March 2012

By Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology

The Affordable Care Act (ACA) represents the most fundamental reform of the U.S. health care system of the past 50 years. Such an important social policy change should be widely understood by our citizens so that it can be most effectively implemented. Yet the ACA is sufficiently ambitious and complicated that understanding of the law is quite poor. This is one of the reasons I chose a graphic format for my book, Health Care Reform: What It Is, Why It's Necessary, How It Works.

You can’t understand the need for, and the accomplishments of, health care reform without appreciating the fundamental failure in health insurance markets today. Unless you are offered insurance by your employer, or by the government, there is effectively no meaningful insurance in America. Individuals subject to the harsh “non-group” market face exclusions from pre-existing illness or can be dropped as soon as they become ill. And the key to solving this problem is the individual mandate, which can end insurance market discrimination by promoting broad insurance participation.

At the heart of this reform is what I like to think of as a “three legged stool” designed to solve this problem and, as a byproduct, cover most of our nation’s uninsured. The first leg is insurance market reform which will end the ability of insurance companies to discriminate against the sick; no longer will we be one bad gene or one bad traffic accident away from bankruptcy. The second is the individual mandate, which requires insurance coverage so long as that coverage is affordable (costs less than 8% of income). This mandate is critical; without it, insurers will react to insurance market reform by raising prices because they are afraid only the sick will buy insurance. But you can’t mandate insurance coverage unless it is affordable, which it is not for low income Americans.  That’s why we need the third leg of the stool: extensive subsidies that will make health insurance affordable for those living below median income.

By Doug Kendall, President, Constitutional Accountability Center

Lyle Denniston recently described “the tendency of the ‘Roberts Court’ to take on the broadest kind of controversy in cases brought to it.” From Citizens United v. FEC, in which the Court expanded the case on its own motion, scheduled a second argument, and then issued a sweeping ruling discarding prior case law, to the Affordable Care Act (ACA) cases about to be argued, in which the Court decided to hear just about every claim presented to it -- including claims unanimously rejected by the lower courts -- and scheduled six hours of argument time over three days, the Court under Chief Justice John Roberts has put itself at the center of some of the most important political controversies of our day.

Decisions like the Court’s 5-4 ruling in Citizens United illustrate that the Roberts Court is not only taking big cases and issuing sweeping rulings, it is also splitting sharply along ideological lines on important questions about the meaning of our founding document. That is the focus of The Constitution at a Crossroads: The Ideological Battle over the Meaning of the Constitution, an attempt by Constitutional Accountability Center (CAC) to map and describe the ideological battlegrounds on the Roberts Court. We began to rollout the Crossroads project today with a media teleconference featuring Tom Perriello (former Member of Congress and current head of Center for American Progress Action Fund) and myself (you can listen to our remarks here).

CAC will be releasing Crossroads chapter-by-chapter over the next several months, beginning today with the release of three chapters on the powers of the federal government, which helps set the stage for the ACA argument later this month. Our plan is to release a dozen or so more chapters over the course of the spring, as the Court races toward the end of its October 2011 Term. After the Court completes its work, we will spend the summer editing, revising and compiling Crossroads into a single document for release in the early fall, timed to coincide with the celebration of the 225th Anniversary of the ratification of the Constitution and  the opening of the Court’s October 2012 Term. Because Crossroads will be released over time and then revised and edited after the Court ends its Term in June, we very much welcome comments and criticisms from ACS members as we shape the final product.

Crossroads is not the first attempt to map the ideological divisions on the Supreme Court. In 1988, in the wake of the decisive defeat of the nomination of Robert Bork to the Supreme Court and in the run-up to an election that seemed destined to determine the direction of the Court for a generation to come, the Reagan Justice Department released a series of reports that highlighted “substantial differences of opinion over the judicial role in contemporary society.” The most famous of these reports, entitled The Constitution in the Year 2000, highlighted fifteen areas of constitutional law likely to be decided by the Supreme Court over the intervening years, and the “alternative roads down which the Court might travel over this time.”