STF na MÃdia - MyClipp
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STF na MÃdia - MyClipp
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The New York Times/ - Politics, Sáb, 31 de Março de 2012<br />
CLIPPING INTERNACIONAL (Supreme Court)<br />
Sense of Peril for Health Law Gives<br />
Insurers Pause<br />
As the Supreme Court considers the constitutio<strong>na</strong>lity<br />
of the federal health care law, one option that had<br />
seemed unthinkable to its designers and supporters<br />
now seems at least possible: that the court could strike<br />
down the entire law.<br />
Although it would be folly to predict what the court will<br />
conclude, policy experts, insurers, doctors and<br />
legislators are now seriously contemplating the<br />
repercussions of a complete change in course two<br />
years after the <strong>na</strong>tion began to put the law into place.<br />
Their concerns were heightened after three days of<br />
court arguments in which some justices expressed<br />
skepticism about whether the full law could stand<br />
without the individual mandate requiring almost<br />
everyone to have insurance.<br />
“Many of us did not get the bill we wanted, but I think<br />
having to start over is worse than having to fix this,”<br />
said Robert Laszewski, a health care industry<br />
consultant and former insurance executive who<br />
opposed the bill.<br />
Others say, however, the last two years have made it<br />
easier for Congress or the states to revisit the issue.<br />
The effort was not a waste of time, said Christine<br />
Pollack, vice president of government affairs at the<br />
Retail Industry Leaders Association, a trade group that<br />
represents large retailers and opposed the law. “There<br />
has been an important dialogue that has happened<br />
over the last three and a half years that has been a<br />
long time coming,” she said.<br />
The most ambitious provisions would be nearly<br />
impossible to salvage, like the requirement that<br />
insurers offer coverage even to those with existing<br />
medical conditions and the broad expansion of the<br />
Medicaid program for the poor. Popular pieces of the<br />
legislation might survive in the market, like insuring<br />
adult children up to age 26 through their parents’<br />
policies, along with some of the broader changes<br />
being made in the health care system in how hospitals<br />
and doctors deliver care.<br />
Abandoning the efforts and billions of dollars invested<br />
since the law was passed in 2010 would result in<br />
turmoil for hospitals, doctors, patients and insurers.<br />
Many insurers would have difficulty changing course.<br />
“The risk of repeal and starting from zero frightens<br />
them infinitely more” than having to comply with the<br />
law as written, said Michael A. Turpin, a former<br />
insurance executive who is now a senior executive at<br />
USI Insurance Services, a broker.<br />
Maryland’s health secretary, Dr. Joshua M. Sharfstein,<br />
said he was worried about the 50,000 people<br />
<strong>na</strong>tionwide who are enrolled in a federally fi<strong>na</strong>nced<br />
insurance program because they are seriously ill and<br />
cannot find coverage otherwise. If the entire law is<br />
thrown out, those people “don’t have other options,” he<br />
said.<br />
Numerous provisions in the law have already gone into<br />
effect, like steps aimed at closing the coverage gap in<br />
Medicare drug plans and some of the regulations<br />
governing the profits of health insurers. The federal<br />
government has also spent about three-quarters of a<br />
billion dollars helping states set up new exchanges for<br />
people to buy coverage in 2014 when the full law goes<br />
into effect.<br />
“The part I struggle with is how you undo two years<br />
worth of implementation,” said Dr. Glen R. Stream,<br />
president of the American Academy of Family<br />
Physicians. “It would leave tremendous uncertainty<br />
about what is the direction we’re going in and that<br />
uncertainty would obviously affect the patients<br />
directly.”<br />
Health insurance companies, which would be freed<br />
from some of the already existing regulations limiting<br />
their profits, would have to readjust their thinking about<br />
how best to compete. While companies would continue<br />
to make money by carefully selecting which customers<br />
to cover and would adjust their business accordingly,<br />
many insurers say the health care market is deeply<br />
flawed. “The system doesn’t work,” said Mark T.<br />
Bertolini, the chief executive of Aet<strong>na</strong>. “Something has<br />
to be done.”<br />
The law, “while imperfect in a number of ways, was a<br />
step forward,” Mr. Bertolini said.<br />
If the law is overturned, some said Congress and the<br />
states could act to restore some of the lesser-known<br />
provisions. For example, the law reauthorized the<br />
Indian Health Care Improvement Act, which fi<strong>na</strong>nces<br />
tribal health programs, allowed the Food and Drug<br />
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