Question

1 Discuss the Presidential role in health policy.

2 Discuss the belief if the President has overstepped his Executive Power boundaries in reference to PPACA.

Answer 1

1.

The role of government in health care has expanded and has been crucial over the years and influenced political discourse and policy. The government, with extensive programs and market influence, is likely to play a major role in achieving better quality and value in health care and in the success or failure of lasting and efficient healthcare reform.

The U.S. spends more per capita on health care than any other nation in the world. Yet the measured outcomes of the care provided are no better than and are often inferior to, outcomes achieved by other developed nations that spend substantially less (Organization for Economic Co-operation and Development). Moreover, best-practices guidelines for healthcare delivery are not followed routinely, and wide geographic variations exist in healthcare costs and quality.

Healthcare costs have increased drastically over the past 3 decades and consume an increasing share of the U.S. Gross Domestic Product (GDP), now accounting for a greater percentage of GDP than any other sector of the U.S. economy.

Federal leadership has been stimulated anew under the ACA and numerous other pieces of recent healthcare legislation. As a result, the role of government in the U.S. healthcare system is being contested more than ever. Several studies have researched the role government can play in the management of healthcare costs and have presented several arguments. Although views on the value and appropriateness of government involvement may differ, there is consensus that government is a major stakeholder in combating rising healthcare costs.

2.

The most legally and politically controversial aspect of the PPACA, the individual mandate requires Americans to purchase health insurance or face a government penalty, with some exceptions—particularly for low-income individuals who cannot afford to buy insurance. The individual mandate has been considered necessary to cover the cost of U.S. health care especially for the ones who cannot afford it. Without a mandate, fewer healthy people would pay into the system to counterbalance the cost associated with care for the sick. The healthy, mostly younger people would be able to “free ride,“ purchasing health insurance only when they got sick, after paying little or nothing up front when their use of services was lower.

States that challenged the PPACA argued that the individual mandate was an overstepping of Congress’s commerce clause powers, the government’s well-recognized power to regulate certain economic activity that either occurs between states or substantially affects the states in the aggregate. The court reasoned that the commerce clause allows the government to regulate the actions of those who participate in a market but not the inactions of those who choose not to participate in that market. Without this distinction, the government could regulate practically anything. Justices analogized that, for example, persons with poor diets are pervasive and more costly to the health care system than the uninsured, yet it would be seen as a strong liberty breach for the government to mandate that citizens purchase only healthy food.

While the court rejected the claim that the individual mandate was within Congress’s commerce power, the mandate was found to be constitutional as a tax. The penalty, though not labeled a tax in the PPACA, is similar in several ways to other taxes. Its amount is determined by income, number of dependents, and filing status, and it is paid into the treasury when filing income tax. It is not a punishment for an illegal action: failure to purchase health insurance is not illegal, the penalty for refusing to purchase health insurance is less than the cost of paying for actual insurance, and there are no criminal sanctions attached. Moreover, while the individual mandate is clearly intended as an incentive to purchase health insurance, many other taxes are also in place to promote certain behaviors—for example, the government taxes cigarettes to reduce nicotine consumption. Thus the Court found the mandate well within Congress’s power to tax. While Congress doesn’t have the power to require individuals to purchase health insurance, it does have the power to tax those individuals who do not.