As of yesterday morning, we have the Supreme Court’s decision on the Affordable Care Act. The verdict: It stands. It’s a little more complicated than that, but practically speaking, “it stands” is all most people need to know.
It means that starting in 2014, everyone will indeed be required to purchase health insurance. I’ve long argued that the individual mandate is crucial to the success of the law. You can’t ask insurers to cover more people with fewer restrictions (which ACA does) without expanding the risk pool (which is what the individual mandate does).
I’m not convinced though that the law’s penalties for not purchasing insurance are a big enough stick to prod healthy young people into the pool. That could be a problem.
And though I agree with the basic principle of making sure all Americans have meaningful, affordable health coverage, the ACA has other problems as well. There’s the Small Business Health Insurance Tax (HIT) and new taxes on pharmaceutical and medical device manufacturers, which will all increase the cost of health care. There are funding cuts to the Medicare Advantage plans that are ultimately going to mean higher premiums or reduced benefits for older Americans. There are not enough provisions that address the real causes of escalating health care costs. And there isn’t much time built in for creating exchanges and getting products approved before the January 2014 deadline.
But these are all problems that can be fixed. So, now everybody can start the work of fixing what needs to be fixed.
Health Care Perspectives 
Dave,
I agree with all you have said! Yet, at least now we have a direction to go, no more Yoggi Berra: “When you reach the fork in the road, take i t!”
Thanks!
JAD
Dave, I totally agree that the ACA still needs work, but I wonder whether any meaningful dialog with policymakers, and the elected officials to whom they answer, is possible until after the November election. As someone who cares very much about improving the delivery of health care in this country and agrees with your analysis of what needs to be fixed, I’m keeping my seat belt fastened until the roller coaster ride is over in November.