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Q: What type of health care do the justices get, and will they be affected by their ruling?
A: The justices participate in the same health care plan as members of Congress and other federal workers. As participants in an employee-sponsored health care plan, it is unlikely that whatever decision the Supreme Court makes will substantially affect their personal health care insurance.
What Obama’s health care law does
A brief summary of the 900-page plus Affordable Care Act, unless noted provisions take effect in 2014:
—Provides coverage to more than 30 million uninsured.
—Expands Medicaid to cover more uninsured low-income people.
—Creates exchanges, state-based health insurance markets, for small businesses and people buying private coverage individually.
—Provides government subsidies for many middle-class people buying private health insurance through an exchange.
—Allows young adults to stay on parents’ coverage until age 26. Already in effect.
—Requires health plans to cover preventive care without charging co-pays. Already in effect.
—Requires most citizens and legal residents to carry health insurance, either through an employer, a government program or by buying a policy directly. IRS will assess fines for noncompliance.
—Requires companies with 50 or more workers to provide coverage, or pay fines if any of their employees ends up getting a health insurance subsidy.
—Raises taxes on upper-income households; imposes a variety of taxes and fees on the health care industry. Places a 10 percent sales tax on indoor tanning. Some taxes already in effect.
—Cuts Medicare payments to hospitals, insurers and other service providers; improves preventive benefits for Medicare recipients and gradually closes prescription drug coverage gap. Limits future increases in Medicare spending. Some Medicare provisions already in effect.
—Significantly increases federal regulation of the health insurance industry. Already in effect.
—Congressional Budget Office estimates coverage expansion will have a net cost of $1.1 trillion from 2012-2021. Spending cuts and tax increases are currently projected to offset the cost, for a modest reduction in federal budget deficits.
Source: Associated Press research.
Q: I’ve heard people say that Justices Elena Kagan and Clarence Thomas should take no part in this case? What’s that about?
A: Opponents of the law wanted Kagan to disqualify herself because she served as solicitor general under Obama when the health care overhaul law was conceived and passed. She has said she did not participate in crafting a legal defense for the law, but her detractors doubt her statement. Thomas’ detractors insist that he should have disqualified himself because his wife, Ginni, worked with groups that opposed the new law.
Decisions to stay out of a case are the responsibility of each individual justice, and neither Kagan nor Thomas justice stepped aside.
Roberts said in his 2011 year-end report that he has "complete confidence in the capability of my colleagues to determine when recusal is warranted. They are jurists of exceptional integrity and experience whose character and fitness have been examined through a rigorous appointment and confirmation process. I know that they each give careful consideration to any recusal questions that arise in the course of their judicial duties."
America’s health care reform through history
The three days of arguments beginning before the Supreme Court on Monday may mark a turning point in a century of debate over what role the government should play in helping all Americans afford medical care. A look at the issue through the years:
Former President Theodore Roosevelt champions national health insurance as he tries to ride his progressive Bull Moose Party back to the White House. It’s an idea ahead of its time; health insurance is a rarity and medical fees are relatively low because doctors cannot do much for most patients. But medical breakthroughs are beginning to revolutionize hospitals and drive up costs. Roosevelt loses the race.
Baylor Hospital in Texas originates group health insurance. Dallas teachers pay 50 cents a month to cover up to 21 days of hospital care per year. The plan grows into Blue Cross.
After five years of work, doctors, economists and hospital administrators on the independent Committee on the Costs of Medical Care publish their report about the increasing costs of health care and the number of people going untreated. They say health care should be available to all.
Americans struggle to pay for medical care amid the Great Depression. President Franklin D. Roosevelt favors creating national health insurance, but decides to push for Social Security first. He never gets the health program passed.
Roosevelt establishes wage and price controls as part of the nation’s emergency response to World War II. Businesses can’t attract workers with higher pay so instead they compete through added benefits, including health insurance, which unexpectedly grows into a workplace perk. Workplace plans get a boost the following year when the government says it won’t tax employers’ contributions to employee health insurance.
Saying medical care is a right of all Americans, President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as “socialized medicine.” Truman tries for years but can’t get it passed.
John F. Kennedy makes health care a major campaign issue but as president can’t get a plan for the elderly through Congress.
Medicare for people age 65 and older and Medicaid for the poor signed into law. President Lyndon B. Johnson’s legendary arm-twisting and a Congress dominated by his fellow Democrats succeeded in creating the kind of landmark health care programs that eluded his predecessors.
Sen. Edward M. Kennedy, D-Mass., offers his proposal for a government-run plan to be financed through payroll taxes.
President Richard Nixon puts forth a plan to cover all Americans through private insurers. Employers would be required to cover their workers and federal subsidies would help others buy insurance. The Watergate scandal intervenes.
Jimmy Carter pushes a mandatory national health plan, but a deep economic recession helps push it aside.
Congress passes and President Ronald Reagan signs into law COBRA, a requirement that employers let former workers stay on the company health care plan for 18 months after leaving a job, with the worker bearing the cost.
Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn’t last long. Barraged by protests from older people upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.
Helping the uninsured becomes a big issue of the Democratic primaries and spills over into the general election. Democrat Bill Clinton wants to require businesses to provide insurance to their employees, with the government helping everyone else; Republican President George H.W. Bush proposes tax breaks to make it easier to afford insurance.
Newly elected, Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have insurance. The plan meets strong Republican opposition, divides congressional Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It never gets to a vote in the Democrat-led Senate.
President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of Johnson’s “Great Society” program for seniors.
Hillary Rodham Clinton makes a sweeping health care plan, including a requirement that everyone have coverage, central to her bid for the Democratic presidential nomination. She loses to Barack Obama, who promotes his own less comprehensive plan.
Obama and the Democratic-controlled Congress spend an intense year ironing out a compromise that requires companies other than very small businesses to cover their workers, mandates that everyone have insurance or pay a fine, requires insurance companies to accept all comers, regardless of any pre-existing conditions, and assists people who can’t afford insurance.
Congress passes the Patient Protection and Affordable Care Act, designed to extend health care coverage to more than 30 million uninsured people. Obama signs it into law March 23.
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