If you follow me on Instagram, you may have noticed that I was in D.C. this weekend and had a bit of a lucky day on Friday on Capitol Hill. I’ll be back soon to share more about the conference I attended and some of my D.C. faves, but today it’s all about super(s)heros — real and fictional.
I was in D.C. for the American Medical Association Medical Student Advocacy Conference (MARC). I made new friends from medical schools around the country, learned about important issues facing patients and healthcare providers, and met with Members of Congress and their staff to discuss pharmaceutical drug pricing, graduate medical education, and gun violence prevention.
We are in a time when physicians are increasingly speaking the language of health policy and public health — “value-based care,” “co-payment,” “social determinants of health,” “accountable care organization” — and are increasingly asked by patients to ensure that a particular treatment or procedure is covered by their insurance before moving forward. This dizzying list of health policy terms (and the responsibility of a physician to understand the lingo) just keeps growing. And there is no better time to introduce students to this world than in medical school, when they are primed for learning and not yet overwhelmed with patient care.
The 116th Congress was sworn in at noon on Wednesday, January 3, 2019. The Senate remains under Republican control but the House of Representatives is now firmly in the grasp of the Democratic Party. How the business of legislating flows between the two houses remains to be seen, but it is fair to assume that health policy will be a focus for the new Congress. A Kaiser Family Foundation poll taken before the 2018 midterm election reported that seven in ten voters (71%) indicated healthcare as “very important” in making their voting decision. In comparison, 64% said the same about the economy and jobs, 55% about immigration, and 53% about tax cuts and tax reform.
In case we haven’t met, hi–I’m Molly and I’m a huge fan of School House Rock. Thanks those VHS’, I grew loving the checks and balances built into our government–the legislative branch creates the laws, the executive branch enforces the law, and the judicial branch interprets laws as constitutional or unconstitutional. Today we’re going to focus on the Supreme Court, the ultimate arbiter of the judicial branch. It is comprised of nine Justices with a lifetime appointment who hear and rule on cases that question federal constitutional issues or conflicts between states.
If you’ve been on social media, any news site, or turned on the T.V., you know that Judge Brett Kavanaugh has been nominated to fill the current Supreme Court vacancy. But we’re not going to delve into the allegations of sexual assault against him or the Judiciary Committee majority’s complete disregard for process, order, or even common decency today. No, we’re going to talk about the impact that one person, Judge Kavanaugh, can have on the entire U.S. health care system.Health care has certainly been on the agenda at #SCOTUS in nearly every recent decade as the federal government as gotten more involved in that policy area since creating the Medicare and Medicaid programs in 1965. But even dating back to Jacobson v. Massachusetts in 1905, when the Supreme Court upheld the authority of states to enforce compulsory vaccination to protect the public health, SCOTUS has been involved in health issues.
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. The ACA represents the most significant expansion of health coverage and regulatory overhaul since the creation of Medicare and Medicaid in 1965. At nearly 2,000 pages, the ACA touches nearly every corner of the U.S. health care system to reduce the rate of uninsured individuals and improve access to affordable, quality health care.
Oh, one more thing before highlight the most impactful provisions of the bill. The ACA is the same thing as Obamacare. They are not two separate legislative efforts that overhauled health care. We promise. Tell your parents, friends, and patients. [Watch this Jimmy Kimmel clip if you need to be reminded that people still don’t know the ACA and Obamacare are synonymous]. Ok, let’s get into it.
I’ll be honest, I used to watch the VHS of Schoolhouse Rock: America about once a week as a kid. It might be more than a few decades old, but it’s still perfectly accurate thanks to Article I of the U.S. Constitution, which grants all legislative powers to Congress, including the authority for each chamber to make its own rules for processing legislation. Before we dive in to the nitty, gritty of drafting, considering, amending, reconciling, and voting on legislation, let’s (re)familiarize ourselves with some vital stats about Congress.
I’ve probably seen every episode of Law & Order: SVU at least twice. Those marathons on USA draw me in every time. Police procedurals on television have familiarized a generation to the reading of Miranda Rights, but did you know there’s another type of police power? Let’s pull out our handy dandy pocket U.S. Constitution and take a look at the 10th Amendment. [You think I’m kidding? I’m not, I actually have a well-worn copy that I purchased at the National Archives as an incredibly nerdy 16 year old.]
The 10th Amendment defines the division of authority between the federal government and state governments: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”