Posted on Sun, Jul. 01, 2012

If you get sick, you can go to the doctor. Most Americans take that for granted, but for the millions of Americans who don’t have health insurance and don’t qualify for either Medicaid or Medicare — including 31.8 percent of Miami-Dade residents and 24 percent in Broward — there has not been any such guarantee.

Thursday’s historic decision by the U.S. Supreme Court upholding the central features of the Patient Protection and Affordable Care Act is a victory for them.

Americans can rely on healthcare insurance without having to worry about a cap on expenses. The law bars insurers from revoking policies after people get sick.

It protects a provision that some 3.1 million young adults have already taken advantage of by allowing them to remain on their parents’ plans until age 26.

And it’s good news, as well, for some of the most at-risk Americans: The act prohibits the denial of health insurance to anyone with a pre-existing condition.

Those who already have insurance through their place of employment will be able to keep it, but there’s a benefit for them, too. Insurers have been shifting the cost of treating the uninsured to everyone already covered, but the reform act puts an end to that.

In order to make all this happen, the law had to require that healthy people pay into the pool. Under the law, they must either purchase an insurance policy or pay a fine.

This is the mandate that Chief Justice John Roberts, writing for the 5-4 majority, upheld in a ruling that relied on the notion that the government’s power to levy taxes covered the mandate.

The court’s ruling does not put an end to the questions over health insurance, however. The law requires states to set up insurance exchanges that allow individuals to buy coverage. If the states don’t do so by Jan. 1, the federal government will do it for them.

Unfortunately, Gov. Rick Scott, an ardent opponent of the healthcare law, and the state Legislature have done everything in their power to stop it from taking effect.

Florida has not only failed to set up an exchange, but has also rejected federal planning money.

Medicaid is another major issue affected by the law and the court’s ruling. The sweeping changes the law envisions allow those with incomes from 133 percent to 400 percent of the poverty level to obtain federal subsidies to buy private insurance.

But it also requires states to expand Medicaid to cover the working poor, those whose income was less than or equal to 133 percent of the federal poverty level ($25,390 for a family of three). The majority threw out a provision obliging the states to comply with this provision or risk losing all Medicaid funds, but it remains an option. If Florida chose not to comply, it would unfairly stigmatize many who most need health protection.

Gov. Scott should read the handwriting on the wall. The Affordable Care Act is the law of the land. It’s far better for the state to set up its own exchange than to allow the feds to do it. Ultimately, the expansion will have a cost, but for the first three years the federal government would pick up 100 percent of the additional outlays. Expanding Medicaid to the working poor is a matter of fairness.

Uncertainty over Medicaid troubles officials at Jackson Health System, who will see more paying customers but lose millions in federal aid for low-income health providers. Still, as Jackson CEO Carlos Migoya said, the worst outcome of the legal fight over the Affordable Care Act would have been the status quo. Thanks to President Obama’s vision, that, fortunately, is no longer an issue.