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The Supreme Court Rules on the Patient Protection and Affordable Care Act

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The Patient Protection and Affordable Care Act establishes a series of reforms
which were upheld substantially today by Chief Justice John Roberts in his deciding opinion.

The reforms include preventing insurance companies from denying coverage to people with pre-existing conditions, denying insurers the discretion to set dollar limits on health coverage payouts, and requiring them to cover things like immunizations and preventative care at no additional cost. Individuals must have health insurance, either through employers or an exchange starting in 2014.

The act requires the payment of a penalty or tax for opting out of the arrangement. Chief Justice John Roberts wrote the majority opinion which upheld the mandate as a tax under the theory that the Congress has the power to “lay and collect taxes“.

Arguments in favor cite that the individual mandate is critical to the ultimate success of the legislation. The mandate expands the pool of people paying for insurance and ensures that healthy people do not opt out by delaying the purchase of insurance until a crisis.

The original Constitution refers to the promotion of the general welfare. Section 8 specifies the power of the Congress which includes providing for the general welfare of the United States. The Constitutional question involves whether or not The Patient Protection and Affordable Care Act is indeed an extension of the Constitutional provision regarding the promotion of the general welfare by the Congress. The  act was passed in March 2010 along partisan lines rather than by a bipartisan majority. Ultimately, the Supreme Court affirmed the power of the Congress to tax individuals who opt out of the health insurance requirement set forth in The Patient Protection and Affordable Care Act.

Arguments against the act emphasize that the government will have too much power over what is believed to be a personal economic choice. More recently, leading health insurers like Humana , Aetna and United Healthcare have agreed to keep offering member services that were part of Obamacare. Examples of these services are free immunizations/screenings, a more streamlined appeals process for coverage denials and allowing young adults to remain on their parents’ health insurance policies until age 26.

The existing Hill-Burton legislation enacted in 1946 provides free or reduced costs health care for persons unable to pay. There are currently 172 Hill-Burton obligated facilities in the United States. The medical facility providers
receive forgiveness of mortgage costs in exchange for delivering the free or reduced cost health care to the poor or patients satisfying the income qualification levels. With the Supreme Court affirming The Patient Protection and Affordable Care Act, the open question is whether or not membership in a Hill-Burton Obligated Facility will suffice for purposes of complying with The
Patient Protection and Affordable Care Act.

Congress has yet to consider expanding the Hill-Burton legislation to build more medical facilities under the Hill-Burton program, which has worked for 66 years. In addition, the Medicaid program provides free or significantly reduced cost health care services to the poor.

The Supreme Court struck down the portion of The Patient Protection and Affordable Care Act which expands the existing Medicaid Program. Currently, 50 million Americans or more are without health insurance and there are estimates that 25 million Americans would be without coverage under The Patient Protection and Affordable Care Act.

Over half the states, led by Florida, believe that individuals cannot be forced to buy insurance. The essence of the argument would leave the purchasing choice to individuals, not the states or federal government. Opponents hold that if the purchase requirement provision is unconstitutional, then the law must be repealed.

Opponents point to otherwise healthy individuals who can live long lives on a simple diet like the Mediterranean Diet combined with exercise. Some patientshave reported living lives upwards of ages 80 to beyond 100 sometimes with very little medical intervention.

Elimination of junk food is another important part of the health and maintenance discussion. In essence, junk food precipitates the need for more disease intervention strategies and management while producers of junk food benefit at the public expense.

At the other end of the spectrum are people who need the health care and cannot afford to pay. The need in many cases is chronic and immediate for undiagnosed HIV aids, mononucleosis, hepatitis and tuberculosis. These diseases can remain undiagnosed for months while the patient remains in continuing discomfort.

So, the lack of available qualitytreatment is a public exigency in some cases. Pregnant mothers who are poor need quality healthcare to forestall the classic problems in pregnancy. Elderly people are susceptible to MRSA and pneumonia. Each of these conditions may be difficult to diagnose early and treat successfully. Sometimes, visitors from overseas import exotic diseases which are difficult and costly to diagnose and treat.

Molds in apartments can result in chronic conditions of the lung which are difficult to diagnose and treat. Food poisons are another medical emergency as are the inhalation/absorption of dangerous chemicals. Burns from fires are conditions which cause huge problems for municipal hospital emergency rooms. In other cases, animals, such as snakes or carriers of rabies, cause the need for immediate medical intervention.

The sum total of all of the above situations will pose unique problems for municipal, state, federal and private health care delivery systems. Herein is the crux of the problem which has precipitated a continuing discussion on standardized health care exchanges and delivery systems over the last several decades or more. The Patient Protection and Affordable Care Act will
reduce the amount of uninsured patients; however, a significant number of
uninsured Americans will remain despite the passing of the legislation and today’s affirmation by the Supreme Court.  Some opponents of the
act believe that a single payer system will expand health care services more
optimally to the uninsured.

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About Dr Joseph S Maresca

I've taught approx. 34 sections of collegiate courses including computer applications, college algebra, collegiate statistics, law, accounting, finance and economics. The experience includes service as a Board Director on the CPA Journal and Editor of the CPA Candidates Inc. Newsletter. In college, I worked as a statistics lab assistant. Manhattan College awarded a BS in an allied area of operations research. The program included courses in calculus, ordinary differential equations, probability, statistical inference, linear algebra , the more advanced operations research, price analysis and econometrics. Membership in the Delta Mu Delta National Honor Society was granted together with the degree. My experience includes both private account and industry. In addition, I've worked extensively in the Examinations Division of the AICPA from time to time. Recently, I passed the Engineering in Training Exam which consisted of 9 hours of examination in chemistry, physics, calculus, differential equations, linear algebra, probability/ statistics, fluids, electronics, materials science/structure of matter, mechanics, statics, thermodynamics, computer science, dynamics and a host of minor subject areas like engineering economics. A very small percentage of engineers actually take and pass the EIT exam. The number has hovered at circa 5%. Several decades ago, I passed the CPA examination and obtained another license in Computer Information Systems Auditing. A CISA must have knowledge in the areas of data center review, systems applications, the operating system of the computer, disaster recovery, contingency planning, developmental systems, the standards which govern facility reviews and a host of other areas. An MBA in Accounting with an Advanced Professional Certificate in Computer Applications/ Information Systems , an Advanced Professional Certificate in Finance and an Advanced Professional Certificate in Organizational Design were earned at New York University-Graduate School of Business (Stern ). In December of 2005, an earned PhD in Accounting was granted by the Ross College. The program entrance requires a previous Masters Degree for admittance together with a host of other criteria. The REGISTRAR of Ross College contact is: Tel . US 202-318-4454 FAX [records for Dr. Joseph S. Maresca Box 646 Bronxville NY 10708-3602] The clinical experience included the teaching of approximately 34 sections of college accounting, economics, statistics, college algebra, law, thesis project coursework and the professional grading of approx. 50,000 CPA examination essays with the American Institute of Certified Public Accountants. Additionally, membership is held in the Sigma Beta Delta International Honor Society chartered in 1994. Significant writings include over 10 copyrights in the name of the author (Joseph S. Maresca) and a patent in the earthquake sciences.