Read the first part of this series, which lays out the reasons why the constitutionality of President Barack Obama's Affordable Care Act is being challenged in the Supreme Court.
The Supreme Court began hearing arguments on the constitutionality of health care reform legislation on Monday.
Brietta Clark, a professor of law at Loyola Law School in downtown Los Angeles who specializes in health care law and access issues, explained to OnCentral that the constitutionality of the Affordable Care Act is being challenged on two points: the individual mandate that all American citizens (with some exceptions) buy health insurance or pay a fine, and the expansion of Medicaid.
Nina Vaccaro, the executive director of the Southside Coalition of Community Health Centers, a consortium of eight health clinics in South Los Angeles that work together to provide a unified voice for health care providers in the area, said the striking down of these two provisions would have a deep impact on South L.A..
"My concern is that if the individual mandate goes away, how incentivized are we to push forward to the exchanges?" Vaccaro said. "What options will then be left? How incentivized will the states really be to create those pools where people can buy into insurance programs that are affordable for them? People don't like to be told what to do or not to do, but when you have a health incident and don't have insurance, it's a drain on resources."
Clark echoed that, saying she believes the individual mandate is constitutional, pointing to the "indisputable link" between the failure to purchase insurance and the cost to the health care industry and interstate commerce, which ultimately takes its toll on taxpayers.
"The dispute really comes down to the fact that this is unprecedented," said Clark. "[People] are not engaging in activity yet, but you're forcing them to do something by virtue of their existence." But she said the healthcare market was unique, because people who are making a decision not to purchase insurance one way – before an accident or unexpected health problem – are choosing to purchase it another way: emergency room and medical bills, without insurance. And that method, said Clark, "isn't viable."
"Unless you are truly independently wealthy, you do not have enough money to pay for the care that you will need in an emergency setting," she explained. And because of those uncompensated costs, a lot of health care providers and hospitals are being forced to shut down and "leave communities that are already underserved."
"That's a real problem that needs to be addressed and can be only be addressed through more comprehensive health insurance," said Clark.
As far as the Medicaid expansion, Vaccaro said it would be "devastating" for folks in the southside if that were to be shot down.
"It would be devastating that folks that have been promised the hope of health insurance would no longer have that access," she said. "One of the things we've been working on is looking at health access in South L.A. as a human right, and that would be a tremendous loss."
And Clark's opinion on the constitutionality of the Medicaid expansion? "I can't even imagine why this challenge made it this far," she said. "As an academic, I try very hard to see an issue from all sides, and I can't for the life of me even understand how this got this far. I think it's hands-down constitutional. I can't see evidence of federal coercion that would justify striking down this expansion."
But if the Supreme Court does decide to strike down one or both of the provisions in question, Clark said she doesn't think the entire law would be struck down due to what she called the "presumption of severability."
"If there's a provision that's found to be unconstitutional, that provision is severed and the rest of the law stays intact," she said. "The court wants to not disrupt the lawmaking process as much as possible.
"I think based on that strong presumption and what lower-court judges have already done," she added, "that the rest of the law would stay intact."
Photo by S. Falkow via Flickr Creative Commons.