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March 25--First of two parts
News and views: Court should uphold affordable health care
Sunday business: Job killer or job creator Businesses need help, but is the health care reform law the solution?
On Monday, the U.S. Supreme Court will open three days of hearings on the constitutionality of President Barack Obama's sweeping health care reform law, one of the biggest cases before the high court in decades.
The law, the signature piece of legislation in the president's administration, will require most Americans without health insurance to buy coverage by 2014 or face penalties. It would also expand Medicaid, require coverage of pre-existing conditions, bar insurers from placing lifetime dollar limits on essential benefits and usher in dozens of other changes affecting everyone from hospitals to businesses to individuals.
Some of the changes have already been implemented since the bill was signed into law on March 23, 2010.
"It's a once-in-a-generation case," said Nicholas Bagley, a University of Michigan assistant law professor. "It doesn't get much bigger than this."
Among those following the case will be Steven Hyder, who calls himself "the individual who hates the individual mandate" to buy insurance.
Hyder, a Monroe attorney, and his wife, Salina Hyder, an artist, say they don't believe Americans should be required to buy coverage. "I'm very concerned about the socialistic bent of this bill," said Steven Hyder, an uninsured, paycheck-to-paycheck lawyer who leans toward a Libertarian, smaller-government philosophy.
Others, such as Deborah Sferlazza, 54, of Shelby Township, back the legislation. Sferlazza got long-delayed back surgery last year, plus physical therapy, because of provisions in the law that allowed her to buy a cheaper insurance policy.
Opponents of the federal law "don't understand there are people like me who, without this plan, would continue to be in extreme pain, causing more and more damage to my body and possibly shortening my life," Sferlazza said.
The Supreme Court could uphold the law, overturn it or strike down parts of it. Fall elections also could affect how it is implemented.
Michigan, one of 26 states suing to overturn the act, has already accepted millions in federal funds to implement various provisions but stalled on others, awaiting the court's decision.
Much at stake for Michiganders in Supreme Court's ruling on health care law
Detroiter Arlyssa Heard, 41, hopes her health holds out for two years.
That's when she expects to have health insurance for the first time in several years, through the Patient Protection and Affordable Care Act.
"Being without health care at this age scares me," said Heard, a college graduate who lost her insurance when she was laid off from her job as a youth specialist for the City of Detroit. "When you are talking about health care, time is not on your side."
Heard and her two sons, 16 and 6, live frugally on a small wage she gets as a Detroit Public Schools classroom aide. Both boys have Medicaid insurance, but she can't afford to buy her own policy, even through a new program that offers more-affordable coverage to people without insurance.
Whether Heard will get insurance by 2014 may hinge, at least for now, on a U.S. Supreme Court ruling on challenges to the health care law that is expected no later than early July. As the court's nine justices -- five appointed by Republican presidents and four by Democrats -- hear three days of arguments starting Monday, supporters and opponents of the law, some arriving by the busload, will swarm Washington, D.C., for a week of news events.
To some, the law is one of the most significant reforms of the century in health care, as important as the creation of Medicare and Medicaid in 1965, two programs to be expanded significantly under the new law. The law will bring health coverage to about 50 million Americans.
But opponents see the law as an ominous step toward Socialism and higher deficits.
The biggest focus in the debate is the law's requirement that most people purchase health insurance by 2014 if they are not covered by an employer, or pay penalties. The penalties start at $95 for each adult or 1% of household income beginning in 2014 and grow to $695 or 2.5% of taxable income by 2016. After that, the fines will increase for inflation adjustments. The U.S. Department of Treasury says it will enforce the penalties, much like it goes after unpaid taxes.
"At a time when America has had its longest recession since the Great Depression, what's the answer coming out of Washington?" said Michigan Attorney General Bill Schuette, one of 26 attorneys general suing to overturn the entire law. "Another big-government program."
Schuette said "it would be dangerous to have the law in effect because you would penalize people by fining them if they do not purchase a product. This is an excessive reach by the federal government."
Schuette said the court has not allowed this much time to hear a case since the landmark 1966 Miranda v. Arizona decision, in which the justices held that police must advise people of their right to an attorney before they can be questioned.
Still, even if the mandate to buy insurance is unprecedented, it doesn't mean it is unconstitutional, said Nicholas Bagley, University of Michigan assistant law professor.
"The fact that Congress has never (required citizens to buy a product such as insurance) before is a factor, but it's not a determining factor," he said.
Bagley said he believes the mandate is constitutional because it is essential to the success of the new insurance exchanges states must set up to help people buy more-affordable policies. Having everyone buy insurance helps spread the cost of care over a broader pool of people, especially since insurers will have to cover people with pre-existing conditions and be under scrutiny to limit rate increases to no more than 10%.
"Congress has the authority to regulate activities that significantly affect interstate commerce," Bagley said.
Americans are nearly divided on what the Supreme Court should do.
A poll released March 14 by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, Calif., found that 51% of the 1,208 adults surveyed said the Supreme Court should rule the mandate unconstitutional.
But U.S. Rep. Sander Levin, a Democrat from Royal Oak, said more Americans support the law when they see how many it has helped.
"The reality is, this act already is working for seniors, for children and the disabled," Levin said. He pointed to dozens of provisions that have helped, including free prevention services for children and seniors, and the elimination of insurance company denials to children with pre-existing conditions.
Patient, consumer aid
President Barack Obama and the law's supporters point to other improvements already in place under the law, from new coverage that lets adult children up to age 26 stay on a parent's policy to a temporary insurance pool for uninsured people that will end in 2014 when people can buy policies through state insurance exchanges.
The expanded coverage for children alone has let 57,527 young adults in Michigan remain on or move to their parents' workplace plan. The coverage is paid by employers.
"I don't care if you are liberal or conservative," said John Freeman, executive director of Know Your Care, a pro-health care reform group in Michigan. "Any parent will have peace of mind knowing their children are protected."
Proponents of the federal law say the American health care system sorely needs to rein in rising costs, as well as cover the nation's 49.1 million uninsured people, including 1.1 million in Michigan.
In fact, many people think the federal health care law doesn't go far enough, said Andy Farmer, associate state director of AARP Michigan.
"In 2011 alone, premiums for family coverage rose almost 10% on average," Farmer said. "If this went away, all it would do is put us back on a faster track towards an unsustainable bubble of growth in health care increases that will return to the rapid death spiral of job losses and erode competitiveness."
Some of the more popular consumer features that proponents hope will reduce insurance costs include controls already under way through the new law to limit rate increases and new spending limits on insurance company salaries and administrative costs. Consumers can now track data for administrative spending and proposed rate hikes through the website of the Michigan Office of Financial and Insurance Regulation, www.michigan.gov/ofir
Consumers will receive rebates by Aug. 1 if their insurance company spent too much last year on salaries and administrative expenses -- the amounts are to be determined based on figures insurers must submit to federal health officials by April. Federal health officials, using figures based on those for Massachusetts, a state with similar health care reforms in place since 2007, estimate that Michigan consumers in high-spending plans may get a rebate of $29.60 each.
Other features of the law expected to gain consumer support are bans on higher insurance rates for women, which can add as much as $1,100 a month in premiums, and the end to dollar limits on essential medical care such as hospital stays. Women's higher rates reflect their much higher likelihood to use health services than men, insurance officials say. Caps on care have been one way insurers have tried to limit spending for costlier services.
About 1,009 hard-to-insure Michiganders, including Deborah Sferlazza, 54, of Shelby Township, have already gotten health insurance through the Health Insurance Program of Michigan -- temporary coverage the law created for people who were denied insurance because of a health problem or who are unable to afford coverage. The program will end in 2014, when consumers will be able to buy what experts hope will be more affordable coverage purchased through Web-based insurance exchanges.
The coverage costs Sferlazza $393.38 a month, with a $1,000 deductible. She had been paying $409 a month for her Blue Cross Blue Shield of Michigan policy, which had a $5,000 deductible and required her to pay more out-of-pocket.
"You can't beat it," Sferlazza said of her current policy.
The insurance paid for physical therapy and back surgery last year that Sferlazza, a disabled Rochester elementary school principal, postponed because she had no way to pay for it. She was so grateful that she wrote Obama to thank him for her coverage. The federal Centers for Medicare & Medicaid is sending a film crew to Shelby Township to do a video on her for a public service announcement it is posting, with others, on the White House blog, www.whitehouse.gov/blog .
Opponents of the law say universal care elsewhere is costly and creates rationing and long waits for care, as occurs in places such as Canada, where a national health care system exists.
Others worry it will hurt businesses and cause job loss at a time when many businesses still are mired in the effects of the recession or just beginning to rebound. By 2014, businesses will pay tax penalties if their workers drop workplace insurance coverage to purchase what could be more-affordable, but more limited, policies through state exchanges.
U.S. Rep. Fred Upton, a Republican from St. Joseph and chairman of the House Energy and Commerce Committee, predicts that employers will cut back workers' hours to less than 30 a week so they won't be required to have health insurance under the law.
"The more people are finding out about it, the more they are shaking their heads," said Upton, who said he finds widespread opposition to the law in his Michigan district.
Steven and Salina Hyder of Monroe feel so strongly about the law that they were among four metro Detroit residents whose attorney sued Obama over it on March 23, 2010, the day it was enacted.
Salina Hyder, an artist, makes $18,000-$25,000 a year, and her husband's income fluctuates between about $40,000 and $60,000. "Fortunately, I'm relatively healthy except for my weight," said Steven Hyder, blowing his nose for what he described as a chest cold. He toughed it out instead of going to a doctor.
The bottom line: The Patient Protection and Affordable Care Act just goes too far, said Hyder and his attorney, Robert Muise.
"One of the problems is we frame everything as a right," said Muise, co-founder of the American Freedom Law Center, a nonprofit whose website describes it as a public interest law center. Muise filed what is believed to be the first legal challenge to the law, the minute he saw Obama on TV signing it. A federal court judge in Detroit dismissed it, a decision a U.S. Court of Appeals panel in Cincinnati upheld.
"If it's a right, on what grounds?" Muise asked. "Are we our brothers' keepers? Should we provide for people in our families and neighborhoods? Yes, I think we should. We have a moral obligation. But to say you have a legal right to have somebody else pay for your health care, there's just no basis for that claim."
Contact Patricia Anstett: 313-222-5021 or [email protected]. Medical writer Robin Erb contributed to this report.
More Details: Founding fathers had their an individual mandate, too
Muskets, wheat and the Affordable Care Act. Yeah, there's a link.
While some are revolted that the federal government might force individuals to buy a product, it's not without precedent.
The Second Militia Act of 1792 ordered every citizen to have a "good musket or firelock, a sufficient bayonet or belt" and ammunition, in case the U.S. was attacked.
And during the Great Depression, the U.S. Supreme Court upheld a federal law that essentially forced farmers to buy wheat from others if they ran short. The law, meant to stabilize prices, placed limits on how much of the crop a farmer could grow.
Ohio farmer Roscoe Wilburn, who violated the law, said the wheat was for his family and livestock. He said he was self-insuring against a shortage.
"It's exactly the same issue as someone saying, 'I can take care of myself. I can self-insure.' ...The times have changed, but the issue is the same," said Sara Rosenbaum, a law professor at George Washington University'sSchool of Public Health.
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