Navigating the Turbulent Waters of US Health Care Reform

The health care debate in the United States of America has been continuing for a long time and the reform on the particular subject matter has always been politicized through judicial activism and unnecessary debates. The health care reform has been facing substantial amount of resistance and obstacle since the time of the President Barrack Obama. The confusing state of health care and citizen’s mixed reaction along with the undemocratic nature of the US Constitution has collectively made the debate more complicated in nature. With every passing legislation on the subject of health care, the debate intensifies and it has left the citizens of the US in a confused state herein.

As the debate on the subject of heath reform is a prolonged matter which has been going on for more than a decade, the comprehensiveness of the debate herein is questionable and the recent developments in respect of the presidential election and the American Constitution herein has added quite a colour into the already piled up reform discussion. While the debate on health reform is of the nature of “positive right” to be exercised by the government, the concept of negative citizenship and misuse of ‘liberty’ and ‘equality’ as enshrined in the US Constitution have come into light. Thus, herein we shall critically discuss the subjective nature of US health reform and how the recent developments only points out towards a asymmetric health care system of US that shall be in gross contradiction to the rights in respect to ‘liberty and equality’ under the wings of the US Constitution.

The US Debate on Health Reform – A constructive timeline

Health reform is a very sensitive issue in US and the topic and agenda towards health reform is one of the key aspects which can genuinely reverse the election poll. To understand the concept of health reform and how it has taken a stronghold position among the minds of the voters, we shall need to retrospect a little into the historical evaluation of health reform and debated attached to that herein.

It is of no doubt that the key point in the health reform debate is to implement “Universal Health Care” in the states of United America in accordance with United Nation Resolution, passed in the year of 2012. However, due to complex nature of the insurance system and several other cost related issues, US has till date, failed to implement a permanent structural health care system that shall be in accordance with the US Federal Constitution. In this segment, we shall discuss the several steps that have been taken by the government of the US in order to implement a steady and stable health care facility within the nation and what were the key points of such debate herein.

1. Fried, Susana T, et al. “Universal Health Coverage: Necessary but Not Sufficient.” (2013); Reproductive Health Matters, vol. 21, no. 42, pp. 50–60

The Implementation of the PPACA or “The Obamacare”

Before the United Nation’s resolution was passed in the year of 2012, the then US President, Barrack Obama aimed for establishing universal health care system within the country and thus, implemented the Patient Protection and Affordable Care Act (PPACA) in the year of 2010 herein. Famously known as the Obamacare, this Act provides emphasis on the preventive attempt in the section of health reform and puts forward several insurance related solutions in order to provide every citizen with a symmetrical health care system herein. The main key points of this ACA or Obamacare are follows herein:

a. This Act helps in building an elaborate preventive plan for the public health in general and such preventive fund shall be used for the preventing the spreading of certain diseases herein.

b. Excessive tobacco use, malnutrition cases to be given special attention under this act herein and each state are to be asked to create special health fund to combat such issues.

c. Federal share in payment of Medicaid were increased by a margin of one percent.

d. In the case of prevention case, the Insurance companies were directed to be more covering towards the certain immunization or diseases in cases of children and it was effective from the year of 2010 onwards hereby.

e. Further, this Act also encourages and establishes home-visiting initiative to be taken at a broader range, especially to people who are at risk or open to contract certain life threatening disease herein.

1. Hall, Mark A, and Richard Lord. “Obamacare: What the Affordable Care Act Means for Patients and Physicians.” (2014) ; BMJ: British Medical Journal, vol. 349

Adaptation to Trump’s “Repeal and Replace” process

While with the Obama’s positive attitude towards the health care reform provided the citizens with a guidance to the Universal Health Care facility, with Trump’s new policy towards the health reform not only broke down all the previous structure in the sector of health but it also provided a negative impact on the “right to health” statement as has been enshrined under the Constitution herein. In his time period, he initiated a seven pointer for the healthcare system which was based on his belief of the free market healthcare system herein. The main seven points of his health care system were:

a. Completely repeal and discard the Obamacare.

b. Loosen and lower the regulatory system in the case of overseas drug transportation.

c. The implementation of price transparency.

d. Block grant Medicaid to states.

e. Implement a full tax deduction system on the premiums paid by the citizens for the purpose of health insurance herein.

f. Lowers the barriers to the interstate health insurance so that people from one state will be able to avail insurance of the other states herein.

g. Add a characteristic of inheritable to the Health Savings Account herein. Thus, after the death of a spouse, the other one shall be able to use the Health Savings Account herein.

While some of the points in this Trump’s approach was good and aimed at providing a better health care system with lesser problematic barriers, most of the approach was targeted towards a the approach of “repeal and replace”. He made the health care rights of the citizens a negative right herein and also suggested the implementation of strict immigration laws for the purpose of cutting down the cost of the health care system within the States herein.

The Pending Case of California v. Texas (Docket 19-840)

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1. MacKay, Douglas, and Marion Danis. “FEDERALISM AND RESPONSIBILITY FOR HEALTH CARE.” (2016); Public Affairs Quarterly, vol. 30, no. 1, pp. 1–29

The eternal debate between the Trump’s “repeal and replace” and Obamacare was finally taken down to the Supreme Court of the United States of America because the seven pointers provides by the Trump did not get full approval of the Congress herein. The approach of Trump started to make the health care right a negative right in the light of the US Constitution and it shall be in contradiction to the spirits of the US Constitution herein. Thus, the administrations of the state filed a lawsuit before the Supreme Court of the State, demanding the reimplementation of the ACA or “the Obamacare” back in the place of Trump’s negative approach to the health care reform. The pending case of California et. Al v. Texas et. al, was instituted before the Supreme Court. The decisions, to be held in the abovementioned case single handedly have the fate of the 20 million citizen’s health care. However, in the light of the recent pandemic, Supreme Court has delayed the passing of the judgment in the abovementioned case regarding the nature of constitutionality of the ACA case herein till the end of June, 2021. In the light of the abovementioned pending case which controls the future of the health care reform of the US herein, another case National Federation of Independent Business v. Sebelius, demands a spotlight position as a landmark judgment in implementing the ACA care of Obama herein.

The Centre point of the US Health Care Reform debate

After carefully examining the abovementioned timeline of the health reform herein in reference to the recent pending case of California v. Texas, which awaits its decision in the end of June, 2021, the centre point of health reform debate of US can be summarized herein.

1. The ACA care implemented by Barrack Obama had the notion of establishing a framework of Health care system which shall closely resemblance the Universal Health Care system as proposed by the UN herein.

2. Under the ACA care, all the Americans were encouraged to have health insurance which shall provide a symmetrical health care system for the country herein.

1. California v. Texas (Docket 19-840)
2. Blendon, R. J., Brodie, M., Benson, J. M., Altman, D. E., & Buhr, T. “Americans' views of health care costs, access, and quality” (2006) The Milbank quarterly, 84(4), 623–657
3. National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012)
4. Quan, Stuart F. “The healthcare debate--is it misguided?.” (2011) Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. 7,2, pp. 133
5. Achenbaum, W. Andrew. “Why U.S. Health Care Reform Is So Difficult.” (1994); The Hastings Center Report, vol. 24, no. 5, pp. 23–25

3. 3. In order to provide all the Americans with health insurance, Obamacare instructed the states to provide their citizens with extreme low-cost or free health insurance herein as such step shall encourage people to avail the health insurance herein.

4. 4. However, to strictly implement the provision of Universal Health Care and successfully implement the ACA care herein, a provision of “individual mandate” was inserted which essentially said if a person will not avail health insurance, he/she shall be imposed with an income tax penalty under the Act herein.

After retaining the power in the year of 2016, Trump instituted an Act of Tax Cuts and Jobs Act, 2017. As ACA already created several controversies regarding the nature and the provision of “individual mandate” of the Act, it created a huge political debate between the Democrats and the Republicans which ultimately led Trump, the leader of the Republican herein to implement the abovementioned Act in order to curtail the Obamacare’s tax mandating herein.

After such implementation of the repeal of the provision of “individual mandate” under the ACA care herein, the State of Texas and 19 other States herein challenged the constitutionality of the ACA after the removal of the abovementioned tax provision as it creates an unequal barrier between the citizens herein and provides the Congressman with huge taxing power. The same was again challenged by the State of California and 26 other states before the Supreme Court herein. It was held by the District court that ACA is not an Act with a clause of severability. Thus the doctrine of severability shall not be applicable herein and if the “individual mandate” is to be discarded, the whole Act shall be needed to be repealed as without the tax penalty provision, the ACA stands unconstitutional. Also, the standpoint of the ACA was on the tax penalty provision. Thus, without the very provision herein, the implementation of the ACA shall be fruitless as it will be just an optional Act herein.

1. Rovner J. The complicated, political, expensive, seemingly eternal US healthcare debate explained BMJ 2019; 367
2. Zieff, Gabriel et al. “Universal Healthcare in the United States of America: A Healthy Debate.” (2020) Medicina (Kaunas, Lithuania) vol. 56,11 580
3. Campbell, Andrea Louise, and Lara Shore-Sheppard. “The Social, Political, and Economic Effects of the Affordable Care Act: Introduction to the Issue.” (2020); RSF: The Russell Sage Foundation Journal of the Social Sciences, vol. 6, no. 2, pp. 1–40

A Critical Evaluation of the Unconstitutionality of ACA – Does the current health reform debate contradict the US Constitution?

In the light of recent development of the Supreme Court debate herein, it is necessary to discuss the unconstitutionality of the debate herein and how such debate forms a slippery slope for all the citizens of America in respect to the health care system herein. Thus, herein we shall critically discuss the nature of the health care reform herein and to what extent such reforms shall contradict the US Constitution and how such unconstitutionality restrains the right to liberty and equality of the citizens of US herein.

The Concept of Liberty and Equality under the Constitution of America

The 14th amendment of the US constitution provides us with the concept of equality and liberty under the US Constitution. The concept of equal protection of law was first instituted in the US Constitution through the case law of Brown v. Board of Education of Topeka, and the 14th amendment of the US Constitution held that “no person shall be denied of their life and right to liberty” under the ambit of the US Constitution herein.

Thus, the concept of right to liberty and equality in the sense of availing equal protection of law is two essential positive rights of the citizens herein and no status of the land shall discard these two rights of the citizens of America herein.

Again, with the right to liberty and equality, comes the right to life which shall extensively cover the right to proper health care i.e. Universal Health Care facility as extended as provided by the UN in the year of 2012. Thus, under the ambit of the US Constitution herein, right life along with right to liberty and equality are positive rights i.e. rights which are treated as fundamental to any person’s existence herein.

1. Constitution of America, 14th Amendment
2. Brown v. Board of Education of Topeka, 347 U.S. 483 (1954)
3. Seagrave, S. Adam, editor. “Liberty and Equality: The American Ideas.” (2015) ; Liberty and Equality: The American Conversation, University Press of Kansas, pp. 9–56
4. Ibid

Arguments in favour of the ACA of 2010 or the “Obamacare” in respect to the doctrine of liberty and equality under the US Constitution

As it had been enshrined by the then US President Barrack Obama in the year of 2010, Affordable Care Act, 2010 is of extreme importance in respect to the asymmetrical health care facility that prevailed across the United States of America. As it has been discussed above, this Act aimed at providing a symmetrical health care system that shall compel different States of the US to provide their citizens with low-cost health insurance or free insurance which shall deem fit in respect of the different marginalized tribe herein. Also, this Act imposed a penalty tax as it has been discussed above in length, in case any person fails to take the health insurance herein.

Thus, the ACA of 2010 essentially aims at establishing an Universal Health Care system which shall provide with all the citizens living in US with a health insurance and in turn, it would be end the never ending crisis of health care disparity across the US which has brought US down to the 11th position in the World health care index herein. The “individual mandate” section as mentioned under this Act shall also provide with a mandatory implication which shall reserve the “right to health” as enshrined under the US Constitution herein and reinstate the right to health along with right to liberty and equality under the purview of the positive rights of the citizens herein.

Thus, if we critically evaluate the health care reform debate in respect of the abovementioned discussion herein, the formation and implication ACA of 2010 shall only provide the citizens with right to health, liberty and equality under the 14th amendment of the US Constitution. Also, it shall aim at serving public health which is one of the characteristics of the federalism of the US Constitution herein.

1. Michael Carome, M.D; Dead Last: U.S. Health Care System Continues to Rank Behind Other Industrialized Countries (2014); Public Citizen < https://www.citizen.org/article/dead-last-u-s-health-care-system-continues-to-rank-behind-other-industrialized-countries/> accessed on 12th June, 2021
2. Ibid
3. Federalism: Basic Structure of Government; United States Government < https://courses.lumenlearning.com/americangovernment/chapter/introduction-3/> accessed on 12th June, 2021

Argument against ACA, 2010 or “The Obamacare”in respect to the doctrine of liberty and equality under US Constitution

From the above discussion and critical evaluation, it might seem that ACA of 2010 is of perfect nature and it perfectly serves the Universal Health Care concept which needs to be implemented in the US. However, along with several good qualities, ACA of 2010 draw several arguments against it as well.

One, the constitutional nature of the “Individual Mandate”. As it has been already discussed before with respect to the case of National Federation of Independent Business v. Sebelius, the constitutional nature of the individual mandate was challenged and discussed in the case herein and several different decisions were held by the Judges herein. Although, through the abovementioned case, the Congressmen succeeded in retaining the fundamentality and the implementation of the ACA of 2010, the tax penalty section of the case was discussed in length. It was held in a 5:4 decision that even though Individual mandate is an important part of the ACA, 2010 and thus, it has been upheld by the judges but it does not provide with right exercise of the Congressmen’s taxing powers herein.

Second, the extensive use of Medicaid was questioned in the same case as has been elaborated above.

Third, in the recent pending case of California v. Texas, it was held by the District Judge that ACA of 2010 is not severable Act and thus it cannot act without the provision of individual mandate which has been curtailed by the Trump’s new approach to the legislation in the year of 2017 herein.

After critically evaluating the arguments herein, it can be stated that by imposing provision of individual mandate in the Affordable Care Act, 2010, it shall not only be unconstitutional in accordance with the Congressmen’s exercise of taxing power and in interfering with the interstate e-commerce system as held by the Department of Health of United States of America, but it might also hinder the liberty of the citizen as well. It is admitted that right to life is a positive right of the citizens of US but with the imposing of the individual mandate, it shall contradict with the right to liberty as enshrined under article – I of the American Constitution herein which provides the citizens with the absolute right to liberty and the state shall not deny the right to life and liberty to any person residing within the territory of the United States of America. If a person does not avail the health insurance, which again shall lie at the mercy of the hands of the individual State herein, a person shall have to count the penalty tax which directly contradicts with the concept of liberty under the American Constitution herein.

1. 567 U.S. 519 (2012)
2. (Docket 19-840)
3. Tax Cuts and Jobs Act, 2017

Again, it has been mentioned under the ACA of 2010 that it shall be optional for State to provide their residents with free or low cost health insurance. Thus, there shall not be a particular measure to which each State need to stick while fixing the health insurance cost and it creates a state of inequality within citizens herein.

Arguments in relation to waiver of individual mandate by Tax cuts and Jobs Act, 2017

As it has been stated herein that after Trump held the position of President in the year of 2016, the Act of Tax Cuts and Jobs of 2017 was introduced which stated that the ACA of 2010 in case of health reform shall function without the provision of tax penalty. Thus, with the nullity of the provision of the individual mandate, it shall not restraint the individual’s liberty in connection with the American Constitution herein and such provision included by the abovementioned Act seems to save the constitutionality of the ACA, 2010 herein.

However, as it has been partially decided in the case of California v. Texas, before the District Court herein, the nature of ACA of 2010 was held to be not severable without the implication of the provision of individual mandate herein. And without the implication of such provision, it shall intervene again with the right to life of the individuals i.e. it would be optional for the State to impose the low cost health insurance as there is no tax penalty involved and only those shall avail the health insurance who can afford it. Thus, the key aim of the ACA of 2010 shall fail and it shall not serve any purpose in the light of establishing a Universal Health Care system herein.

Also, it can be critically discussed that along with the abovementioned implication of the Act of 2017, Trump has also provided several other suggestions as has been already discussed herein which aims at converting the availing of the health insurance a privilege for the citizens of US and strengthen the immigration law of the State in order to provide the citizens with a stable health care system and such categorization shall put the right to health along with liberty and equality under the sphere of negative right.

Thus, from the abovementioned arguments herein, it can be held that while keeping the constitutionality of one provision or one section, the other provisions of the same Act proves to be unconstitutional with respect to the concept of liberty and quality as has been provided by the American Constitution herein.

An overall critical evaluation of the arguments stated herein with respect to the concept of Liberty and Equality under the American Constitution

Thus, from the abovementioned discussions herein, if we critically evaluate each and every argument that has been done in favour and against of the recent developments of the Health Reform Debate herein, it can stated that none of the arguments pose any perfect solution to Universal Health Care system which shall also be constitutional. In order to do public good, the liberty of the people needs to be curtailed and limited or else, if we care about not curtailing the liberty of the people, we shall impose inequality within the citizens of the States and the situation of the health care in the United States of America shall not change. Unless and until any kind of penalty is imposed upon the public in general, no government can confirm imposition of the Universal Health Care. In other words, in absence of the abovementioned ACA of 2010 and the provisions of individual mandate herein, the citizens of US shall either rely on their own pocket to avail health care or go for expensive health insurance or the government can take the form of a complete socialistic government who shall bear all the expense of the public health without any established health insurance which in turn shall destroy the economical condition of the State herein.

Thus, herein we can see the concept of liberty in respect to the imposition of the ACA of 2010 under the light that ‘liberty shall mean not harming the liberty of other people’. Thus, in order to prevent and prevail a good public health, limiting one’s liberty shall not be held unconstitutional as long as it involves harming the liberty of the other person. Thus, by not availing health insurance and waiving the right to proper health care (in case of infectious disease), a person shall harm the liberty of other’s right to life. Hence, if we critically evaluate the concept of liberty as has been enshrined under the US Constitution in such light, the provisions of ACA of 2010 shall stand valid and America shall finally have Universal Health Care system.

1. Bradley A. Positive rights, negative rights and health care. J Med Ethics. 2010 Dec; 36(12):838-41

Conclusion

Although, we have herein twisted the meaning of the liberty in order to fit the concept and definition of the ACA of 2010, in the light of recent case, there exist more ground of unconstitutionality of the ACA of 2010 than it being contradicting to the concept of liberty and equality. The most anticipated case of Supreme Court is pending for the end of June, 2021 which shall decide the fate of the Affordable Care Act, 2010 herein. While the aim and endeavor of the Affordable Care Act, 2010 is for the public good and public health, the unconstitutionality nature with respect to liberty and equality shall fall under the exemptions as it has been mentioned under the case of Katzenbach v. Morgan and Shelby County v. Holder where it has been held that the Congressmen has the right to control the rights enshrined under section 5 of the 14th amendment of the American Constitution beyond the scope of the judiciary. However, with the case of City of Boerne v. Flores, it also states that the Congress shall only have the right to impose preventive measures in consistent with the 14th amendment of the US Constitution herein only and not more. In concluding the debate of the health reform of the US, we can assume and deduce that the contravention of the concept of liberty and equality under the US Constitution shall depend upon the collective definition and limitation of the liberty and equality along with the citizen’s right to life and health herein.

Introduction

The Health Reform Debate of the United States of America is of controversial nature and it has been debated since a long time, starting from the year of 2010 with the enactment of the Affordable Care Act, 2010 by the then President of the USA, Barrack Obama. However, while the Universal Health Care characteristics prescribed by the Affordable Care Act, 2010 stands valid for the purpose of aiming public health, it also contradicts and contravenes with the basic concept of the ‘right’ and ‘liberty’ as it has enshrined under the US Constitution. Thus, the validity of the ACA, 2010 shall depend and rely on the careful introspection of the doctrine of liberty and equality along with right to life and health of the citizen at large under the Constitution of the United States of America herein.

1. Katzenbach v. Morgan, 384 U.S. 641 (1966)
2. Shelby County v. Holder, 570 U.S. 529 (2013)
3. City of Boerne v. Flores, 521 U.S. 507 (1997)

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BIBLIOGRAPHY

Article

Blendon, R. J., Brodie, M., Benson, J. M., Altman, D. E., & Buhr, T. (2006). Americans' views of health care costs, access, and quality. The Milbank quarterly, 84(4)

Quan, Stuart F. “The healthcare debate--is it misguided?.” Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. 7,2 (2011): 133-4

Zieff, Gabriel et al. “Universal Healthcare in the United States of America: A Healthy Debate.” Medicina (Kaunas, Lithuania) vol. 56,11 580. 30 Oct. 2020

Rovner J. The complicated, political, expensive, seemingly eternal US healthcare debate explained BMJ 2019; 367

Bradley A. Positive rights, negative rights and health care. J Med Ethics. 2010 Dec; 36(12):838-41

Michael Carome, M.D; Dead Last: U.S. Health Care System Continues to Rank Behind Other Industrialized Countries (2014); Public Citizen < https://www.citizen.org/article/dead-last-u-s-health-care-system-continues-to-rank-behind-other-industrialized-countries/> accessed on 12th June, 2021

Federalism: Basic Structure of Government; United States Government < https://courses.lumenlearning.com/americangovernment/chapter/introduction-3/> accessed on 12th June, 2021

Hall, Mark A, and Richard Lord. “Obamacare: What the Affordable Care Act Means for Patients and Physicians.” (2014) ; BMJ: British Medical Journal, vol. 349

Fried, Susana T, et al. “Universal Health Coverage: Necessary but Not Sufficient.” (2013); Reproductive Health Matters, vol. 21, no. 42

BOOK

Seagrave, S. Adam, editor. “Liberty and Equality: The American Ideas.” Liberty and Equality: The American Conversation, University Press of Kansas, 2015

Journal

Garber, Alan M., and Jonathan Skinner. “Is American Health Care Uniquely Inefficient?” The Journal of Economic Perspectives, vol. 22, no. 4, 2008, pp. 27–50

GROTT, CATHERINE J. “THE DEVELOPMENT OF THE U.S. HEALTH CARE SYSTEM AND THE CONTEMPORARY ROLE OF THE PUBLIC HEALTH DEPARTMENT.” Journal of Health and Human Services Administration, vol. 29, no. 3, 2006, pp. 336–359

Campbell, Andrea Louise, and Lara Shore-Sheppard. “The Social, Political, and Economic Effects of the Affordable Care Act: Introduction to the Issue.” RSF: The Russell Sage Foundation Journal of the Social Sciences, vol. 6, no. 2, 2020, pp. 1–40

MacKay, Douglas, and Marion Danis. “FEDERALISM AND RESPONSIBILITY FOR HEALTH CARE.” Public Affairs Quarterly, vol. 30, no. 1, 2016, pp. 1–29.

Legislations

Tax Cuts and Jobs Act, 2017

Affordable Care Act, 2010

Constitution of United States of America, 1789

Case Laws

Katzenbach v. Morgan, 384 U.S. 641 (1966)

Shelby County v. Holder, 570 U.S. 529 (2013)

City of Boerne v. Flores, 521 U.S. 507 (1997)

Brown v. Board of Education of Topeka, 347 U.S. 483 (1954)

National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012)

California et. al v. Texas et. al (Docket 19-840)

Report/others

Achenbaum, W. Andrew. “Why U.S. Health Care Reform Is So Difficult.” The Hastings Center Report, vol. 24, no. 5, 1994, pp. 23–25