Dr. Robert Stone has seen his share of emergency room
surprises. But some sights have become all too commonplace.
The injured man, for example, who walks around on a broken
ankle for days before seeking treatment – yet still begs from the sick
bed not to be X-rayed because of the expense.
Or the diabetic, who stops testing her blood sugar because
she isn't insured, only to end up in the ER in diabetic shock.
"They're afraid to go to the doctor because they can't
afford it, so by the time they get to the ER they're so sick they have to go to
intensive care," Stone said. "Now maybe they've got a second night in the
hospital before they go home, and their bill gets up over $50,000, and then
they're financially ruined."
As an ER physician at Bloomington Hospital, director of
Hoosiers for a Commonsense Health Plan and a board member of Physicians for a
National Health Plan, Dr. Stone has a direct interest in what President Barack
Obama's new health care legislation means. He also has opinions.
Although the reforms are far from perfect, and the number of
uninsured is likely to grow until the president's plan is fully implemented in
2014, the new bill was still an "important precedent," he said.
"From my perspective as an ER doctor, anything that
increases coverage – that covers, hopefully, at least half the uninsured
– that's wonderful," Dr. Stone said. "The free market experiment that
we've been on since the early '90s has been a disaster."
Still, despite reports from the trenches, and endorsements
by non-profit, non-partisan groups like the American Hospital Association,
Indiana's Attorney General, Greg Zoeller announced last week he would join 13
other state attorneys general in suing the federal government, in hopes of
overturning health care reform in court.
"When the federal government imposes unprecedented legal
obligations of this magnitude on state government, it is my obligation as
Attorney General to join and participate in challenging the constitutionality
of the bill," Zoeller said in a press statement.
For anyone who's followed the trajectory of Indiana politics
over the last half year, the move was hardly a surprise. In truth, the suit was
a long time coming. Zoeller probably couldn't have stopped it if he'd wanted
The governor's baby
As much or more than any other piece of legislation to
emerge during Gov. Mitch Daniels' tenure, the Healthy Indiana Plan (HIP) was
the governor's baby. Centered on personal health-care accounts, and paid for
with money to spare by increased cigarette taxes, HIP was a centerpiece of progressive
conservative lawmaking that showcased the best parts of Daniels' political
mantra – that personal and fiscal responsibility are crucial components
of successful social welfare.
Indeed, while Washington Republicans were hard-pressed this
past year to convincingly demonstrate a willingness to pursue meaningful
reform, HIP was something Daniels could tout in contradistinction to Obamacare
– an example of the conservative approach made good.
Little surprise, then, that Obama's health care reforms
– which, once fully in place, will effectively kill Daniels' piece de
resistance by moving its beneficiaries to
an expanded version of Medicare – provoked a strong reaction from the
Critics have long maintained that HIP doesn't go far enough.
According to the Indiana Family and Social Services Administration (FSSA),
roughly 561,000 Hoosiers are without health insurance.
Once implemented, the federal reforms should translate to
coverage for most of those uninsured Hoosiers, in large part by adding roughly
half-a-million people to the 1.2 million already on Medicaid.
But the Daniels administration would prefer to expand HIP,
believing that the Medicaid expansion will cost the state dearly in financial
terms. As such, Daniels blasted the federal bill as a "very, very serious
mistake" and immediately suspended new enrollment by childless adults in HIP,
citing financial concerns.
The suspension has drawn fire, but Jane Jankowski, a
spokeswoman for Daniels, argued that the move will have little effect because
of a federal cap on the number of childless adults the state is allowed to
enroll in order to receive matching funds – a cap that was met last year,
putting as many as 40,000 Hoosiers on a waiting list.
Critics say HIP's impending demise is the real reason behind
the Attorney General's lawsuit, and that the move to suspend HIP enrollment is
an exercise in cutting off one's nose to spite one's face.
Indiana House Speaker, Rep. B. Patrick Bauer (D-South Bend)
called the HIP suspension "mean and ugly," and questioned the legal authority
of the governor to suspend enrollment in a program that was duly passed by the
"I think the governor is very, very disappointed the health
care bill passed because he wanted to showcase his HIP program," Bauer said.
"He's leaving thousands of people without healthcare because this federal law
doesn't start until 2014. So, for three and-a-half years, they're not going to
have any health care."
"I just think it's sort of a form of vengeance for passing a
federal health care program that interferes with his agenda," he added. "And I
think that's a shame."
At a recent press conference, Daniels was pressed as to why
he felt it necessary to suspend some HIP enrollment now when new rules won't go
into effect until 2014. He replied that it was "a precautionary move for the
"I don't see any reason to add people to the rolls of a
program whose days are numbered," he said.
meantime, the question remains: Does Zoeller's lawsuit stand a chance?
Before he joined the lawsuit, Zoeller had already done his
homework – notably when Republican Sen. Richard Lugar asked him to look
into the constitutionality of the Senate bill passed in December. Of particular
concern was the individual mandate, which will require everyone that isn't
eligible for Medicare or Medicaid to purchase insurance from a private carrier
or a state-run insurance exchange. Those who do not will face a fine.
Zoeller produced a 55-page report in February, outlining the
case against the bill. Among his reasons, Zoeller argues in the report that the
individual mandate "would exceed even the most expansive understanding of the
Commerce Clause," and that "by regulating insurance companies so
comprehensively, the Bill would render them de facto public utilities and
stifle their ability to earn a profit."
Professor John Hill, a constitutional law expert at the
Indiana University School of Law in Indianapolis, said he felt the bill
represented "an eroding of certain constitutional values." Whether or not it
actually infringed upon a particular clause of the constitution, "as it's now
interpreted by the Supreme Court," he said, was a "tougher call."
A real hot potato
"Supreme Court precedent over the course of the twentieth
century has really altered the meaning of many of the provisions of the
Constitution that might be applicable," Hill said.
Hill added that Zoeller's argument regarding profit-making
infringement lacked persuasive power. Energy utilities exemplified an important
precedent whereby private companies were essentially made public. Interpreted
broadly, any tax could be construed as stifling a company's ability to earn a
Zoeller's contention regarding the individual mandate made a
more compelling argument, Dr. Hill said, although history still leaned in favor
of the president and Congress. Along with ample court precedence since the
1930s, he noted that the judiciary was in many ways the government's weakest
branch, and would likely avoid overturning such a massive bill.
"In the past, in most cases, the court has been reluctant to
inject itself into real political disputes," he said. "All precedence aside,
the institutional dimension means that the court would be very cautious before
it jumped into this. This is a real hot potato."