The State of the Union and Health Care Reform

Perhaps the most contested issue of President Obama’s presidency so far, the dispute over health care policy is grounded in a longstanding tension within American politics—federal versus state/individual power. This aspect of the debate will play out on its largest stage yet in March, when the Supreme Court hears the main challenges to the law. Meanwhile, although the health care system is beginning to improve, thanks largely to the provisions of the law that have already gone into effect, too many people remain uninsured, too many are struggling to pay their premiums, and our obligation to provide the basic right of affordable health care to everyone still stands. The Patient Protection and Affordable Care Act set us on the right path. Now only a few days away from the 2012 State of the Union address, we hope President Obama will continue to stress the importance of health care reform and defend the law.

The Patient Protection and Affordable Care Act, which was signed into law on March 23, 2010, is comprised of multiple parts to be gradually put into effect over the next seven years. Overall, the law was designed to strengthen existing coverage and expand coverage to 32 million uninsured Americans. Just a handful of the many provisions that have been or will be put into effect by the law are expanding Medicaid eligibility; prohibiting the denial of coverage to children and adults with pre-existing conditions; providing free preventive care for seniors; beginning to close the so-called “donut hole” in Medicare prescription drug coverage; addressing Medicare overpayments to big insurance companies; ensuring that at least 85 percent of every premium dollar collected by insurance companies for large employer plans (and 80 percent for individual plans) is spent on health care services and improvements in quality; and rebuilding the primary care workforce.

However, many have questioned the constitutionality of some of the law’s provisions. In order to ensure that as many people as possible are covered and premiums are held down at a reasonable rate, the law requires that most Americans purchase health insurance coverage or pay a penalty. Whether Congress has the constitutional power to enact this provision, often referred to as the individual mandate, is one of the issues the Supreme Court will consider in March. The Court will also consider whether the Anti-Injunction Act bars challenges to the individual mandate; whether some or all of the law must be overturned if the individual mandate provision is found to be unconstitutional (an issue known as severability); and whether the expansion of Medicaid, whereby Congress requires states to follow the new program rules or risk losing all of their federal Medicaid funding, is coercive.

The fate of the health care reform law is in the hands of the judicial system for now, but the President should still use his prime-time slot during the State of the Union address to educate the American people about the benefits of health care reform and advocate for broader public support of the law.

Watch the speech on Tuesday, January 24, at 9 p.m. ET to hear if President Obama mentions health care reform, and make sure to follow along with the RAC’s BINGO board to see what else he discusses. Also, keep checking RACblog between now and the speech for more updates on the issues we chose for our BINGO board.