The Supreme Court upheld most of Obama’s Affordable Care Act yesterday. So how does that decision shape the health care market going forward? Grace-Marie Turner has some ideas. She's a co-author of "Why ObamaCare is Wrong for America." Turner is also president and founder of the Galen Institute, a public policy research group that aims to promote free-market solutions for health reform.
"It's going to increase taxes, it's going to increase the deficit, [and] it's massively unpopular," Turner says of the Act. The author also points out that the Supreme Court's ruling does not render the entire law constitutional.
"There were only two provisions of this 2700-page piece of legislation that were before the court: the individual mandate and the mandate on the states to dramatically expand their Medicaid budget. It didn't uphold the whole law," Turner says. "There are still a lot of other provisions in this law that are not settled and are very likely to continue to make their way through the courts." One example Turner mentions is the HHS mandate, which requires religious institutions to provide no-cost contraceptives to employees.
Turner points out another possible stumbling block for the Act's policies: the states themselves, who now face a deadline to set up the prescribed healthcare exchanges. “Wisconsin will not take any action to implement Obamacare,” Republican Governor Scott Walker said in a statement. “I am hopeful that political changes in Washington, D.C., later this year ultimately end the implementation of this law at the federal level.”
Mark Pauly is a conservative economist and is considered the father of the individual mandate idea. For Pauly, one of the major concerns is the exclusive nature of the exchange markets.
"I personally think it's appropriate to offer fairly generous subsidies to lower or middle-income people to help them afford health insurance," the economist says. "But the way the law works, you only get that subsidy if you get your insurance through the exchange, whereas [if] you take a lousy job at a good company to get health insurance, you don't get any help at all. You're on your own."
Turner believes that the Act relies too much on mandates, and favors a more incentive-based program. "Given the proper incentives and the proper health plan, people will voluntarily get the preventive care they need," the public policy researcher says. "They're healthier, and they actually wind up spending less on health care because they actually have more control over their personal resources and the policy they have."