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As Medicare reaches age 50, we see periodic signs of limited efforts to move beyond its youthful exuberance as a full-fledged pay-as-you-go, fee-for-service, universal entitlement program and toward a somewhat more market-oriented direction. Most notably, the last decade since the passage of the Medicare Modernization Act of 2003 has produced rapid growth in enrollment in Medicare Advantage private plan options. Over 30% of Medicare beneficiaries are enrolled in these more market-based alternatives to the traditional Medicare fee-for-service program.
Today’s 50th anniversary salutes to the enactment of the Medicare program on July 30, 1965 will emphasize how much Medicare changed the world of health insurance coverage and medical care for Americans over age 65. A closer look at the program’s origins and early history certainly confirms its primary accomplishments. However, it also suggests how improving necessary care for older Americans might have proceeded differently without producing some of Medicare’s chronic long-term problems that we continue to avoid dealing with today. (Part two of this post will examine how this history also offers some lessons to would-be repeal-and-replace critics of the five-year-old Affordable Care Act).
Before we hold a going-out-of-business sale for the rule of law, following yesterday’s King v. Burwell ruling at the Supreme Court, let’s review some between-the-lines highlights. The Scalia dissent already took care of the fundamental analysis of how the Court veered so far off course.
The wait is over. The Supreme Court has finally ruled (6-3) in King v. Burwell that the tax credits under the Affordable Care Act (ACA) are available to purchase insurance on the federal health care exchanges being used in 36 states as well as on the exchanges set up by the remaining states. The ACA has survived a second, and likely last, near-death experience.
Supreme Court upholds Obamacare subsidies. Where do Republicans go from here, other than summer vacation?
If you were going to boil the decision down to two sentences, it would be this one from Roberts, writing for the majority: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.” And this one from Antonin Scalia: “We should start calling this law SCOTUScare.” Looks like opponents won’t win in court, so they will have to win at the ballot box if they continue to seek total repeal or substantive change. But reform seems a more likely outcome and fruitful path forward and should be considered. […]
On June 24, the House Appropriations Committee will vote on legislation that would eliminate funding for the Agency for Healthcare Research and Quality (AHRQ). Compared with the NIH or the CDC, AHRQ is virtually unknown to the public, but its work can have just as much influence on the health care of all Americans. […]
“A Contingency Plan for King v. Burwell,” published recently by the American Enterprise Institute, lays out a proposal that Congress and the president could adopt if the Supreme Court invalidates the payment of premium subsidies in states that rely on the federal health insurance exchange rather than building their own exchanges. As one of the nine authors of the “Contingency Plan,” I support the recommendations of that report. However, there are important issues that deserve further discussion and clarification, and there are both political and practical uncertainties that must be resolved if the Supreme Court’s decision opens up a new opportunity to adopt market-based reforms of our health financing system. What follows are my views on several of these issues.
If the Supreme Court sides with the plaintiffs in King v. Burwell, Congress will be under pressure to enact a remedy that stabilizes health insurance markets and protects millions of people from losing their coverage. But that remedy should not simply undo the effects of the court’s decision.
Because the heart of medicine remains the encounter between one who suffers (the etymological rendering of “patient”) and another “highly trained and socially authorized person who has publicly professed to help,” the traditional ground for reclaiming medicine as a profession in the best sense remains alive–even if in need of a healthy change in lifestyle.