We all need to be able to see a Doctor when we’re sick.
It’s that simple. And somehow, that fact seemed to elude much of our discussion around the Supreme Court oral arguments on the Affordable Care Act.
Legal arguments, particularly when they reach the highest court in the land, can be detached from daily life. But this may have been one of the more insensitive and callous cases we have heard in recent years.
A debate about the US Constitution’s Commerce Clauses can be a yawn. But in this case, the question of whether the Constitution allows our national leaders to have us pay a penalty or purchase health insurance can be a matter of life and death, particularly for people of color. Fifty million people are uninsured in the US today, even if they have a job. And insurance and accessible healthcare providers are two of the biggest contributors to our health.
Far too many people, many of them white men, are losing healthcare insurance as they lose their manufacturing jobs. This is commerce by most real world definitions. The market is the driver of healthcare affordability. People of color are worse off because of higher rates of uninsurance, despite employment, and because they have fewer places or farther to go to get care. Almost a third of Latinos and 20% of African Americans and 16% of white people lack a usual source of health.
Many readers know that people of color are more likely to suffer from chronic illnesses, disease and die younger than their white counterparts. One of the important things the Affordable Care Act does is attempt to address health disparities. The Joint Center for Political and Economic Studies reported in 2009 that reducing health disparities could prevent 85,000 deaths per year.
The central fight in the case has been the so called "individual mandate," which requires those who don’t choose to buy insurance to pay a token penalty on the annual federal tax return. Justice Scalia asked the US Solicitor General whether this would empower Congress to force people to buy broccoli. Walter Dellinger, with whom I had the privilege to speak with the day after arguments concluded, explains eloquently why this is a ridiculous "fear" from a legal perspective. The callous part of this line of questioning is the suggestion that it is more important to protect people from broccoli than from death.
Justice Scalia’s argument, echoed by Justice Alito and other conservative Justices in different ways at various points in the argument, suggests that it is wrong for elected leaders, elected by voters at state and local level, to promote healthcare through a small penalty. In other words, well over 84,000 people dying each year (that number does not include White deaths, so it must be much higher) is not as important as permitting people to stay out of the insurance market and, eventually, crippling the economy when they get uncompensated care.
While the moral issue of life and death should be reason enough, this is clearly an economic issue. The Center for American Progress reported that racial health disparities are estimated to cost $415 billion dollars in health costs, lost wages, and lost productivity per year. The Joint Center for Political and Economic Studies found that between 2003 and 2006 health inequities cost the nation $1.24 trillion dollars.
The Affordable Care Act’s contribution to longer and healthier lives is being overshadowed by the individual mandate question.
Ironically, the States that are fighting to kill this life-saving legislation have the most reason to support it. Texas and Louisiana, for example, have 24% and 20% uninsurance rates, respectively. And as states with large numbers of people of color, huge constituencies would benefit from the Act. Based on our own research at the Center for Social Inclusion, in Louisiana, 17 parishes with a significant adult population of color could see a possible increase of 43% to 69% in Medicaid enrollment. This is significant considering that over 30% of the population of color is currently uninsured.
Additionally, Justice Alito made an argument last Tuesday that young people were being forced to subsidize everyone else because they are healthier and generally pay less than the cost of the premiums in the individual market. Today, half of those 18 years of age and under are people of color. They are excluded from the insurance market, not opting out of it by choice. And given that they may be watching their parents, aunts, uncles and teachers die premature deaths from cancer, heart diseases and many other conditions, it stands to reason that they see the importance of their contributions to the greater good that will benefit them directly as well. And finally, it would be truly confounding if Social Security, which also has us all supporting each other into retirement, as well as ensuring our own nest egg, is permissible to the court, while life balances differently. Justice Ginsburg suggested as much in the argument.
If the Supreme Court strikes down the Affordable Care Act in its entirety, its message to the country, including the millions of people dying needless deaths, will be, “Let them eat broccoli.”