He's a conservative economist, and, ironically, the individual mandate now pilloried by conservatives was originally a conservative idea. The gist? Everyone must buy coverage to prevent freeloaders — those who refuse to buy health insurance but get care in a crisis, paid for by others.
The individual mandate was upheld by the Supreme Court Thursday with the surprising support of Chief Justice John Roberts, who sided with the four liberal justices. The ruling was seen as a big win for Obama, who made health-care reform a cornerstone of his administration.
In the 5-4 decision, Roberts reasoned that the penalty was a tax and, thus, constitutional.
Seven justices, however, found problems with the law's expansion of Medicaid, saying that Congress couldn't force states to participate in the expansion.
For the uninsured
People who are uninsured currently have few choices, said David Grande, assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine. They can go to the city health centers or nonprofit clinics, but those centers are "overburdened" and have "a limited amount of services they can offer," he said.
Under the new law, states are supposed to set up insurance exchanges that will be operational come Jan. 1, 2014, when the Affordable Care Act is to fully go into effect. If states don't do so, the federal government will set up the exchanges for them.
Starting in 2014, people who are uninsured can buy insurance via the exchanges.
Some people — with incomes between 133 and 400 percent of the federal poverty level (in 2012, for a family of four, that's about $30,000 to $92,000) — would qualify for federal subsidies to get insurance on the exchange.
The very poor who would not be eligible for that subsidy would qualify for the expanded Medicaid program.
One group of residents who will remain uninsured and won't be able to get private health insurance is undocumented immigrants, Grande said. They will likely continue to get care, if they need it, at the city's health centers, which don't discriminate in terms of who they give care to.
Donald Schwarz, the city's health commissioner, said that whether the eight city health clinics will see a change in demand at the centers will depend on whether Pennsylvania expands its Medicaid eligibility provision. "If the state decides not to take that option, we will still have a lot of uninsured people," he said.
For the insured
For the 82 percent of Americans in the country who are insured, "there is no news," Pauly said. "But if something terrible happened," like they lost their job, then they have a better chance of keeping their coverage.
Pauly noted that there will have to be some way to pay for the federal subsidies offered on the insurance exchanges. He believes that, down the road, workers will see moderate increases in their federal income taxes to pay for them.
Also, premiums may rise for young, healthy adults, but those people are expected to benefit in the long run.
Under the law, small businesses (those with fewer than 50 employees) will not be penalized for NOT offering any health insurance.
For those with 50 or more employees, if the employer doesn't offer coverage, there could be a penalty. What triggers it, though, gets a bit complicated, and it's best to contact your insurance broker.
Contact Julie Shaw at 215-854-2592 or firstname.lastname@example.org, or on Twitter @julieshawphilly.