Post Supreme Court: Reviewing The Health Care Law

Last week's Supreme Court decision upholding the Affordable Care Act has brought the 2010 law back into the news. If you've forgotten all the things that are in the massive measure, never fear. Morning Edition has this refresher course.

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LINDA WERTHEIMER, HOST:

Let's move to the federal health care law. Now that the Supreme Court has upheld it, we thought it would be worth a refresher course on what's in the massive law.

Here's NPR's Julie Rovner.

JULIE ROVNER, BYLINE: So rather than just rattle on about the law, let's try a little quiz. Don't worry, there won't be any grades. We'll be using comments from elected officials who appeared on the Sunday talk shows to argue about the health law.

Let's begin. Here's House Democratic leader Nancy Pelosi describing what the law provides for consumers.

(SOUNDBITE OF TV SHOW, "MEET THE PRESS")

REPRESENTATIVE NANCY PELOSI: If you're a person who has a child with diabetes, no longer will they be discriminated against because of a pre-existing condition. If you're a woman, no longer will you have to pay more; no longer will being a woman be a pre-existing medical condition. If you're a senior, you pay less for your prescription drugs, and nothing for a preventive check - wellness checkup.

ROVNER: True or false?

(SOUNDBITE OF BELL RINGING)

ROVNER: If you said true, give yourself an apple. These are mostly benefits that have already taken effect, other than not charging women more because of their gender. That one doesn't start until the year 2014. Next, here's a comment from Louisiana Republican Governor Bobby Jindal, also from "Meet the Press."

(SOUNDBITE OF TV SHOW, "MEET THE PRESS")

GOVERNOR BOBBY JINDAL: Every governor's got two critical decision to make. One is, do we set up these exchanges, and secondly, do we expand Medicaid. And no, in Louisiana we're not doing either one of those things. I don't think it makes sense to do those. I think it make more sense to do everything we can to elect Mitt Romney to repeal Obamacare.

ROVNER: Now, this one's a little bit trickier. In fact, it's also true, although it wasn't before last week's high court decision. Let's take them one at a time. Health exchanges are the online marketplaces where individuals and small businesses will go to shop for health insurance, and for many individuals get subsidies from the federal government. States can set up their own exchange, or, if they choose not to, the federal government will run one for them.

Medicaid is a little different. The law calls for a major expansion of the joint health program for people with low incomes - adding everyone with income under about 15 thousand dollars a year to the rolls. Until last week, that was in effect a requirement for states. But the court ruled it has to be optional. With the federal government picking up the vast majority of the cost, though, most states are expected to take the money. So far only about a half dozen Republican governors, including Jindal, say they won't. Moving on, here's an exchange between House Speaker John Boehner and CBS reporter Norah O'Donnell on "Face the Nation."

(SOUNDBITE OF TV SHOW, "FACE THE NATION")

REPRESENTATIVE JOHN BOEHNER: It's clear that Obamacare is increasing the cost of health insurance for all Americans and making it virtually impossible for small employers to hire new workers.

NORAH O'DONNELL: How does it make it hard for small employers to hire more workers?

BOEHNER: Because they're being required to either provide health insurance or pay a fine. Well, I'm sorry, a tax. It's now a tax, since the court said it was a tax.

(SOUNDBITE OF BUZZER)

ROVNER: Not so much. The court did say the penalty some people will pay for not having insurance starting in 2014 is a tax. That's what Chief Justice Roberts said makes it constitutionally permissible. But small employers aren't actually subject to that requirement. That's why it's called the individual mandate. Most small employers - those with fewer than 50 workers - don't have to do anything under the law, and could actually save money by being able to purchase insurance through the new health exchanges.

Really small employers, those with fewer than 25 workers, don't have to do anything, but if they do offer insurance, they're eligible for a tax credit. Finally, a little more on the tax question, again, from Louisiana Governor Bobby Jindal and "Meet the Press" host David Gregory, about what happened in Massachusetts, which imposed a similar insurance requirement in 2006.

(SOUNDBITE OF TV SHOW, "MEET THE PRESS")

JINDAL: They can...

DAVID GREGORY: In Massachusetts there were very few people who actually had to pay. Most people got health insurance. That's a fact, isn't it?

JINDAL: But now they can compel - that's the whole point. This is not about collecting revenue. It's about changing behavior. So for example, the first lady...

GREGORY: But you say it's a big new tax increase. Very few people actually had to pay a tax.

JINDAL: It's the threat of a new tax increase to change behavior.

GREGORY: Right.

JINDAL: So now...

(SOUNDBITE OF BELL RINGING)

ROVNER: A-ha. Now we're getting somewhere. For Republicans, it's not about how many people might pay the tax. It's the concept of using the tax code to force people to do things they might otherwise prefer not to. The Urban Institute estimates that only about seven million Americans will even be subject to the possibility of having to purchase insurance or pay the fine, tax, or whatever you want to call it. And you can expect to hear a lot more of this in the coming weeks and months. Julie Rovner, NPR News, Washington.

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