President Barack Obama’s health care law has stayed controversial from its 2010 passage to the Supreme Court ruling upholding it last week, but the University of Minnesota has stayed on the same course with its enactment of it the whole time.
The individual mandate, which will require citizens to either purchase health care or face fines starting in 2014, has spurred debate both on and off the University campus. The June 28 ruling upheld most of the act, including the controversial mandate. The vote was 5-4, with Republican President George W. Bush-appointed Chief Justice John Roberts swinging left unexpectedly.
The University has required health insurance as a term of enrollment for 25 years, according to Boynton Health Service Chief Operating Officer Carl Anderson, so the federal mandate applies to coverage most students already have.
Boynton was already in the process of implementing a more comprehensive waiver this fall that will require students to submit either electronic verification or certificates of coverage as proof of insurance. It’s aimed to catch the estimated 7 to 10 percent of uninsured students at the University who slip through the cracks currently.
The majority found that the mandate passes muster because it is Congress collecting taxes, which the government has the authority to do under the Constitution.
University political science student Tom Torkelson said, while he supported the health bill overall, he disagrees with the mandate.
He said the mandate made the otherwise-good bill unnecessarily divisive, and a switch to a Canadian-style, single-payer system would reduce health care costs enough without the mandate. Under the single-payer system, the government collects and distributes health care funds, mainly through taxation.
Lynn A. Blewett, director of the State Health Access Data Assistance Center, said she was relieved the individual mandate didn’t sink Affordable Care. Her organization, housed in the University’s School of Public Health, is currently working in a partnership with 10 other states on national health reform, so returning to the incremental pre-ACA system for state funding would have been a serious setback, she said.
Lawrence Jacobs, director of the Center for the Study of Politics and Governance at the University, said the mandate was only ever going to affect a few people. He said after subtracting the 18- to 26-year-olds newly covered on their parents’ plans, those receiving health benefits through their employers and everyone on Medicaid, only about 2 in every 100 people would have to purchase insurance.
Still, the bill sets many new precedents at once, which he said “doesn’t happen more than a few times in a lifetime.”
Anderson said he thinks the ruling suggests Boynton’s commitment to the health care safety net “is being recognized on a much bigger level.”
Jacobs said he also considers the Supreme Court’s decision pivotal. But he said he believes this based on his review of ACA provisions that were overlooked before the ruling.
The bill initially allowed the federal government to pull state funding for Medicaid if states failed to comply with the law’s plan for expanded coverage. Many state leaders saw this as coercive, and the courts agreed that it constituted an excess of federal influence, Jacobs said.
As the act stands now, the federal government cannot pull existing Medicaid funds from states, but they can withhold additional money from states that don’t expand access.
Blewett said a state’s decision not to go along with the federal plan would “really just amount to a loss.”
In states like Texas — which has about 6 million uninsured people compared to Minnesota’s approximately 450,000 — this gentler version of the Medicaid provision still amounts to plenty of financial pressure.
“There are a lot of wrinkles in the ruling,” Jacobs said.
He said he hopes now that the court has officially put the constitutionality debate to bed, discussion can progress to the bill’s other strengths and weaknesses.
—The Associated Press contributed to this report.
