The Decision of the Supreme Court on the PPACA Constitutionality

The Decision of the Supreme Court on the PPACA Constitutionality

From the moment the Patient Protection and Affordable Care Act (PPACA) was just in its proposal stage, it proved to be the most argued upon piece of US legislation of the last decades. It stirred controversy among the general public, medical professionals, raising concerns of various nature, including public health, legal, and ethical, to the delight of hundreds of political analysts. “Chief Justice Roberts has handed a political weapon to the Republicans, who can portray the PPACA as a major tax increase. Another potentially disturbing element of Chief Justice Roberts's opinion is the limitations he places on the federal spending power… The federal government could place conditions on the new Medicaid grants, Roberts argued, but could not threaten existing Medicaid funding without being unconstitutionally coercive. This part of Roberts's opinion is unfortunate, making it more likely that a few red states will reject the Medicaid expansion for no compelling reason.” (Lemieux, 2012)

From the public health perspective, the decision of the Supreme Court does not seem beneficial. It is obvious that PPACA was intended to address the social inequalities that prevent millions of low income, uninsured citizens to benefit of decent health care. The law aims to accomplish the following major tasks: to raise the quality of medical care, to offer care based on the patients freedom of choice, the affordability of such treatments, and a nation to share both the costs and the benefits of healthcare. However, these goals turned out not to please everyone. According to Sorrell, “one probable reason is that there are significant differences in the priorities that Americans assign to these goals and important differences in beliefs and values. Social injustice occurs when all people are not treated with equal moral concern… A society in which the most fortunate help the least fortunate is not only a moral society, but a logical one.” Sorrell also mentions “the concept of a social contract, in which liberty is carefully balanced with individual rights and the overall good of society, with special emphasis on making the worst off as well off as they can be.” As a consequence, the PPACA has become a source of alarming rumors and myths. The most alarming involves the idea of the government wanting total control over the healthcare system. In reality, the law intends to address the access to care and the efficiency of the treatments, based on state specific regulations, which will require open and reasonable collaboration from private health care providers and insurers. Another matter of public concern was that the law would offer free health care to the millions of undocumented immigrants, at the expense of the citizens and legal residents. On the contrary, the law is about offering affordable or free coverage to more of the uninsured citizens, while those who are able to afford it, will still have to pay for it, but at more reasonable rates. The most controversial provision of the bill, about the death panels, has been removed, because too many argued that the physicians would gain life and death decision power over the elderly. It is still uncertain if the PPACA would increase or not the national debt, however, the report of the Health and Human Services states that the spending on Medicare will decrease by $575 billion by 2019, under the new law. “It seems reasonable to consider the estimates by the non-partisan Congressional Budget Office.” (Sorrell, 2012). The anxiety about the difficulties that small businesses can encounter was somehow put to rest, by the increase in the medical coverage of affordable options. This was, the small businesses may be able to attract employees who would otherwise prefer to work for large organizations, in order to receive quality healthcare benefits.

From the legal perspective, the decision of the Supreme Court seemed fair enough. “The Supreme Court ruling provides some stability for those relying on the law, and health care providers may now proceed with planning for the future with some certainty about the trajectory of health care reform.” The law contains an elaborate plan, with steps to stabilize and improve the healthcare system, in a transition lasting from 2012 to 2015, allowing more freedom and adding more benefits, for the parties involved in the system patients, providers, insures, employers, and last but not the least, the states.

The ethical perspective addresses the fact that the PPACA targets the injustice in the healthcare system and many agree on that. The law takes in consideration the patients best interest and puts a cap on the financial demands of the insurance companies and the physicians. Ethical reform of health care necessitates addressing numerous important ethical and moral issues. The recently enacted Affordable Care Act (PPACA) of 2010 has fueled ethical debate of several important controversial topics. Ethical issues of health care reform include moral foundations, cost containment, public health, access to care, ED crowding, and end-of-life issues. These issues are of paramount importance to the efficient and compassionate practice of emergency medicine.”

References:

(n.a.) (n.d.). The Ethics of Health Care Reform: Issues in Emergency - Medicine - An Information Paper. American College of Emergency Physicians. Acep.org. Retrieved from http://www.acep.org/Physician-Resources/Practice-Resources/Professionalism/Ethics/The-Ethics-of-Health-Care-Reform--Issues-in-Emergency---Medicine---An-Information-Paper/

Labban, A. Puleo, J (n.d.). Supreme Court Allows Health Care Reform to Move Forward. Smith Moore Leatherwood. smithmoorelaw.com. Retrieved from http://www.smithmoorelaw.com/Supreme-Court-Allows-Health-Care-Reform-to-Move-Forward-11-20-2012

Lemieux, S. (2012). A Tale of Two Justices. The American Prospect. prospect.org. Retrieved from http://prospect.org/article/tale-two-justices

Sorrell, J., (November 9, 2012) "Ethics: The Patient Protection and Affordable Care Act: Ethical Perspectives in 21st Century Health Care" OJIN: The Online Journal of Issues in Nursing Vol. 18 No. 1.