By Talib I. Karim, Health & Technology Writer
Astute students of history recall the exact date when Brown v. Board of Education was decided. Thursday, June 28, 2012 may also be etched into history as the day the U.S. Supreme Court issued its ruling in what some consider the Brown case of this era, National Federation of Independent Business v. Sebelius.
In the Sebelius case, the nation’s high court preserved, almost completely, President Obama’s signature legislative achievement, the Patient Protection and Affordable Care Act.
The Affordable Care Act, or “Obamacare” (as described by critics) was designed by Congress to expand health insurance coverage to over 30 million in the US and decrease health care costs. To achieve these goals, Congress included a provision in the law requiring taxpayers to obtain a “minimum” level of health insurance coverage. Those who failed to secure health coverage and were not exempt were mandated, by 2014, to begin paying a penalty to the IRS, similar to tax penalties.
In 2010, right after the President signed the reforms into law, the Affordable Care Act was challenged in court by groups, including the National Federation of Independent Businesses. Earlier this year, the challenges made their way to Supreme Court, which set aside an unprecedented three days of oral arguments to review the health law.
By a 5-4 decision, the Court made several findings in the case. First, the Court upheld its prerogative to review the individual mandate, bypassing a reconstruction-era requirement, the Anti-Injunction Act, which prevents a tax-related issue from being reviewed by the Court until the tax is accessed. Next, Chief Justice John Roberts, joined by the Court’s four traditionally conservative members (Justices Kennedy, Scalia, Thomas, and Alito), ruled that the individual mandate could not be sustained under the Constitution’s Commerce Clause. Initially, this ruling caused some media outlets to incorrectly report that the entire law was struck down.
However, the Chief Justice and the liberal wing of the Court (Justices Ginsburg, Breyer, Sotomayor, and Kagan) sided together in ruling that the individual mandate could be upheld, nonetheless under the long established Constitutional power of Congress to “lay and collect Taxes.”
Finally, the Court ruled that the Affordable Care Act could not penalize states who refused to expand Medicaid by cutting off all federal Medicaid funding. This, the Court’s majority held, was an impermissible “threat” against the rights of states.
Brown vs Sebelius
In comparing the Brown and Sebelius cases, the NAACP’s Hillary Shelton sees distinctions and similarities. Shelton notes that “Brown concerned a fight over equal education, and whether segregated schools were legal so long as they were equal.” Brown was argued by Thurgood Marshall, then the NAACP Legal Defense and Education President, who would go on to become the first African American US Solicitor General and Supreme Court Justice.
Shelton observed that “The thing Americans needed to be successful in the 1950s was good education…today…its good health care. Further, Shelton pointed out that while Brown sought to protect mostly African Americans, the current ruling seeks to ensure working class and poor people of all races have the right to equal health care.
Impact on Doctors and Patients of Color
Congresswoman Donna Christian-Christensen of the U.S. Virgin Islands, a physician, and chair of the Congressional Black Caucus’s health reform task force, said the ruling “means a lot for people of color.” Specifically, the Court’s decision protects numerous programs and initiatives such as placing minority health officers in each major health agency to ensure that people of color’s needs are being met, noted Christensen.
Dr. Cedric Bright, National Medical Association President, called the health reform ruling “a great victory,” yet observed that many health providers still don’t understand how the law impacts them and their patients. “Health providers need to know how to participate in an Affordable Care Organization (ACO); how they can get funds for electronic medical records; and the benefits of using preventative health care.” Dr. Bright recommends that as a next step, the Obama administration should sponsor seminars to educate health providers on implementing the Affordable Care Act.
The director of the DC Department of Health, Dr. Mohammad Akhter, views the case as a win for District’s residents and its budget. “[The ruling] means that the 30,000 DC residents moved on to Medicaid can stay. It would have a huge budget impact had [the law] not been upheld.” Dr. Akhter points to several new community health centers in the District built using tobacco settlement money, but which depend upon the Affordable Care Act funding to remain operational and thriving.
However, Drs. Christensen, Bright, and Akter, all view the Affordable Care Act as just one step in a long march towards the end goal…quality, affordable health care for all.
The writer can be reached at firstname.lastname@example.org.