March 30, 2012

Justices To Vote Friday On Health Care

It is likely we won't know the outcome of President Obama's much-debated historic health care plan until June, but the justices of the Supreme Court will likely have an idea before the upcoming weekend begins, as they meet today, Friday March 29, to vote on the case.

Yet, even if the Supreme Court strikes the measure down, possibly ruling the law unconstitutional, California's Governor Jerry Brown vowed he will push forward to get elements of the bill passed in his state.

Health and Human Services Secretary Diana Dooley said California should at least consider enacting its own universal health care legislation, which includes requiring every Californian to buy health insurance.

"I think that we should be committed to making this system more rational than it is today, and improving the health of the people of California," Dooley said in an interview. "If we ask the insurance plans to take everybody and insure everybody with no screens or pre-existing conditions, then we have to have everybody buying some level of health insurance to meet their responsibility to the system."

Dooley's remarks came a day after the Supreme Court finished three days of oral arguments over President Obama's signature health care plan.

The fate of the president's bill will be played out as the justice's meet this morning to vote. They will meet in a wood-paneled conference room on the court's main floor. No one else will be permitted to be at the session.

But a vote today will not be final. Even after the meetings are ended, individual votes can change. In the coming weeks, the justices will go over each other's draft opinions and dissents. Today's vote will be followed sometime soon by the assignment of a single justice to write a majority opinion, or perhaps two or more justices to tackle different issues of the bill. In the meantime, we will have to wait it out, as they will have until early summer to reveal their ruling.

The big issue of the bill is whether Congress can possess the ability to require people to buy health insurance and, separately, whether lawmakers overstepped in pressuring states to expand their Medicaid coverage.

In 2010, California, amid urging from the White House, became the first state to enact legislation establishing a public health insurance plan to implement the Affordable Care Act. That insurance exchange is expected to serve more than 2 million Californians beginning in 2014, many who are currently uninsured and do not qualify for existing public health care of cannot afford coverage on the open market.

Currently, California's Medicaid services, called Medi-Cal, covers nearly 8 million low-income residents, including children and their parents, disabled individuals and the elderly. A separate program, Healthy Families, serves 878,000 children whose families earn too much to qualify for Medi-Cal.

If the federal healthcare overhaul succeeds, the government would cover most costs for new enrollees such as single adults and parents who cannot qualify for Medi-Cal. In the first 5 years of the overhaul, beginning in 2014, California stands to receive $45 billion to $55 billion from the federal government, according to the Kaiser Commission on Medicaid and the Uninsured.

"Just from her (Dooley's) point of view, from the agency she manages, it's an infusion of literally billions of dollars into our health care system and our economy that is pending here," said Anthony Wright, executive director of Health Access California, an advocacy group.

Wright said an insurance exchange without federal subsidies "could still provide an easy, consumer-friendly marketplace that doesn't exist now in a very complex and confusing world." But compared to what President Obama's healthcare law could do, there isn't much similarity.

"There are some portions of the reforms that we can go forward with," but the "key thing is money," he said.

The California health exchange would bring together private insurers to serve new healthcare enrollees, subsidized by those federal and state dollars. But it is difficult to know how any part of the program will fare until the Supreme Court reaches a final decision.

Friday's vote will be the first time all the justices gather as a group to discuss the case. Even they do not always know what the others are thinking when they enter the conference room. They customarily shake hands upon entering, then Chief Justice John Roberts will take his seat at the head of the table. Justice Antonin Scalia, the longest serving among them, will be at the other end. The other seven justices also sit according to seniority, the four most junior on one side across from the other three.

During the course of the meeting, each will speak in order of seniority, and it should become clear fairly quickly what the outcome will be on the healthcare overhaul. That's because Roberts speaks first, followed by Scalia, and then Justice Anthony Kennedy. If the three men hold a common view, the Obama health care overhaul probably is history. If they don't, it probably survives.

If Roberts is in the majority, he will assign the main opinion, and in a case of this importance, he may well write it himself, several former law clerks said. If Roberts is a dissenter, the senior justice in the majority assigns the opinion.

The court won't issue its ruling in a case until drafts of majority opinions and any dissents have circulated among the justices, changes have been suggested and either accepted or rejected.

No one will know precisely when decisions on particular cases will be coming, until perhaps Roberts ends a court session in late June by announcing the next meeting will be the last until October. Then it's relatively safe to assume that whatever hasn't been decided will be on the last day. And decisions in the biggest cases very often aren't announced until that last day of the term.

Supreme Court opinions rarely find their way to the public before they are read in the marble courtroom, although the court inadvertently posted opinions and orders on its website about a half hour too soon in December.

If the justice strike down the mandate that everyone carry health insurance, it is unknown how successfully the exchange can operate. Insurers were counting on the mandate to ensure they could afford to cover high-risk individuals who have health conditions and deliver health care at an affordable price.

"We're all on pins and needles on the Supreme Court stuff," said Robert Ross, a health exchange board member and president and CEO of healthcare foundation The California Endowment. "We still have 7 million uninsured in the state, and we still have out-of-control health care costs."

If the law is struck down, it is unclear whether the state could maintain some provisions already in effect, including not allowing most insurers to deny coverage to children because of pre-existing conditions and allowing people up to age 26 to remain on their parents' policies.

There is a "very good chance" the Supreme Court will rule in the government's favor, said Dooley. But if not, it may leave certain federal subsidies in place, she added.


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