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Advocates hail Supreme Court’s health decision

Paul Kleyman | 7/3/2012, 8:40 a.m.

Some experts believe that even staunch GOP governors and legislatures won’t pass up the generous payments to states set by the law. Under the ACA, the federal government will pick up 100 percent of the cost of newly insured people for the first few years and 90 percent after that. But others aren’t so sure.

For very low-income people in the Medicaid program, the federal government sets minimum rules for what a state has to cover and pays from 50-70 percent of the costs, with poorer states, such as Mississippi, receiving the larger subsidy.

But states have had a lot of leeway to restrict eligibility rules, such as according to what illnesses people have or how severely impaired they are. Recession-strapped states have also been able to limit access to care, such as twisting a cap on how many prescriptions a patient needs at a time, regardless of their need or physician’s orders.

With the ACA, anyone now unable to get coverage need only show that his or her income is below 133 percent of the federal poverty line, that is, just a little above being the poorest of the poor.

Under the Supreme Court’s decision, though, some health care advocates are asking whether, for instance, the 26 states with Republican governors — the same states who sued the Obama administration, partly leading to the Supreme Court’s decision — could simply ignore the ACA’s Medicaid provision.

Others speculate that few if any states will decline such rich funding to provide vulnerable citizens with health care.

Impact on multiethnic communities

The ACA’s complications will be entangled in intense debate through the November election and beyond. But for now, health care advocates are counting the law’s blessings to date.

The American Public Health Association, for example, noted in praising the decision that already 54 million U.S. families have additional benefits, including greater access to preventive health care services recommended by the U.S. Preventive Services Task Force.

Kathy Lim Ko, president and CEO of the Asian and Pacific Islander American Health Forum, issued a statement hailing the decision and calling ACA a “landmark civil rights law that brings the work of equity and justice to the health arena.”

Ko noted that through implementation of ACA’s early provisions, “97,000 Asian American and Pacific Islander young adults have been able to remain on their parent’s insurance plans and nearly 3 million Asian Americans have received preventive health care at no cost. By 2016, an estimated 2 million Asian Americans will have gained or become eligible for coverage.”

At the Greenlining Institute, a multiethnic policy nonprofit, General Counsel Samuel S. Kang, stated, “Every day we wrestle with the reality that African Americans, Asian Americans and Latinos are less likely to have health insurance than whites, and the Affordable Care Act is already helping to fix this massive problem.”

Health care gaps remain

In the long run, however, the 2,700 pages of the Affordable Care Act and the 200 pages of interpretation — majority and dissenting — added by the Supreme Court, leaves “a substantial gap between the diagnosis of America’s medical problems and the remedies the White House and Congress could agree to,” according to Yale professor emeritus Theodore Marmor, among the leading health policy authorities in the country.

Although ACA’s mosaic of “bits and pieces” of reform undeniably benefits many, the measure fails to create a coherent national health care policy within a system of continuity of care, fails to establish long-term care for elders and those with disabilities, and fails to control health care spending in a system now costing double that of countries having significantly better health outcomes than the U.S.

For today, though, most health care advocates would concur with the statement Thursday of APHA Executive Director Georges C. Benjamin, MD. The Supreme Court’s decision, he said, “marks tremendous progress towards reshaping our health system into one that saves the lives of at least 44,000 people who die annually simply because they do not have health insurance that could keep them healthy.”