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University of Michigan experts respond to U.S. Supreme Court health care reform decision

HEALTH POLICY

"The decision was good news for consumers and the health care system. The affordable Care Act establishes comprehensive insurance market reforms that will guarantee access to health care and protect Americans from catastrophic medical costs."
— Tom Buchmueller, the Waldo O. Hildebrand Professor of Risk Management and Insurance, Ross School of Business.


"I'm extremely pleased that the Supreme Court decided that millions of Americans will now have access to health care to allow them to become healthier."
— Dr. Mark Fendrick, professor of internal medicine, Medical School, and of health management and policy, School of Public Health, and co-director of the U-M Center for Value-Based Insurance Design.


"The Supreme Court's ruling is a step forward in the effort to reform our health care financing and delivery system. We shouldn't forget that we are not on a sustainable path and the same cost, quality and access challenges exist regardless of the ACA's ultimate fate."
Richard Hirth, professor of health management and policy, School of Public Health


"In upholding the Obama administration's Affordable Care Act, the U.S. Supreme Court deferred to Congress on how to reform our nation's health care system. Contrary to most expectations, the majority opinion, written by Chief Justice John Roberts Jr., relied on Congress's taxing authority to uphold the mandate that individuals must purchase health insurance or be subject to a penalty. With this ruling, the ACA's future returns to the political process where it rightly belongs.

"Those who claim that the Affordable Care Act will be more expensive and result in lower quality of care are wrong on the merits. The ACA stimulates needed changes in the market that will reduce costs and improve the quality of care. More importantly, ask the millions without health insurance and people who have pre-existing health conditions that would otherwise disqualify them for health insurance benefits whether they are worse off because of the ACA. The answer is obvious."
Peter D. Jacobson, professor of health law and policy and director, Center for Law, Ethics, and Health, School of Public Health


"The individual mandate decision is really important. There are millions of uninsured and underinsured Americans who will gain substantial coverage due to the ACA. The Medicaid decision is a potential problem though. If the states can opt out of expanding Medicaid without penalties, and if some of them do that, many poor people may not get coverage in those states. What individual states will do, however, remains to be seen."
Richard Lichtenstein, professor of health management and policy, School of Public Health


"The Affordable Care Act is not a perfect law. But it is so much better than what we have without it. The court's decision and careful deliberation affirms that our form of government works, balancing competing views in a fair and thoughtful manner. It is, indeed, a remarkable day in health care."
Marianne Udow-Phillips, lecturer at the U-M School of Public Health and director of the Center for Healthcare Research & Transformation, a nonprofit partnership between the U-M Health System and Blue Cross Blue Shield of Michigan.


"I'm delighted and relieved by the Supreme Court decision. We shouldn't and don't let the uninsured die on street. People who can do so must contribute to the possible future expense of their care."
— Susan Dorr Goold, medical ethicist, professor of internal medicine, Medical School, and health management and policy, School of Public Health.


"I applaud the Supreme Court's decision. Now let's get on with the important work of covering the uninsured and ensuring that health spending is on a sustainable path."
— Helen Levy, research associate professor, Gerald R. Ford School of Public Policy, as well as at Institute for Social Research and the health management and policy, School of Public Health.

LAW

"I am sorry that the Court did not adopt what I would have thought to be an obvious proposition – that because it has asserted since McCulloch v. Maryland in 1819 that in regulating commerce Congress may use any means it deems appropriate and that is not otherwise unconstitutional, Congress may, if it deems it appropriate in regulating commerce, require individuals to buy a good or service (a type of mandate that states may unquestionably impose and that Congress may in other contexts).

"But what's the damage? As I understand the chief's opinion, it only limits Congress from requiring under the commerce power, that individuals purchase designated goods or services. And, as he says, Congress has never done so before. I didn't think the fact that it never did so before was a strong argument – it's never felt the need to do so, and may not again. But I suppose that if Congress does want people to buy broccoli, it can now impose a tax on those who fail to buy it."
— Richard Friedman, the Alene and Allan F. Smith Professor of Law, Law School.


"The Court's decision to uphold the individual mandate is a big win for the Affordable Care Act and the Obama Administration. But the Court's Medicaid holding threatens to undermine the part of the Act that was expected to provide coverage for more than 15 million individuals. And, by holding for the first time ever that a conditional federal spending program unconstitutionally coerces the states, the Court has created the prospect of a wave of new litigation challenging the conditions on cooperative federal-state programs in education, civil rights, and other areas."
— Samuel Bagenstos, law professor, Law School.


"What's the legal effect of the decision? Although it was the focus of all the pre-opinion debate, the Commerce Clause analysis may well be dictum. The health care effect? It remains to be seen how many states now scramble to get their exchanges up and running."
— Jill Horwitz, law professor, U-M Law School, and professor of health policy and management, School of Public Health and Gerald R. Ford School of Public Policy.

NURSING

"The ACA is a call to action for America's Nurses, and for States to elevate and encourage their full participation in health delivery. The demand for nursing will increase as more Americans will have access to care. Nurses need to 'step up' to the challenge of improving care quality and clinical outcomes as we 'bend the cost curve' in health care, and as the capacity of our national provider base swells to accommodate some 30 million more Americans. Nurses must be full partners with their physician counterparts to drive better care at lower costs. Nurses must also assume leadership in care coordination, from preventive medicine to self–care, to health promotion. In fact, the entire value proposition of the ACA depends on these aspects of health care being improved.

"As we re-imagine and recast the role of the nurse practitioner to make implementation of the ACA successful, States must assure that the nurse practitioner and other APRNs can practice to the full extent of their education and training, and be participatory in provider networks. Physician providers alone will not be able to meet the demand created when this decision was handed down, and that is where our nurses come in."
Dean Kathleen Potempa, U-M School of Nursing

POLITICS

"The Supreme Court decision today was a significant victory for the Democratic health care policy, but the Republicans and Mitt Romney will use it to energize their base in this fall's campaigns. The Court did not help the Democrats by accepting their third argument for constitutionality - that it was a permissible tax passed by the Congress."
Michael Traugott, professor of communication studies, College of Literature, Science, and the Arts, and senior research scientist at the Institute for Social Research's Center for Political Studies.


"Cutting in his favor: The ruling allows Obama to claim that the Affordable Care Act was a success and it was one of the major accomplishments of his first term in office. The Supreme Court's decision psychologically validates the law, even though, technically speaking, the ruling applies only to the law's constitutionality, not to its substantive merits. Importantly, today's ruling gives the president a renewed opportunity to explain to the public why the Act is important and how it will improve health care, since he failed to effectively project his message on these points when the Act was initially being debated in Congress.

"Cutting against him: The ruling raises the salience of what is already a highly unpopular piece of legislation that has damaged the president's public standing. It will likely galvanize the conservative grassroots to actively support Republican nominee Mitt Romney, which they have been loathe to do up to this point."
Michael Heaney, professor of organizational studies and political science, College of Literature, Science, and the Arts.

 

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