A lot is riding on the Supreme Court's ruling, expected this month, on the constitutionality of the Affordable Care Act, one of President Obama's signature achievements. Not only is the healthcare law a focus of the presidential campaign, but Americans on both sides of the issue are waiting to see what the decision will mean for them. January Angeles, a senior policy analyst at the Center on Budget and Policy Priorities, spoke with U.S. News about the implications of overturning the individual mandate and why healthcare has become a central part of the political scene. Excerpts:
What is the Supreme Court deliberating?
I believe they're deliberating a number of things. One is the constitutionality of the mandate and whether the federal government can require individuals to purchase health insurance. Another thing that they're deliberating is Medicaid expansion, and whether the requirement for states to expand the Medicaid program is considered coercive.
What happens to the law if the mandate is overturned?
It's really unclear. The Supreme Court could decide to overturn the entire law, the Supreme Court could decide to uphold the entire law, and between those two possibilities there are several different potential variations. The main provisions that are closely related to the mandate are the coverage provisions and the requirement for insurers to sell healthcare insurance to anyone who wants it, and it's also tied to the requirement to basically not allow insurers to charge different prices based on people's health status and other demographic characteristics, like age, limiting the amount that premiums can vary by age. Those provisions aren't in effect yet; they will come into effect in 2014. If the Supreme Court decides to strike down the mandate, what other provisions remain in effect depends on what other things the Supreme Court decides in terms of what provisions are integrally tied to the mandate and cannot stand if you don't have the mandate, and we don't really know at this point.
How informed is the public?
I think people are aware that the Supreme Court is considering the constitutionality of the mandate, but it's not clear to me how much people have thought about the other provisions of the law and what happens short of fully upholding or fully striking down the entire law.
Why is healthcare so politicized?
I think to a lot of people healthcare is a very personal decision, so a requirement for people to purchase healthcare may rub some people the wrong way. Another reason it may be such a hot topic at this point is because there's a lot of discussion around healthcare and its impact on the economy. Healthcare as a percentage of GDP has been growing, and a lot of people are concerned that spending on healthcare programs like Medicare and Medicaid is increasingly consuming our federal resources, so there's concern about how to control that growth.
Who does the healthcare law benefit most?
Along with the healthcare mandate there's going to be a Medicaid expansion to help people with very low incomes qualify. Right now, a lot of people don't necessarily know that even though Medicaid is a program for low-income people, there are a lot of low-income people who still can't qualify for Medicaid. Along with that expansion there are also subsidies that will be available to help people purchase coverage. Those provisions are there to make sure that the requirements for people to purchase coverage don't impose a burden on people.
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