than its estimate a year ago. (The government is counting on the penalties surrounding the individual mandate bringing in $27 billion between 2012 and 2021.)
Many of those who lose their employer-sponsored insurance will go onto Medicaid, raising that program’s costs – and consequently, the costs to the states, which partner with the federal government in Medicaid. The federal law, CBO projects, would ensure insurance coverage for 93 percent of those under age 65. That’s down from the 95 percent it projected a year ago. CBO still expects 26 million to 27 million people to remain uninsured.
There are taxes on high-premium insurance policies, penalties for companies that don’t provide “minimum health benefits” for their employees; price controls on medical services in Medicaid and Medicare ... and no incentives for more health-care professionals to enter or remain in the profession. Medical professionals will have to increase patients – and reduce patient time – to recover their costs and make up for government-controlled payments.
The fix is not in the 2,700-page federal law. The fix is in the states, and the Georgia Public Policy Foundation’s scholars have worked diligently to come up with practical solutions that put health-care consumers in control of their health care. And that is critical: As Senior Fellow Ronald Bachman pointed out in a recent commentary, if the U.S. Supreme Court overturns the federal law, the ball is back in Georgia’s court. There are 1.8 million Georgians without insurance, small businesses dropping coverage, and only a 25 percent chance of having insurance if you work for a company with fewer than 25 employees.
Bachman proposes Georgia-focused reforms that could reduce the number of uninsured by more than 1 million and premiums by up to 40 percent. Today, individuals without employer-sponsored insurance are unfairly penalized by taxes if they purchase their own insurance, because they are unable to deduct the premiums. Changing that provision would save families thousands of dollars and increase insurance affordability.
The state could facilitate competition through participating in a regional insurance market with interstate reciprocity. A Southeast marketplace with up to 50 million health care “customers” would reduce costs and increase choices.
For those “uninsurable” Georgians, Bachman proposes that the Legislature establish a state high-risk pool and support the expansion of the Georgia charity care organizations providing volunteer, faith-based care at the local level.
There are those uninsured by choice, choosing other priorities – especially among younger Americans, who use few medical services. There are those underinsured who need more coverage but can’t afford it. But the federal sledgehammer mandate doesn’t differentiate. Wherever possible, the Foundation proposes that Georgia’s solutions be Georgia-based and predicated on free markets, personal responsibility, competition, choice, transparency and a level playing field.
Dodd is vice president of the Georgia Public Policy Foundation (www.georgiapolicy.org).