As residents of a state that has never aggressively looked after the health and well-being of the least of its inhabitants, Alabamians suffered a defeat last week at the U.S. Appeals Court for the 11th Circuit.
One facet of the Affordable Care Act, the individual mandate to purchase health insurance, was deemed unconstitutional by two of the three 11th Circuit appeals judges who reviewed the case. The majority called the mandate “a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”
Calling it a commendable defense of “federalism and limited government,” Alabama Attorney General Luther Strange added his voice to those cheering the ruling.
In dissent, 11th Circuit Judge Stanley Marcus latched on to that argument, countering that “the mere fact of its novelty does not yield its unconstitutionality.”
These rarified legal matters seem to carry a whiff of a law-school library on some pristine campus. They are far removed from the day-to-day lives of Alabamians struggling to make ends meet, keep a family fed and pay the medical bills.
In 2009, the Kaiser Family Foundation estimated 1-in-7 Alabamians don’t have health insurance. This unfortunate 14 percent of the state’s residents have the most to gain if the Affordable Care Act can withstand a legal challenge in the U.S. Supreme Court, which is where the case will ultimately be decided.
The rest of the state isn’t off the hook, though.
For starters, when one of Alabama’s uninsured gets sick, they often end up putting off treatment until they must rush to the emergency room, where the costs rise exponentially. Hospitals, and by extension all Alabamians with insurance, pick up the tab. Yes, we bear the costs in the most costly and inefficient way.
Approximately half of Alabamians are covered through employer-based plans. The notion of connecting a job to health insurance was a product of debate on universal coverage during the middle part of the last century. In short, it was a tradeoff to keep at bay those forces trying to convince the Truman administration to push for government-mandated coverage. Sixty years later and with a new economy that places far less value on one worker staying with one company for a career, the demerits of an employer-based system are more obvious.
One-third of Alabamians receive what we could call government-sponsored health care, either through Medicaid (for the very poor), Medicare (for the elderly) or S-CHIP (for the children of what we might call the working poor). These residents could be forgiven for worrying if Alabama’s ideological zealots who sued to prevent more Alabamians from getting health care might someday turn their ire and lawsuits on Medicaid, Medicare and S-CHIP.
Sounds far-fetched, doesn’t it? Yet, here is Alabama spending some of what little cash it has in the bank, trying to take away the promise of health insurance from 14 percent of its residents. Cruelty could scarcely be better illustrated.