Supporters and opponents stake out positions on the sidewalks
Advocates on both sides of the Patient Protection and Affordable Care Act brought their messages to the Supreme Court late last month, as justices heard lawyers articulate arguments that will help the court determine the future of the two-year-old law.
The Supreme Court heard challenges to the law brought by private parties and 26 states after U.S. District Courts issued differing opinions on the constitutionality of the individual mandate, which requires almost everyone in the U.S. to carry health insurance or face a penalty.
Three other issues also were argued before the justices: whether the Affordable Care Act challenge is even ripe for review since no one has yet paid a penalty for failure to comply with the mandate; whether Congress unfairly expanded Medicaid and coerced states into funding additional
beneficiaries; and whether part or most of the law can still stand if the mandate for individual coverage is struck down.
CHA joined with other major hospital associations in entering two amicus briefs in the case — one defending the mandate and the other the Medicaid enrollment expansion.
According to the CHA-endorsed amicus brief supporting the individual mandate: "The vast cost of health care for the uninsured is borne by the rest of the nation. That cost shifting badly distorts prices in the health care sector É That is a quintessential 'substantial effect' on interstate commerce." If the court agrees with this premise, the mandate will be upheld, lawyers said.
Lisa Gilden, CHA's vice president and general counsel, was present in the courtroom on March 27 for arguments focused on the individual mandate.
"Having worked on health reform for many years with CHA and our members, I was struck by the fact that the fundamental idea of health care for everyone would now turn on a narrow constitutional question involving interstate commerce," Gilden said.
The court heard oral arguments related to challenges to the Affordable Care Act for more than six hours over three days — more time than has been allotted to any single case in several decades. As the opposing lawyers made their points and answered questions from the justices inside the courtroom, on the wide sidewalks outside demonstrators took up microphones, megaphones and poster-board signs to trumpet their opinions of the law.
On March 26, the opening day for oral arguments, physicians and nurses addressed the crowd and reporters from a sidewalk podium. One after the other defended theAffordable Care Act and explained the beneficial effects it is having and will have on patients and communities.
"All too often I have patients who present to my office who have no health care insurance and have been (injured) for months," said Dr. Marc Rankin, an orthopedic surgeon and sports medicine specialist at Providence Hospital in Washington, D.C., part of St. Louis-based Ascension Health.
The Affordable Care Act, Rankin said, will help improve outcomes by ensuring that patients with injuries that require quick treatment will not wait until their conditions have worsened or have become more complicated and expensive to treat.
"Let's remember when all the hoopla is gone, all of the politics, this is really about preserving human dignity. If you don't have your health, what else do you have?" Rankin said to the crowd that had grown to hundreds of proponents and opponents of the law.
Demonstrators chanted their "love" or "hate" for the law with catchy — and some not-so-catchy — slogans to grab the attention of TV camera crews, reporters and passersby. At various points the cacophony created by the simultaneous and opposing chants in a crowded space at the foot of the 77-year-old courthouse made it impossible to hear any message at all.
KnowYourCare, a coalition comprised of dozens of pro-reform groups, organized the pro-Affordable Care Act demonstrations. The group also convened daily news conferences during the oral arguments, including one that featured several people who have been helped by the law.
Helen Dally, a 23-year-old woman working in Brooklyn, N.Y., said she has health insurance as a result of the Affordable Care Act provision that allows young adults up to age 26 to stay on their parents' family health insurance plan. Dally also talked about her parents' auto repair store in Portland, Ore., which she said receives an Affordable Care Act tax credit for providing health insurance to its employees.
Jeff Tieman, CHA's senior director of health reform initiatives, found it "reassuring and heartening to see so many people passionately marching and singing in favor of the health care law." Tieman, who returned to the demonstration areas daily duringthe three days of oral arguments, said, "The enthusiasm around keeping this law in place was evident, even in the early morning hours."
In the lead up to the historic Supreme Court proceedings, pro-health reform lawmakers and other Affordable Care Act proponents trumpeted many other stories of individuals and families who have obtained needed care or coverage as a result of the law. Among those benefiting from the law is Bob Meeks.
"Before the Affordable Care Act, I would fall into the 'donut hole' every year around May," said Meeks, a 75-year-old Medicare beneficiary who spoke at a press conference on Capitol Hill celebrating the two-year anniversary of the Affordable Care Act's passage.
The donut hole refers to a gap in coverage of Medicare prescription drugs that the Affordable Care Act incrementally closes until the gap is eliminated altogether in 2020.
"My prescriptions were costing me $1,200 a month, and I had to pay it all," Meeks said. "Thanks to the Affordable Care Act, I received a $250 check in 2010. That helped." Meeks said that in2011 his monthly drug costs when he was in the donut hole dropped to between $600 and $800, depending on his health. "This has been a huge help to me and my wife," he said.
Commentators expect the Supreme Court to issue its decision on the Affordable Care Act in late June.