Cities and counties are deciding if they want North Carolina to join other states in suing the federal government over the new Patient Protection and Affordable Care Act.
As details of the new health care law begin to surface, concerns are rising among local officials about the constitutionality of the legislation and hidden costs awaiting residents in years to come. The constitutional question arises around the bill’s mandate forcing insurance to satisfy specific coverage requirements. Can Washington coerce a local government to buy policies only from providers approved by the federal government? The fiscal worry surrounds the expenses public agencies will incur for the health insurance they purchase for their own employees.
Carolina Journal has been able to find no research projecting the fiscal impact of the federal law on health insurance plans provided by public employers. Estimates of the legislation’s costs have instead focused on public assistance programs including Medicaid and private health insurance premiums.
Even so, cities and counties are wise to be worried, said Joe Coletti, director of health and fiscal policy studies at the John Locke Foundation. He said local governments across the country must decide whether their health insurance coverage meets federal standards. If not, counties and cities will have to pay hefty fines imposed through the new law beginning in 2018. This cost, in turn, will be passed on to local taxpayers in the form of higher taxes.
“This is a constitutional question,” Coletti said. “If the federal government is telling the local government what to provide, does that mean the federal government is overstepping its bounds? That’s a constitutional issue, because one form of government cannot tax another.”
Unfunded mandate
Meantime, Sanford Mayor Pro Tem Mike Stone said the federal government has added a new unfunded mandate — a program that will affect local governments while offering agencies no means to pay for it.
“Clearly the new health care plan has well-meaning intentions, but the actual implementation isn’t fully understood by cities and counties at this point,” he said. “Cities will have to consider that insurance rates will skyrocket in cost due to the fact that all individual premiums will be essentially the same regardless of risk.”
To date, 20 states have joined in a federal lawsuit challenging the constitutionality of the law.
Duplin County is hoping North Carolina will become one of those states. Recently, county commissioners passed a resolution by a 4-2 vote urging Attorney General Roy Cooper to join in a lawsuit “in order to protect the freedom of North Carolinians and the sovereignty of our great state.”
Republican Commissioner Harold Raynor submitted the resolution, which he, two Democrats, and an unaffiliated commissioner supported.
“We’re going to do what we can and we’ve got some pretty prominent folks behind us,” he said. “We’re going to give it a try and fight this thing. We want to be responsible and proactive.”
Raynor said there isn’t a lot of public support for the resolutions at the present time, but he believes that’s because most the people don’t understand the ramifications of the bill. Once the information concerning the ultimate cost of the bill begins to surface, however, he feels most people will change their minds.
“It will get interesting in the next 12 months,” he said.
Jones asks Cooper to join lawsuit
U.S. Rep. Walter Jones, R-3rd District, also sent a letter asking Cooper to join the lawsuit. Jones favors health care reform, but says Congress rushed through the process too quickly. “So many in the House and Senate were saying ‘Slow it down, slow it down so we can understand all the aspects of the bill,” he said. “We need to take it one step at a time and deal with the problems in health care one at a time.”
He said if nothing is changed in the existing law, then counties will have to raise their constituents’ taxes.
“I didn’t vote for it,” he said. “I know many people that feel some aspects aren’t constitutional. It can become a legal issue. There are many questions that need to be answered by the court. I’ve asked our attorney general to fight this.”
To date, Cooper has not agreed to participate in that lawsuit. In a memorandum to Gov. Bev Perdue dated April 16, Cooper stated, “After careful consideration, I have concluded that North Carolina will not join this lawsuit. The United States Supreme Court has held that duly ratified acts of Congress are presumed to be constitutional and it is clear that Congress has extremely broad authority under the Commerce Clause of the United States Constitution.”
Mark Hall, professor of Law and Public Health at Wake Forest University School of Law, agreed.
“Federal reform invites states to play a key role in designing key elements of the insurance market, such as high risk pools and the insurance exchanges,” he said. “This critical role for the states is in the great spirit of federalism on which our country is founded and that underlies the claims of states’ rights.”
Hall said it is contradictory to attack the very law that protects states’ rights. He said it’s inappropriate for a state to sue a law as unconstitutional at the same time they are trying to implement it.
Jones disagreed. “This is a massive expansion of the [federal] government into the lives of the American people,” he said. “I’ve met with doctors, nurses, health care workers, hundreds of them, and almost every one of them said there are aspects of health care that need to be reformed, but it doesn’t need more government.”
Jones said important changes to the law could not happen until more conservatives are elected to Congress.
“That’s when I think we’ll see a rebuke of certain aspects of the bill,” he said. “We’ve got to dismantle this big bill. The costs have not been fully calculated or understood. Information keeps creeping out on this thing every day, every week, every month. It’s an intrusion of the federal government. It’s just not going to work.”
Karen Welsh is a contributor to Carolina Journal.