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Will the Supreme Court back the U.S. into a one-payer system?


Nine justices are expected to determine the fate of the Affordable Care Act (ACA) in June, but their decision may well push the U.S. whither many conservatives would not go. This is why: The course toward insurance reform already is in process. Nurses, doctors, hospitals, and patients know what politicians and pundits haven’t yet realized: The transformation will continue to move forward irrespective of what the Supreme Court decides. If the individual mandate is found to be unconstitutional, this may well accelerate the movement toward government-sponsored health care.  It might reverse Washington’s relentless push to regulate individual and business behavior, but could ultimately push the United States into  a single-payer system like Medicare. ACA prohibits insurance companies from denying anyone coverage or charging people with preexisting conditions higher premiums. To appease private insurance companies, the act also requires all citizens to obtain healthcare coverage or pay a financial penalty (the mandate), and thus by weight of numbers subsidize coverage for low-income individuals–which, according to statements made by Supreme Court justices during the April hearings, the Supreme Court is likely to find unconstitutional.

ACA could be implemented without the individual mandate, except that costs are rising rapidly (and have been for decades) and each year more Americans—now totaling 50 million—are becoming uninsured. Requiring health insurance companies to cover everyone without price discrimination—and with no mandate—would accelerate health insurance inflation and push millions more Americans out of the private health insurance system. But that won’t stop them from going to emergency departments (EDs), which by another law must treat them. When people can’t pay EDs and hospitals, uncompensated care costs will rise, and so will charges to insurance companies, causing costs to skyrocket. At that point, Americans would have a choice: Watch people without health insurance suffer and die, or finance health insurance for them by extending government-run programs, most likely Medicaid, to the entire uninsured population. No matter how poorly government programs were run, millions of Americans currently insured by their employers would find themselves without insurance as employers will opt out of private insurance due to skyrocketing costs; this would leave employees with little choice other than the public option. Thus, America would be backed into a single-payer system—perhaps ultimately one much like Medicare.

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

5 Comments. Leave new

  • One thing not considered in this blog and Q/A is the role of the states in developing programs for the uninsured, and developing options for insurance coverage. The federal government is not the only resource for health care, and states can be more innovative than the federal government, because they can address their unique populations. Don’t underestimate the American people and the states creativity.

  • I think the Supreme Court has way too much power. I don’t have any use for socialistic government or for Obamacare, but Almost anything is preferable to a dictatorship of 9 old men…whatever happened to the balance of powers?

  • Leah Curtin
    May 14, 2012 4:25 am

    In response to Bonnie: If the Supreme Court found the ACA mandate unconstitutional not severable,all aspects of the law would fall, unless Congress acted quickly(?!)…so no coverage for pre-existing conditions etc. In response to Tamara: you are entitled to your opinion, but I think nothing would return to pre-ACA days: there would be chaos as hospitals sought reimbursement for the lower rates under ACA, insurance companies wouldn’t cover kids to 25 etc., etc

  • I disagree with Dr. Curtin. I think that if the Supreme Court finds the ACA unconstitutional, all will return to pre-ACA days. I see no evidence to speak of that hospitals could not reverse course quickly if the actually have made changes based on this law. However, I think that many, if not most, have adopted a ‘wait-and-see’ attitude…Of course, we’d still have that 40or 50 million uninsured…

  • If the Supreme Court found the mandate unconstitutional, and also found that it was not severable, then all provisions of the ACA would be void. So what would happen to those provisions already in effect (coverage of kids to age 25, no exclusions for pre-existing consitions, changes in re-imbursement and so forth)?


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