How will the Supreme Court ruling on health care affect Washington state?


The United States Supreme Court has ruled the “penalty” imposed for not purchasing a government-approved health insurance policy is actually a “tax.” Consequently, Congress has the power to force every person to purchase health insurance or pay the tax. The Court found the Affordable Care Act (ACA) constitutional, and it is the law of the land.

What does this mean for our state? The most recent local poll shows the vast majority of Washingtonians oppose the individual mandate (64 percent opposed versus 33 percent in favor). The people of Washington also oppose the entire health care law by 46 percent to 41 percent.

There are currently 900,000 seniors enrolled in the Medicare program in Washington state. These seniors often have a difficult time seeing a doctor because of poor provider reimbursements from Medicare. To see a Medicare patient, a doctor receives only about 70 percent of what private insurance pays. Even so, the ACA cuts $580 billion from the Medicare program over the next ten years, and the vast majority of these cuts are taken from hospital and doctor payments. As a result our seniors will find getting access to a doctor is even worse under the ACA.

Coulee Medical Center ER and Walk-In Care

Washington state has 1.2 million people enrolled in the existing Medicaid program. Medicaid payment to providers is only 40 percent of the amount private insurance pays. Most doctors are not able to cover their overhead with Medicaid reimbursements, let alone earn an income. The ACA will add 320,000 to 520,000 more people to Medicaid in Washington state. Although on paper they will have “health insurance,” Medicaid enrollees will experience limited access to care, just like our current Medicare patients. The expansion of Medicaid will also add a new financial burden to Washington state taxpayers.

The ACA also requires employers with fifty or more employees to provide health benefits or pay a tax. The tax is set so low, however, that many, if not most, employers will simply pay the tax and stop providing health care benefits. Based on national estimates, at least 280,000 workers in Washington state will lose their employer-sponsored health insurance in the next few years.

Almost one half of the funding for the ACA will come from new taxes on insurance premiums, health insurance companies, drug manufacturers and medical device makers. These new taxes will be passed on to anyone in our state who uses health care. In other words, costs will go up for everyone.

Proponents of the ACA argue the law is already having beneficial effects. Small employers can now get a limited federal tax credit if they provide health insurance. Yet because of the regulatory burden, less than 10 percent of employers who qualify have applied. Young adults, under age 26, can now use their parents’ health insurance. This is almost a moot point because the vast majority of people in this age range are healthy and almost never need insurance anyway.

Proponents also emphasize the preventive care mandated in the ACA. Yet many, if not most, insurance plans already include preventive care. Medicare patients will now have more of their drug expenses covered. However, the overall drug savings to seniors is a small amount compared to the $580 billion cut the ACA makes in the overall program.

Elected officials should instead focus on workable solutions by putting patients in charge of their health care. The use of health savings accounts, high deductable insurance plans, more competition in the insurance market by allowing interstate purchase of insurance and meaningful reform to Medicare and Medicaid would go a long way toward patient control of their own health care.

At the time of our founding, James Madison wrote that the powers of the states are “numerous and unlimited” and the powers of the federal government are “few and defined.” The Supreme Court ruling shows there seems to be no boundary to the power of the federal government and the liberty of every person in Washington state has been reduced as a result. Unfortunately, this all occurs without addressing the rising cost of health care or improving access.

Dr. Roger Stark is a retired cardiac surgeon and a health care policy analyst at Washington Policy Center, a nonpartisan policy research organization in Washington state. He is the author of the book “The Patient-Centered Solution: Our Health Care Crisis, How It Happened, and How We Can Fix It,” available at


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