Adjunct Professor of Healthcare Services, Policy, and Practice
Academic Development Director, Executive Masters in Healthcare Leadership Program
Contact: David Orenstein: 401-863-1862
“If the entire program is repealed, chaos will ensue. Millions of people and millions of dollars will be thrown into motion. The adult children 26 years and younger who thought they would be covered by their parents’ policies will be scrambling to get coverage. Some 12 to 16 million Americans with pre-existing conditions will sooner or later become the uninsured and undoubtedly increase the number of bankruptcies due to health care emergencies.
“I believe the fact that the law requires that 85 percent of health insurance premiums must be spent on health care and not contribute to profits or used to defray promotional expenses has greatly mitigated the rate of healthcare inflation. Over the last two years, this rate has been the lowest it has been in 50 years. When Massachusetts instituted a similar system, the Commonwealth lost its distinction of providing the most expensive health care. Massachusetts went from number one to number seven. With the elimination of the shifting of nonhealthcare delivery costs to consumers, Massachusetts now has a healthcare inflation rate lower than the national average.
“Mandating health insurance coverage is not a new idea. George Washington required employers to provide hospitalization insurance for sailors. ... It is truly a national embarrassment that as the world’s leading and richest nation, we did not continue this tradition and now have so many citizens without health insurance and without access to healthcare services.
“As an economist, I am hopeful that this law will continue to exist so that a more rational health insurance market will be created, with 30 million people who have a greater ability to buy health insurance.”
Florence Pirce Grant Professor
Department of Health Services, Policy and Practice
Contact: David Orenstein: 401-863-1862
Mor’s research focuses on the organizational and health care delivery system factors associated with variation in use of health services, and outcomes experienced by frail and chronically ill people. Areas of study include the quality of nursing home care, Medicare funding for post-acute care, the determinants of hospitalization, disease management for cancer patients, and age and racial discrimination in health care treatments.
Of the three issues the court is considering — whether to consider the case, the individual mandate, and the Medicaid expansion — the third is a “sleeper” that could be the most difficult, Mor said. “The big expansion of Medicaid is how we are going to cover more people with health insurance in America.” Doing away with the individual mandate would certainly upset a lot of stakeholders, especially insurers who can no longer turn away sick people, but in many states the health care law could still survive, Mor said. If the court throws out the intention to expand Medicaid to 133 percent of the poverty line, however, it would in principle endanger previous Medicaid expansions, too — for pregnant women, for example. In states like Texas and Mississippi, which already have high levels of uninsured, the loss of the Medicaid expansion could leave many people without a means of getting insurance, and current benefits could end up being rolled back. Mor said he would be very surprised if the court did that, however.
In addition to his academic duties, Tung is a practicing neuroradiologist at Rhode Island Hospital and an active participant in the Rhode Island Health Care Commission subcommittee of healthcare providers:
“The arguments before the U.S. Supreme Court are a watershed moment for the Affordable Care Act. This law requires almost all individuals to obtain health insurance or to pay a financial penalty. It also requires health insurers to provide insurance to individuals regardless of pre-existing illness and to pay for preventative care. Finally, the law expands Medicaid, the federal health insurance program for the poor, and provides subsidies to low-income people. The individual mandate is a key provision of the Affordable Care Act. This mandate requires all Americans to obtain healthcare coverage. The question is whether Congress overstepped its power to regulate interstate commerce by enacting this provision of the law. What would happen to the Affordable Care Act if the individual mandate were to be struck down by the Court? Opponents of the law argue that the entire law should fall; supporters argue that only the provision prohibiting the insurance companies from covering people with pre-existing illness depends on the integrity of the individual mandate. I think, in a nutshell, if the individual mandate is overturned healthcare reform will move forward in a far less dramatic fashion. The final issue is whether Congress has the right to compel states to expand Medicaid. Since the Affordable Care Act is a critical issue in the 2012 Presidential campaign, the decisions of the Supreme Court on these issues, which likely will be announced in June, will undoubtedly have far reaching implications. In Rhode Island, even if the individual mandate falls, I am confident that healthcare reform changes, led by the lieutenant governor’s HCR Commission, will move ahead in many important ways: medical homes, insurance exchange and insurance reforms.”
Wilson is interested in how structural features of healthcare systems affect the interactions between physicians and patients and how those interactions in turn affect patients’ health outcomes. To study these relationships he has studied patients with chronic conditions such as the elderly, persons with depression, and persons with HIV. Recently his research has focused on understanding and improving the quality of medication prescribing and medication management.
On the arguments before the U.S. Supreme Court, Wilson points out that while the individual mandate’s constitutional fate hangs in the balance, the national problem it was intended to solve is real and needs to be fixed: “For those who don’t have a job or those whose employer doesn’t offer employer based insurance (which employers are not required to provide), the only place to turn is what is called the individual insurance market, and there is broad agreement that the individual insurance market in the United States is a failure.”