The volatile battleground on health care reform shifted to Florida on Thursday with a court hearing on the Affordable Care Act. Judge Roger Vinson...

The volatile battleground on health care reform shifted to Florida on Thursday with a court hearing on the Affordable Care Act.

Judge Roger Vinson of the federal district court in Pensacola is hearing arguments from the Justice Department and from attorneys representing 20 states – including Georgia – who are challenging the health reform law.

The states object to the law’s requirement that most individuals obtain health insurance. That same ‘’individual mandate’’ provision was declared unconstitutional earlier this week by Judge Henry Hudson in federal court in Virginia.

Many experts expect Vinson, a Ronald Reagan appointee, to make a similar ruling. He has already criticized the individual mandate, notes Health News Florida.

The constitutional issues are expected to be ultimately decided by the U.S. Supreme Court. A New York Times article looks at the role that partisanship could play in courtroom battles over the reform law.

Meanwhile, the rollout of the new law continues, with states working on designing the health insurance exchanges, or marketplaces, set to debut in 2014.

Proponents of health reform have been adamant that the requirement to buy insurance is central to the law’s effectiveness. But talk has also surfaced about a Plan B if the individual mandate is struck down.

As the Associated Press reports, the White House could use a tactic borrowed from Medicare. If there is no mandate, the government could instead impose a penalty for those who don’t sign up for insurance during an enrollment period. That penalty could escalate the longer they waited to get insured, just as Medicare has done for people signing up for doctor coverage. “It’s better than nothing,’’ health consultant Chris Jennings, a Democrat, told the AP. The change could be even more effective than the current requirement, other experts told the AP.

Yet Bill Custer, a health insurance expert at Georgia State University, pointed out Wednesday that the insurance reforms that have already kicked in under the Affordable Care Act rely on the mandate. And health insurers agreed to the ban on rejecting people with pre-existing conditions – beginning in 2014 – because millions of new customers, including the young and healthy, were to be required to buy policies.

“There has to be an incentive for ‘good risks’ to sign up for coverage,’’ Custer said, adding that the individual mandate, combined with a modest penalty, led to high enrollment in Massachusetts’ insurance reform plan, enacted under Gov. Mitt Romney.

Custer also said major changes to the law, such as the Medicare penalty idea, would put health reform back into the thick of the political process. Changes would be ‘’very difficult to enact’’ in the current political climate, he said.

“It was a small miracle for [the health reform law] to be passed,’’ Custer said. “It may take a couple of other miracles for it to be fully implemented.’’


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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