The Florida judge who declared the federal health care reform law unconstitutional "updated" his own ruling yesterday and urged that "the sooner this issue is decided by the Supreme Court, the better off the entire nation will be."

On January 31, 2011, U.S. District Judge Roger Vinson (Pensacola, Florida) determined that the “individual mandate” provision of the Patient Protection and Affordable Care Act (PPACA) is unconstitutional and declared the remainder of the Act void because it was not severable.  The defendants (the Obama administration) filed a motion to clarify with the court, suggesting that there would be adverse consequences from an immediate halt of implementing the Act given that many provisions are now in effect and that several other district court judges have upheld the law.

Yesterday, the judge stated that while his original order “was as clear and unambiguous as it could be, it is possible that the defendants may have perhaps been confused or misunderstood its import.”  He did however, treat the clarification as a stay from his original order and as such granted it.  He conditioned the stay upon the defendants filing their anticipated appeal within seven days of his order, either in the Court of Appeals or with the Supreme Court. He chastised the administration that it had been more than a month since his order and the defendants had not filed their notice of appeal.

Twenty six states, including Indiana, are party to the lawsuit. On Wednesday at the Indiana Statehouse, a joint meeting took place with the House and Senate Insurance and Health Committees. Attorney General Greg Zoeller commented on PPACA and offered his view that in those states that were party to the suit the Act was unenforceable. Those comments do not apply a day later as Judge Vinson’s stay to his original order was granted. 

Recently, the governor’s Interagency Task Force on Health Care Reform conducted three separate forums: one each for employers, health providers and health insurers. Each industry was given the opportunity to provide comments about the Patient Protection and Affordable Care Act (PPACA) and the insurance exchange (the mandated entity at the state level that will market health care products and determine eligibility). While the administration was looking specifically for information to assist it in its decision-making process regarding the exchange, the forums also allowed each industry to vent about its frustrations with PPACA.

The Indiana Chamber commented on the impact on health insurance premiums due to no lifetime limits and coverage of children up to age 26. Further concerns were made known about the ability (or lack thereof) to maintain grandfathered status on existing health plans, the possibility of employers “dumping” employees into the exchange and the significant cost concerns related to the new enrollees in the Medicaid program under PPACA. David Wulf, chairman of the Chamber’s Health Care Policy Committee, provided his perspective as vice president of administration at Templeton Coal Company, specifically sharing his concerns about PPACA.

Since then, the Chamber has had ongoing discussions about the exchange and has been asked by the Department of Insurance to look into the idea of a defined contribution plan within the exchange. Utah created the first defined contribution plan that allows employers to contribute a dollar amount to an employee that purchases insurance through the exchange. Eventually, the employee would be able to combine federal subsidies, employer contributions and spousal employer contributions to purchase an individual policy based upon a group rate through the exchange. Several states are looking into the idea and the U.S. Chamber of Commerce is in support of the program.

While many agree that health care reform is necessary, the level of disagreement on the current proposals in Washington is extremely high. Let’s hope that reasonable debate and compromise will lead to a sensible solution.

No matter how that plays out, one aspect that needs to stop is the all-out attack on the insurance industry. House Speaker Nancy Pelosi (D-California) has made insurance companies the primary culprit. "It’s almost immoral what they are doing," Pelosi told reporters, adding, "Of course they’ve been immoral all along in how they have treated the people that they insure. They are the villians. They have been part of the problem in a major way."

President Obama, in discussing the public option for health insurance, said, "We want to keep the insurance industry honest" and that can be done by having a public option that will compete with private insurers.

I understand that many folks don’t like the fact that insurance companies make a profit. Profit in this country, for some unknown reason, has become an evil pursuit. In a recent Fortune magazine ranking of industries, health insurers ranked 35th with a 2.2% profit margin. (The larger numbers cited for earlier in the decade were primarily a result of significant consolidation in the industry).

Let’s face it: Either the employee-based system of using private insurance to provide for our health care needs is a good thing or it’s not. If it’s not, then go to the public plan and be honest with the American people. If it is good, let’s promote an environment that allows insurers the ability to compete and make a profit while holding them accountable to improve administrative efficiencies.

Without the ability to underwrite business, an insurance company can’t make a profit. That ability is what has afforded us the best policy benefits and coverages in the world. It also has resulted in private initiatives between insurers and employers to address some of the system’s runaway costs. Let’s work together to continue to do a better job in that area instead of simply casting blame on insurers.