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Health care law survives; what’s ahead?

The U.S. Supreme Court upheld the Patient Protection and Affordable Care Act in a ruling announced Thursday, June 28. Jim Winkler , general secretary of the Board of Church and Society, which filed an amicus brief in the case, spoke at a rally in Washington, D.C in March 2012.  A Web-only photo courtesy of the United Methodist Board of Church and Society.
The U.S. Supreme Court upheld the Patient Protection and Affordable Care Act in a ruling announced Thursday, June 28. Jim Winkler, general secretary of the Board of Church and Society, which filed an amicus brief in the case, spoke at a rally in Washington in March 2012. A Web-only photo courtesy of the United Methodist Board of Church and Society.

The U.S. Supreme Court, by a 5 to 4 majority, largely upheld the Patient Protection and Affordable Care Act, President Obama's health care legislation.

Some United Methodists hailed the decision, saying the law's provisions will help extend health insurance to the poor and even save local churches money. But,even proponents agree the legislation likely will need improvements.

The majority ruling, announced on the morning of June 28, held that the much-contested mandate that all Americans buy insurance is constitutional under the U.S. government's taxing authority.

The top court, in the opinion, National Federation of Independent Business v. Sebelius, also upheld most of the provision requiring states to comply with new eligibility requirements for Medicaid. The court ruled that states could lose only new federal funds not their entire funding if they did not comply with the new requirements.

"My first reaction is pleasant surprise and a sense of relief," said Dr. Wayne J. Riley, president and chief executive officer of Meharry Medical College School of Dentistry in Nashville, Tenn. "The Medicaid expansion we feel is a very important first step toward extending health insurance toward minority and underserved communities."

What the law does

Under the Patient Protection and Affordable Care Act, people with family incomes up to 138 percent of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will be generally eligible for the expanded Medicaid program by 2014.

People participating in the new state-based health insurance exchanges will be eligible for federal subsidies for insurance if their income is below four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012).

The share of Americans who would benefit from these programs varies greatly by state. But on average, an estimated 17 percent of the nonelderly population in the United States would benefit from the Medicaid expansion and tax credits, according to an analysis by the Kaiser Family Foundation. That translates to about 33 million more Americans who will be able to obtain medical insurance.

The health care law also includes provisions that could benefit people regardless of income, the foundation notes. These include:

  • the ability for parents to cover children up to the age 26 on their insurance plans
  • a limit on out-of-pocket costs in all insurance plans
  • preventive benefits with no patient cost-sharing
  • guaranteed access to insurance regardless of pre-existing conditions

A pre-existing condition is a physical or mental health condition, disability or illness that people have before they enroll in a health plan. Some plans have considered acne, asthma or high blood pressure a pre-existing condition. Others narrowed the definition of pre-existing conditions to cancer or diabetes.

By requiring healthy people to enter the insurance market, the mandate aims to help insurance companies cover the additional costs of taking on those with pre-existing conditions.

Meharry, a United Methodist-related medical, dental and research university, is the United States' largest private, historically black medical school and, according to a 2010 study, one of the nation's top producers of primary-care physicians.

"Since our business is training physicians and dentists to serve low-income communities in part, we think this is very good for our potential patients," he said.

The United Methodist Board of Church and Society, the agency charged with advocating for the denomination's social teachings, was among more than 60 religious groups that joined in an amicus brief in support of the Medicaid expansion.

Also joining in the same brief was the United Methodist Women unit at Biltmore United Methodist Church in Asheville, N.C.

"I think this is great day for thinking about health care in this country and how it's going to cover 33 million more Americans," said the Rev. Cynthia Abrams, who directs the health care advocacy program for the Board of Church and Society.

She applauded the court's limitations on how the federal government can withhold Medicaid funding. If states lost all their federal matching Medicaid funds, the people most affected would be low-income people, Abrams said.

Impact on local church

Among the beneficiaries of the new law, Abrams said, will be local United Methodist churches.

She said some annual (regional) conferences are planning to use the state-based insurance exchanges that are scheduled to be operational by 2014.

"If they do that," she said, "then clergy and local church employees will be in a larger risk pool, which will include a healthier population than just the United Methodist clergy. That will decrease costs in terms of health insurance premiums."

Surveys repeatedly have found United Methodist pastors in the United States have a higher incidence of health problems than their peers. Abrams said many local churches also will be able to take advantage of a new small-business tax credit under the health-care law.

Lonnie Chafin, the treasurer of the Northern Illinois Conference, estimates the law will reduce the conference's annual budgets from $15,500 to $6,000 per appointment. "I believe that many of the associate pastor positions that went to lay people to shed benefits can transfer back to elders," he said. "I reckon we will gain 20 appointments in associates and small church pastorates."

Abrams added that fewer dollars spent on health benefits would leave more resources for programming at the local church.

Differing opinions

United Methodists, like most Americans, have taken varying positions on the health care legislation.

When the law was approved in 2010, the majority of United Methodist lawmakers in the U.S. House of Representatives voted against the plan. However, then-Speaker Nancy Pelosi, D.-Calif., referred to The United Methodist Church as one of many organizations "sending a clear message to members of Congress: Say yes to health care reform." More specifically, the United Methodist Board of Church and Society was included on Pelosi's website in a list of organizations supporting reform.

A June 21-24 survey by the Public Religion Research Institute found a plurality (43 percent) of Americans opposed the U.S. Supreme Court overturning the health care law. The same poll found white mainline Protestants divided with 44 percent in favor of overturning the law and 34 percent opposed.

On June 28, United Methodist lawmakers' reactions split largely along partisan lines, with Republicans decrying the decision and Democrats hailing it.

"I am disappointed in today's Supreme Court decision," said U.S. Rep. Kay Granger, a Republican from Texas, in a statement. "The court decided the health care law was constitutional. It did not decide it was good policy."

U.S. Rep. Emanuel Cleaver II, a Democrat from Missouri, and an ordained United Methodist elder, said in a statement that the decision marks "an historic day in this country - but not a day to deepen our divisions or throw up our hands and say our work is done.

"For all Americans, Republicans and Democrats, the states and the federal government must continue to work together to make sure health care is functional, full and fair."

Good News, an evangelical caucus, has criticized how the Board of Church and Society advocated for the legislation. The Rev. Keith Boyette, the chair of the board of Good News, said the caucus saw the agency's lobbying tactics as too partisan. However, Good News never has taken a position on the legislation itself.

Boyette, an attorney and former member of the United Methodist Judicial Council, said he sees the June 28 ruling as momentous as the U.S. Supreme Court's decision to uphold Social Security.

"Now the principle that the government is going to be involved in insuring health care has been established," said Boyette, the founding pastor of Wilderness Community Church in Spotsylvania County, Va. "Now the question will be the mechanics of that, and that will be where the battles are fought."

The ruling on June 28 did not address the legal challenges against the requirement that employers provide workers with contraception insurance coverage. Those lawsuits filed by at least 55 individual plaintiffs are just beginning to work their ways through the courts. United Methodists, including Boyette, have varying views on whether the requirement related to birth control violates religious freedom.

An historical position

Going back to its founder John Wesley, the Methodist movement has historically supported access to health care for all.

Wesley preached on the biblical mandate to care for the sick, and he set up the first free public clinic in London, which he ran until it became too expensive for his limited resources. Later, he wrote "Primitive Physick," a self-help primer on health and medicine for individuals too poor to pay for a doctor.

"It's kind of neat that on the day of John Wesley's birthday we're celebrating something that I think he would be justifiably proud of because of his commitment to make sure poor people were taken care of," Abrams said.

What The United Methodist Church teaches

From the Book of Discipline, which outlines church law, doctrine and organization:

From the Book of Resolutions, the denomination's statements on social issues:

United Methodists have continued Wesley's commitment to ministry with the sick with church-supported health clinics, hospitals and nursing homes. The United Methodist Association today represents more than 380 United Methodist-affiliated health and welfare ministries, including hospitals and retirement communities.

But the denomination's official position is that the church and its members cannot provide comprehensive health care alone.

"Providing the care needed to maintain health, prevent disease, and restore health after injury or illness is a responsibility each person owes others and government owes to all, a responsibility government ignores at its peril," asserts the Book of Discipline, the denomination's lawbook.

Resolution 3201 in the United Methodist Book of Resolutions, which contains the denomination's pronouncements on social issues, also tasks the United Methodist Board of Church and Society with "primary responsibility for advocating health care for all in the United States Congress."

General Conference - the denomination's highest legislative body - approved the resolution in 2008. However, the assembly has not endorsed any specific U.S. legislation.

More work to be done

Even proponents of health care law say more work needs to be done to ensure the nation's poor have access to health care.

Dr. Ted Hill, a physician and ordained United Methodist deacon, is the medical director of the Salvus Center, a faith-based health center in Sumner County, Tenn., that serves working uninsured.

Assuming the law stays intact, Hill said many of his current patients will be able to access insurance by 2014. But that does not mean that they will able to find enough primary-care doctors who can serve them, Hill said.

"There will still be a gap of people of who have minimal coverage but they won't have anybody to take care of them," he said.

He added that there will still be about 17 million people in the United States, including immigrants, who have no health insurance.

Riley of Meharry Medical College said he shares the concern that the Patient Protection and Affordable Care Act does not do enough to help reduce the costs of medical care. According to the Robert Wood Johnson Foundation, which researches health policy, the United States spends a larger share of its gross domestic product on health care than any other major industrialized country.

Riley said some of the drivers of those costs are unnecessary tests and treatments.

Still both Riley and Hill see the health care law as an improvement to the status quo.

"Is every part of the law exactly what we need? I don't know, and I don't think anybody knows," Hill said. "But I do know there is something on the table; there is now something to work with. If we find that there are some things that aren't working, my gosh, we've got smart enough people to tweak those."

*Hahn is a multimedia news writer for United Methodist News Service.

News media contact: Heather Hahn, Nashville, Tenn., (615) 742-5470 or newsdesk@umcom.org.