The Patient Protection and Affordable Care Act of 2010 (commonly known as the ACA) is the most hotly debated legislation of our time. Its fate now rests with the Supreme Court, which recently heard three days of oral arguments regarding its constitutionality and promises a ruling by late June.
It is beyond my purpose or ability to discuss the Act in detail (the published summary alone runs to 13 pages). Nor do I intend to endorse a political position on this issue. But I would like to consider some biblical principles that seem relevant to the debate, whatever the Court decides.
Among the Act’s most popular provisions already in place:
- The Medicare rebate for brand name drugs was increased.
- Adults with pre-existing conditions are now eligible for insurance.
- Insurers cannot impose lifetime dollar limits on essential benefits.
- Dependents are permitted to remain on their parents’ insurance plan until their 26th birthday.
- Insurers cannot exclude pre-existing medical conditions for children under the age of 19 or drop policyholders when they get sick.
In the future, insurers will not be allowed to discriminate against or charge higher rates for individuals based on pre-existing medical conditions. Nor will they be allowed to establish annual spending caps.
How will insurance companies be able to afford these changes? Now we come to the most controversial part of the Act: the “individual mandate.” By 2014, all Americans will be required to purchase insurance or pay a penalty, by mandate of Congress based on its constitutional powers to regulate interstate commerce.
One in six Americans is currently without health insurance. Advocates of the ACA point out that every family medical policy costs about $1,000 more per year because of the price of treating the uninsured. Unless something changes, that number will only grow in years ahead. Critics allege that this provision exceeds the power of Congress by forcing Americans to buy something they may not want. As Justice Scolia asked during oral arguments, if the ACA is made law, what is to stop Congress from forcing us to buy broccoli?
And they claim that Obamacare will set us on the path to a two-tier system. In their view, the wealthy will opt out and pay private doctors for the health care they want. Everyone else will be left in a government-run system that provides impersonal care based on cost. They assert that a “free-market” alternative would be better.
How are biblical principles relevant to this debate? I have no idea if the Act’s provisions to enable children and the sick to gain insurance are feasible or affordable. But I do believe that they are consistent with God’s concern for the disadvantaged:
- “If there is a poor man among your brothers in any of the towns of the land that the Lord your God is giving you, do not be hardhearted or tightfisted toward your poor brother. Rather be openhanded and freely lend him whatever he needs” (Deuteronomy 15:7-8).
- “Do what is just and right. Rescue from the hand of his oppressor the one who has been robbed. Do no wrong or violence to the alien, the fatherless or the widow, and do not shed innocent blood in this place” (Jeremiah 22:3).
- “Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world” (James 1:27; see 5:14-16).
Nor could I take a legal position on the constitutionality of the individual mandate. However, Scripture does encourage the importance of individual liberty and wise choices: “Choose for yourselves this day whom you will serve” (Joshua 24:15); “it is by grace you have been saved, through faith” (Ephesians 2:8).
Should the Court uphold the Act in its entirety? Should it declare the individual mandate unconstitutional but leave the rest of the Act intact? Should it strike down the Act completely? We’ll know the Court’s decision in June.
In the meantime, know that the Great Physician is not subject to the vagaries of our legal process. He is “the Lord who heals you” (Exodus 15:26). How is his promise relevant to your needs today?