The Opt Out: The Supreme Court's contribution to the undermining of the Affordable Care Act

Advocates and defenders of the Affordable Care Act cheered in 2012 when the Supreme Court upheld the legislation. Rather than a mandate, mandatory participation was viewed as a tax and on those grounds was able to stand and not violate the various Constitutional concerns.

However there has proved to be one point that has largely been forgotten. There were a few commentators making noise about it at the time but it's really starting to be felt.

And that was the expansion of Medicaid. The Court ruled that states could not be coerced to expand the programme and they could 'opt out' of the Federal funds etc...

In this case the 10^th Amendment trumped the commerce clause.

At the time this seemed to strike a balance, upholding the law and yet giving states some latitude in how it would be applied in their particular situation.

A few warning voices pointed out that down the road this may help to undermine the law. The only way the insurance industry would sign on was if they could demand a universal mandate. That's the only way a universal coverage will work in a privatised context.

But allowing states to opt out of Medicaid expansion meant millions of people (I'm one of them) would fall through the cracks. These people would not be able to afford insurance, and yet still don't qualify for Medicaid in their state under the normal guidelines. The expansion would have meant that most of the people would have been insured through Medicaid...a Medicaid with wider standards subsidized by Federal funds.

They're free to purchase it in the marketplace, but for most of these people it was already unthinkable. But now the fact that millions have been exempted from the Act through this loophole (and others) means the universality aspect is failing. In addition, the rollout troubles have meant the numbers are way below where they need to be.

Consequently rates are skyrocketing, the insurance industry is laughing and Obama looks like a fool. Many people are going to be furious as they will be penalized for non-compliance when they file their 2014 taxes.

I'm out altogether. We have no health care. We couldn't afford it before, and now it's unthinkable. Thankfully for us, our income is low enough that at least we will be exempted from the penalty as well. In our case, our governor chose not to expand Medicaid and so the working poor in our state are still without. If you make more than about $.25 over the minimum wage you make too much to qualify.

In our case we were kind of hoping for the expansion. Even minor surgery is enough to break our bank. With no primary care it means that we wait until a crisis occurs and visit the Emergency Room which often doesn't solve the problem. The Emergency Room just patches you up and tries to give you a referral, most likely to a doctor who demands payment up front before they will see you.

The law has been a colossal failure and those on the Left said so from the beginning. It was written by the insurance industry and for the insurance industry. But if it fails too badly it will hurt them as well. I can't say that I will weep for them considering their business model is to cash in on manipulation, fear and the pain and suffering of the people they purport to represent.

Some are trying to remain hopeful and after the debacle in 1993, they are glad something was passed. They think that maybe this will provide a platform for further improvements. I'm thinking it's going to be defunded and obstructed and ends up crashing and burning. I guess the question will be...how long before someone dares to take it up again?

In the meantime the richest country in the world continues with one of the worst and most corrupt health care systems on the planet.