A New Year's Forecast For The Health Care Bill

One of the biggest political question marks going into 2012 is the fate of the Affordable Health Care for America Act. Audie Cornish speaks with Noam Levey of the Los Angeles Times about what's ahead for Americans in terms of health care in the new year, including a constitutional challenge to the law's mandatory health care provision.

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AUDIE CORNISH, HOST:

This is WEEKEND EDITION from NPR News. I'm Audie Cornish. One of the biggest political question marks going into 2012 is the fate of the Affordable Health Care for America Act. This upcoming spring, in the midst of the campaign season, the Supreme Court is set to hear arguments about whether or not the heart of the new law, the regulation mandating that all citizens have health insurance, is constitutional. In the meantime, some states are working on implementing some of the law's other provisions while other states who oppose it are adopting a wait-and-see attitude. Plus, there are some new laws that people are already getting used to. Here to help us sort out what 2012 has in store for the health laws is Noam Levey. He's a health reporter for the L.A. Times and he joins us in our studios here in Washington. Welcome.

NOAM LEVEY: Thank you.

CORNISH: So, this was supposed to be the year that Republicans were going to repeal health care or delay the health care. What ended up happening with the health care regulations in 2011?

LEVEY: Well, there was a lot of sound of fury at the beginning of the year. When the Republican Congress came in, there were votes actually to repeal the whole thing, throw it out and then a promise to develop a replacement. None of that really happened. There was a vote - and it passed the House; it didn't pass the Senate; never got to the president's desk. And there's been a real slowdown actually on the Hill in coming up with potential replacements. So, we're sort of kind of in a wait-and-see mode, I think, right now on that. And a lot's going to depend in that case on the 2012 presidential election. I think a lot of people believe if there's a Republican president and Republicans control both the House and Senate, that the guts of the law will be thrown to the curb.

CORNISH: And in the meantime, some of the provisions of the law did start to take effect in 2011, correct?

LEVEY: There are two big ones so far, I think, that probably have had the most impact, one of which is quite surprising. When the law was signed, one of the early benefits that President Obama and Democrats were looking forward to offering Americans was the ability for adult dependent children, up to age 26, to stay on their parent's health plans - the so-called slacker benefit. And it turns out that more than two and a half million young people have remained on their parent's health plan, surprising a lot of people that it would be that big. The other benefit which has come in early is some additional help for senior citizens on Medicare to help them buy their prescription drugs by closing the so-called doughnut hole. About two and a half, three million people a year are benefiting from that as well. The really big benefits, though, are still a couple of years away.

CORNISH: For 2012, it seems like the biggest to-do for health care is the Supreme Court, right? What's going on there?

LEVEY: That's right. The Supreme Court in November decided that they would consider this law. They're going to hear arguments in March over the course of several days, and we expect a decision from them some time later in the spring. The big issue before the court is the one that's been roiling courts around the country is the mandate, and whether or not Congress has the authority to require Americans to buy a product - in this case health insurance - is sort of at the top of the issues that the court will decide. And then two smaller issues which the court has taken up as well which have not gotten as much attention; one of which is a requirement in the law that states expand their Medicaid program for low-income Americans to help guarantee universal coverage in 2014. And then a potentially very consequential issue called severability. And what that is, essentially, if you throw the mandate out can the rest of the law survive?

CORNISH: If the Supreme Court were to toss out the mandate, can you give us any scenarios? What are the other aspects of the law that might kind of come apart as a result?

LEVEY: Well, you know, one of the primary promised benefits of the law was that everybody would be able to get insurance; that if you were sick, if you had cancer, if you had heart disease, you could go to an insurance company and say I want to buy a health insurance policy.

CORNISH: And they couldn't turn you down.

LEVEY: And they couldn't turn you down, nor could they cut you off if you got sick.

CORNISH: And that this would help pay for the whole thing in a way, the fact that everybody being in it would sort of help with the costs, correct?

LEVEY: Exactly. I mean, the principle of insurance is that if everybody's in the pool then it becomes more affordable because risk is spread. So, if you don't require people to get insurance, there's a concern that you have no incentive to sign up when you're healthy so only the sick people sign up. If only the sick people sign up and you can sign up basically on the way to the hospital, you're not going to buy insurance. That's going to make insurance a lot more expensive for everybody.

CORNISH: Given the health care changes that did kind of come online in 2011, did any of them save taxpayers money and is there any indication or signs that any of this legislation or any of these regulations will do so in 2012?

LEVEY: Well, that's the $64,000 question, or maybe it's the two and a half trillion dollar question for...

CORNISH: Right. Hopefully, a little bit more than that.

LEVEY: ...for our health care system. I think it's possibly too early to tell. There's some indication that some of the benefits that are promised by the law are having the opposite effect of in fact pushing up costs. But I think there's also some indications that some of the more underlying reforms in the way that health care's delivered by getting doctors and hospitals to work together more closely, to use information technology more efficiently, that some of those may, may have the seeds of cost saving in the future. But I think everybody realizes that no matter what the Supreme Court does next year that's a long-term project in order to make sure that costs don't continue to spiral up and out of control.

CORNISH: Noam Levey. He's a health reporter for the L.A. Times and he spoke to us in our studios here in Washington. Thank you so much.

LEVEY: Thank you.

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