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John G. Roberts Jr.,
Chief Justice US Supreme Court |
Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."
The Chief Justice, writing for himself, stated, "Every reasonable construction must be resorted to in order to save a statute from unconstitutionality." If it is "fairly possible" to interpret the statute as merely imposing a tax on those who've failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.
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Constitution of the
United States |
The Court indicated that the assessment is not really a "penalty." "Taxes that seek to influence conduct are nothing new," the Chief Justice wrote. He reasoned for the Court that there are no negative legal consequences to not buying health insurance, because beyond requiring a payment to IRS, Congress anticipated that some 4 million people would pay the penalty, and Congress did not treat them as "outlaws."
While certain taxes are prohibited under the U.S. Constitution, the penalty under the Affordable Health Care for America Act 2009 is not barred. The Court reasoned that the Constitution states, "No Capitation, or other direct, Tax shall be laid, unless in Proportion of the Census or Enumeration herein before directed to be taken." The majority of the Court held that a tax on "going without health insurance" does not fall within any recognized category of direct tax since it is triggered by certain specific circumstances.
The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment. The state-enacted systems were created for the protection of the lives, health and safety of the employees. The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault. The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment. New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).
Medical Delivery & Fees
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and
expands the scope of Medicaid and CHIP payments.
Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust." They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality," and they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format.
Non-Traditional Revenue Stream
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."
"Libby Care"--Universal Care
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Center for Asbestos Related Disease
Libby, MT. |
A provision of the Act, that has already been implemented, provides for the treatment of medical conditions, including asbestosis & mesothelioma, arising out the Libby, Montana asbestos contamination. The industrially caused catastrophe in Libby has resulted in widespread illness and death. The ACA provides medical attention to those exposed to occupational toxins. The Center for Asbestos Related Disease is now operating in Libby, MT. The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. This type of program, minimally, needs to be expanded to include all occupational illness nationally.
The Future: Universal Health Care
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| Landmarks on the Path to Federalization |
It is very doubtful that ACA repeal legislation, to be offered by the Republicans in the House will pass Congress, nor will the President sign it.. There may be some technical and substantive revisions to the ACA in the next Congress. If there is a mixed political government after the next election, the ACA will be implemented and go forward as the law of the land.
History reveals that a series of efforts have been made by the Federal government to federalize medical care for industrial accidents and illnesses. Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has accelerated the nation down that promising path.
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Jon L.Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).
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