Duke Faculty: Health Care Fight Not Over Yet

Supporters call law a first step for fixing health care, though political ramifications far from over

Duke faculty members were largely supportive of the Supreme Court's decision on Thursday to uphold most of the Affordable Care Act, noting that once the dust settles from the bitterly debated law many Americans will see it as a good thing.

"I think it's a great victory for people who otherwise would be uninsured," Don Taylor, associate professor of public policy studies, told WRAL.

Taylor, who conducts research on aging and comparative health systems and health policy, added the legislation "isn't a perfect step," but it should serve as a catalyst for further improvement of the nation's health care system.

"Our political system does not produce perfect results," he said. "It's very doubtful now that the Affordable Care Act is going to go away, and the political parties need to work on the next steps."

Following the Court on Twitter

Within moments of the release of the decision, Duke faculty members were sending out responses to the ruling on Twitter.

Some poked fun at CNN for getting the big story wrong -- the network initially reported that the individual mandate had been struck down.  Others considered the political ramifications. To see a range of selected tweets on the ruling, click here.

In its 5-4 decision, the high court upheld nearly all of the provisions in President Obama's historic yet divisive overhaul of America's health care system, including the so-called individual mandate clause that requires most Americans to have health insurance or face a penalty.

The court, with Chief Justice John Roberts writing the opinion upholding the ACA, ruled that the penalty should be considered a tax, in part, because the money would be collected by the Internal Revenue Service.

The court also rejected the Obama administration's claim that Congress had the power to create the mandate under the constitution's commerce clause, which allows lawmakers to regulate interstate commerce.

"I do think it's significant and quite incorrect that the court disabled Congress from using the commerce clause," Duke law professor Neil Siegel said during a Web discussion on the court decision.

Siegel said the court made it clear that people have a choice to get coverage or pay a penalty. "It's not a mandate, it’s a modest financial incentive," he said.

Politically, health care reform will remain a hot topic in this year's election, and the court's decision gives Republicans plenty of ammunition, said Michael Munger, a professor of political science and economics.

"What the court decided was that if the mandate requirement is simply interpreted as a new -- and rather large -- tax, then it would be constitutional," Munger said via email. "This is actually a little embarrassing for the president, because the court saying 'it's a tax' will be very useful for Republican attack ads.  After all, the president said he would not raise taxes on anyone under a $250,000 income, and anyone who called the ACA mandate a 'tax' was playing with language. 

"Combine that with the fact that up to 70 percent of Americans disapprove of the mandate, and this is not that good a day for the president, in terms of politics."

Dr. Peter Ubel, a physician and behavioral scientist at Duke's Fuqua School of Business, told WRAL that despite the controversy over ACA, it's a good first step toward fixing America's health care system.

"I know this is a very polarized debate, but I think when the dust settles people will realize that this is largely good for Americans," Ubel said. "There will still be things to fix up in the future no matter who gets elected president. ... But what we now have is the vast majority of Americans will have health insurance."

Added Ubel, who studies the role of values and preferences in health care decision-making: "We know now that when people get sick they'll at least have some financial support to help care for themselves and that you won't have people free-riding on the system without insurance, expecting the rest of us to pay for them."


Duke Faculty in the News

Dr. Peter Ubel: For Obama, after Supreme Court comes court of public opinion (Washington Post)

Dr. Peter UbelThe political impact of the health care ruling (Triangle Business Journal)


Neil Siegel: Legal Scholars React: 'Many People Were Stunned' (National Public Radio)

Neil Siegel: Legal expert: Court nearly rejected entire health care law (Yahoo! News)

Neil Siegel: Online chat (National Constitution Center)

Neil Siegel: Not the Power to Destroy: An Effects Theory of Tax Power (Balkinization)


Dr. Victor Dzau: Local officials, experts react to health care decision (Durham Herald Sun) 


Jed Purdy: How to Read the Health Care Option (Huffington Post)