Members of the Johns Hopkins Berman Institute of Bioethics faculty respond to the Supreme Court’s announcement of their ruling that the federal law reforming America’s health care system is constitutional.


leslie_meltzer_henryLeslie Meltzer Henry, MSc, JD

“The magnitude of Chief Justice Roberts’ decision today cannot be underestimated. In one narrow ruling, he simultaneously rescued the Supreme Court from further criticism for judicial activism, and he secured access to health care for millions of Americans.”



oconnorDan O’Connor, PhD

“This is good news. The Supreme Court has affirmed the ability of the US government to actually govern in the best interests of the public good, even if that governance means higher taxes or some infringement on supposed personal liberties. Millions and millions of people are better off today because of this ruling. It’s a political victory for Obama, but it’s a moral victory for Americans.”



LeonardRubenstein_BWLen Rubenstein, JD, LLM

“There is a supreme (pardon the word) irony in the decision on the Affordable Care Act (ACA).   The Administration and Congressional Democrats decided not to offer the simplest route to universal or equitable health care coverage through a single payer system financed through taxes, like Medicare for all.  They opted instead of a complex system that reinforced inequities in coverage depending on whether and how much health insurance employers provide and also relegated the poorest Americans to the second-class benefits of Medicaid.   And yet the Supreme Court upheld the individual mandate provisions of the ACA on the grounds that it constituted a tax, which is the vehicle anticipated by the Constitution to provide to meet the needs of the nation as a whole.  At the same time, the Supreme Court made it clear that the route Congress took leaves states free to refrain from expanding Medicaid after the initial period of 100% federal funding, thus potentially excluding a large group of low-income Americans from coverage.   Thus, while a victory for expanded coverage and the individual mandate, the Supreme Court’s decision reveals how far we are from a just health care system.”


Michelle Huckaby Lewis, MD, JD

“This is a great day for America, and an even greater day for Americans with serious health conditions.

The Supreme Court decision will impact:


People with serious health conditions:

The Supreme Court’s decision to uphold the individual mandate to purchase health insurance or pay a penalty lets stand other provisions of the Affordable Care Act (ACA) that make affordable health insurance accessible to patients with serious health conditions.  Insurers will not be able to limit or deny benefits to children because of pre-existing medial conditions, and beginning in 2014, insurers will not be able to deny or limit coverage of adults with pre-existing conditions.  Lifetime and annual limits will be eliminated over time.



Insurers will not be able to limit or deny benefits to children because of pre-existing health conditions. Also, parents can extend their policies to cover their children until age 26.  This access to health insurance is particularly important when so many young people are finding it difficult to find jobs and therefore do not have access to employer-sponsored health insurance.


The poor:

Prior to today’s decision, the ACA would have required that states expand state Medicaid programs by 2014 to cover all individuals under 65 years of age with incomes below 133% of the federal poverty level.  Under the ACA, the federal government will pay 100% of the costs of covering these individuals through 2016.  After that, states will assume a portion of the financial responsibility of this expanded coverage, but the federal government will still pay a minimum of 90% of the costs of coverage.  This expansion of Medicaid coverage would have eliminated much of the state by state variation and the resulting disparities currently seen in health care coverage of the poor by state Medicaid programs.


As a result of today’s ruling, states may decline to participate in the Medicaid expansion and therefore decline the accompanying federal funding without any fears of repercussions for their existing state Medicaid programs.


According to today’s decision, “States may decline to participate, either because they are unsure they will be able to afford their share of the new funding obligations, or because they are unwilling to commit the administrative resources necessary to support the expansion.  Other states, however, may voluntarily sign up, finding the idea of expanding Medicaid coverage attractive.  We have no way of knowing how many States will accept the terms of the expansion…”


Expanding Medicaid will involve significant administrative costs, and after 2016, states that accept federal funding for expanded Medicaid coverage will be expected to assume part of the financial responsibility of the expanded coverage.  Although the federal government will still pay for 90% of the costs, the remaining 10% must be covered by the states.  In terms of total dollars, the administrative costs combined with the additional costs of coverage may be a significant amount of the state budgets, and some states may decline to participate in the expansion of coverage in order not to incur additional financial obligations, particularly in this era of fiscal distress.  The result is that the Affordable Care Act will no longer eliminate the disparities in health care coverage of the very poor  from state to state.  For the poor, their access to health insurance will depend upon the state in which they live and whether that state has chosen to participate in the Medicaid expansion.”

3 people like this post.


Daniel O'Connor
Leonard Rubenstein
Leslie Meltzer Henry
Michelle Lewis

Tags: , , , ,

Leave a Reply