Daily Editors' Notes

Why the Supreme Court will vote in favor of the Affordable Care Act

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
You may not like — nay, hate — the Affordable Care Act. The U.S. Supreme Court may agree with you.

That doesn't mean the justices will strike it down.

In the arguments last week, a lot of the conservative protesting was centered on the individual mandate. It's unconstitutional, they argued, to make someone buy a product, because it violates the commerce clause.

Here's why it doesn't: You, your residents and every other American will need healthcare at some point. It is a product that's unique, in the truest sense of the word. To compare it to having to eat broccoli, in the words of Justice Elena Kagan and others, is dumb. Not only is no one going to pass a law to make you eat broccoli, there are no emergency rooms for non-broccoli eaters.

Nor are nursing homes faced with residents who spent a lifetime being unable to afford broccoli or have expensive broccoli-related complications that the government pays for.

Apart from the commerce clause, many of you just don't think it's fair to make people have health insurance. Well, I don't think it's fair that I'm paying $1,000 a year for uninsured people who wind up in the ER.  I'm also not so crazy about my taxpayer dollars going to large corporations, oil subsidies or even the expansion of highways. But those are all constitutional. Just because you don't like something does not make it against the law.

You know what else is constitutional? Disagreeing with one's boss. I believe, based on the transcripts and eyewitness accounts from the Supreme Court, that my boss has it wrong and the ACA will be upheld, 5-4.

It's not that I think that the conservative justices like the law; it's that I think they actually care more about the legal intricacies of the act than they care about being liked. Of course, no one will really know until late June when the court announces its decision.

The Obama administration has repeatedly refused to dabble in hypotheticals. Luckily, I don't have those qualms.

Apart from the individual mandate and Medicaid expansion, what does upholding the ACA mean for long-term care? For one, there's a lot of ACA initiatives, such as accountable care organizations, quality measurement guidelines and the creation of the Center for Medicare and Medicaid Innovation, that are geared toward making your residents' lives better and to make federal reimbursement make sense.

If you follow just mainstream media reports, it's easy to forget, for better or worse, all the minutiae in the ACA and that healthcare professionals have already spent two years evaluating and implementing portions of it.

The law, of course, is not perfect. It could be better. But if the ACA is struck down, we haven't heard much from the GOP presidential candidates as to what they'd do to implement healthcare reform. Like it or not, this is where we are, this is what we have, and the best use of mental energy is to try to find a way to make it work.

Or to quote the late, great, Molly Ivins: You got to dance with them what brung you.

EDITOR'S NOTE: Feel free to leave comments below, but realize this is a place for civil discourse. Agree, disagree, bring up a new point, etc.... BUT keep it clean and no name calling! This is a moderated site and you don't get to spout off without abiding by certain common standards. Especially when you post anonymously (but even if you don't). Many good examples of people who have figured out how to make excellent, civil arguments  — on both sides of the issue — can be seen below. 

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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