The nation's highest court is about to judge the president's signature legislative achievement — and it's not just politicians who are invested in the outcome

The Week
MARCH 13, 2012, AT 6:45 AM
by Bill Frist, MD

Is the new health care law constitutional? You might think it doesn't matter — or at least, that it doesn't matter to you. But the fact is, the Supreme Court's decision on President Obama's Affordable Care Act (ACA) will almost certainly affect you directly.

How, exactly? For one thing, the court's decision could play a key role in determining our next president and possibly your next congressman. If you are poor, the ruling may decide whether or not you have coverage. If you are not poor, it will impact how much you pay for health care. If you own a small business, it might determine if you must purchase health insurance for your employees. And if you work for a large business, it may determine whether you still receive your insurance from your employer. If you're a doctor, it will likely affect your reimbursement. If you're a patient, it will determine your benefits.

On March 26, 27, and 28, the Supreme Court will hear extensive oral arguments on the constitutionality of the ACA. This is the culmination of 26 states filing suits in federal district courts and opinions from seven federal appellate courts. A final written opinion likely will be delivered in June, 18 months before the individual mandate kicks in and just five months before the presidential election.  

If the individual mandate is ultimately deemed constitutional, then for the first time in our history, you will have to purchase a product to live in America.

The ACA is a highly charged law that, according to the latest RealClearPolitics average, is viewed unfavorably by half of Americans. The law essentially does two massive, controversial things: (1) Mandates that individuals purchase health insurance coverage, and (2) expands Medicaid by 16 million enrollees. This expansion means almost one in four Americans will be on Medicaid, the government program originally intended for our poorest citizens. If you don't purchase insurance, you will pay a fine of $695 per adult and $347 per child.

Together, these provisions will reduce the uninsured by 32 million, but will still leave an estimated 23 million individuals uninsured in 2020.

The focus of the Supreme Court opinion will be on the constitutionality of these two issues, though two additional items will also be considered. One is whether the entire law falls if a part of it, such as the mandate, is ruled unconstitutional, and the other is whether the court has jurisdiction to rule at all now, since the law has yet to go fully into effect.

There is already plenty of discussion on the legal merits of the case, particularly as it regards the taxing power and the Commerce Clause. But what are the very real implications of the upcoming ruling? Here is what to look for:

1. If the court upholds the individual mandate, it will take effect 18 months later — unless Congress acts to repeal or postpone it (which won't happen as long as Obama is in the White House). If the individual mandate is ultimately deemed constitutional, then for the first time in our history, you will have to purchase a product to live in America.

2. If the individual mandate is ruled unconstitutional, the court will then decide whether to let the rest of the law stand, including the expansion of Medicaid and the largely popular individual insurance reforms. If the rest is left intact, the Congressional Budget Office projects that 16 million of the 32 million Americans expected to gain insurance under the law would be ineligible for the new coverage and that non-group, individual premiums might increase 15 to 20 percent. It would then be up to each state to decide whether or not to adopt the individual mandate.

3. If the court decides that the Medicaid expansion is constitutional, it will take effect in 2014 — unless Congress acts to postpone, repeal, or not fund it. But if the expansion is left intact, with almost a quarter of all Americans covered by Medicaid, the program would grow to include a portion of the middle class.

4. If Medicaid expansion is overruled, coverage will remain at current, varying state levels, and an estimated 16 million low-income individuals will not be able to take advantage of the new Medicaid coverage that would have begun in 2014.

5. Politically, if the new law is judged constitutional, Democrats will celebrate the judicial affirmation of the spirit and substance of the historic reform, illustrating President Obama's leadership. Republicans would fan the existing flames of unpopularity among the majority of Americans, citing federal government overreach, rallying around an election call for repeal as they did in 2010. If any part is unconstitutional, the bases of both parties will be emboldened to make health reform the defining issue, after the economy, in the elections in November.

This one is worth following. It will be a game-changer. And not just for the politicians and pundits in Washington. It's a game-changer for you, too.

Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books. Learn more about his work at BillFrist.com.

Over the past two weeks, I have continued to work on the research paper on the status of the Framework Convention on Tobacco Control (FCTC) supply strategies in the African Region as reported by the Parties to the Convention. My plans to have the first event of the employee community service program in March have been stalled. We also had an unfortunate incident in Brazzaville on the 5th of March. A fire started at a military arms depot and set off a series of explosions killing more than 150 people and leaving thousands displaced. This sad event was felt at the office as many workers lost their homes. As a result, things were a bit slow at the office this week. The event has been postponed to April to allow time for things to settle back down.

The Week

Americans hear a lot about decline. Declines in manufacturing, fading productivity, plummeting home values, spiraling deficits, and sadly, dwindling faith in the American dream.

Let me tell you where I see the worst decline — but also our nation's best hope.

One in five kids in America lives in poverty. That's 20 percent of America's future left behind. Left to drop out of high school, suffer through shorter lives, commit crimes, have a child in their teens — and then perpetuate this cycle with their own children.

It doesn't have to be like this. Imagine an America with 20 percent fewer high school dropouts, 20 percent fewer teen pregnancies, and a 20 percent reduction in chronic health problems like diabetes and hypertension. Picture an America with a workforce that is 20 percent more productive and packed with 20 percent more qualified job applicants. Dream of an America with 20 percent more middle-class citizens. We would be a country poised to soar.

So how do we get there?

The fastest route out of poverty lies with education. With better education, kids live longer, earn more, wait longer to have a child, and are less likely to commit a crime. More importantly, these benefits pass on to their children, snapping the cruel cycle of poverty.

Poverty, especially during formative early years, can be an enormous hurdle for a child's development. At U.S. schools where less than 10 percent of the student body is impoverished, reading scores rank first in the world. Yet these same scores for U.S. schools where 75 percent or more of the student body is impoverished rank 45th.

In a country with a failing K-12 school system, is it really possible to improve education for impoverished children? Yes, and here are three ways: Providing a boost for kids, lending a hand to parents, and pulling together crumbling neighborhoods.

First, we must start young, much younger than you might think. Most poor children are already behind on their first day of school. At age 4, poor children are 18 months behind developmentally, and without access to early education, kids are 25 percent more likely to drop out of high school.

Communities must target vigorous pre-K education and daycare programs for the one in five kids whose parents simply can't afford them. Soft skills such as sharing, negotiation, reason, and concentration are instilled between finger-painting and building with blocks. The critical ingredient of high expectations is introduced. These are not luxury goods. They are essential in making communities more prosperous. When states think about job training, they should begin with pre-K education.

Second, a renewed focus on parents can be the lever to pry kids from a life of poverty. For example, Nashville's Martha O'Bryan Center provides the education and resources needed for parents to raise healthy families. Parents learn positive parenting skills, tools for making their children better learners, and smart exercise and nutrition strategies to keep kids healthy. These lessons, as simple as immunization and reading to kids at night, can also delve into more substantive issues like child maturation and brain development.

Parents learn that their role is not just to put food on the table, but to act as their child's first teacher, role model, and advocate.

In addition, an educated parent is more likely to elevate a child from poverty. A parent who earns a GED provides for his or her family better, giving kids that extra boost that can make all the difference. Learning soft skills and simple trades, such as basic culinary training, can help a parent get that first job, propelling the family to a brighter future.

Third, communities play a role. Last year, Nashville began an innovative strategy providing "cradle-to-career" services to 6,000 children in one of the city's most challenging neighborhoods. The Nashville Promise Neighborhood, modeled after the successful Harlem Children's Zone, is a public-private partnership uniting government agencies, nonprofits, schools, churches, and neighbors to provide continuous, coordinated health and education support.

Instead of uncoordinated institutions attacking different problems in piecemeal fashion, the most pressing needs are attacked with proven solutions. A dependable support network is built for all residents, including early education, expanded access to learning technologies, and family support including day care. Make no mistake, this is an ambitious program and requires total buy-in, but by pulling together, entire communities can pull themselves up.

To get America back on track, we must help those who have fallen behind. Only with our nation's full strength and commitment can we tackle the trends that drag us down.

How do you think America can fix its child poverty problem? Tell us on Twitter using the hashtag #ChildPoverty.

Brazzaville!!!!I can’t believe I am finally here! After weeks and months of applications and planning and finally a twenty-two hour journey from Johnson City in Tennessee, I have arrived and I am ready to do some public health. Driving into town from the airport, the driver with the World Health Organization, the Organization with whom I would be working with during my three month stay, showed some of the remarkable places in town.
Death and dying are never easy to deal with as a physician. However, that process is different in Africa. Morbidity and mortality are more commonplace and seem to be accepted. Religion is pervasive in all aspects of healthcare: the Wednesday morning chapel service, the preoperative prayers, and the prayers after meetings.
In my third week at Karapitiya Hospital I was introduced to Dr. Kumara, senior lecturer in Surgery. Participating in various surgical cases was what I was most looking forward to on my rotation in Sri Lanka. Walking into the OT I noticed it was quite a different set up from the operating rooms back in the states. Patients were lined up on a bench right outside of the open theater doors with their medical chart in hand.
In my third week at Karapitiya Hospital I was introduced to Dr. Kumara, senior lecturer in Surgery. Participating in various surgical cases was what I was most looking forward to on my rotation in Sri Lanka. Walking into the OT I noticed it was quite a different set up from the operating rooms back in the states. Patients were lined up on a bench right outside of the open theater doors with their medical chart in hand. Some patients were even curious enough to stand and watch the ongoing procedures from the doorway. On the other side of the patient bench was a make-shift PACU where the post-operative patients were still coming out of their anesthesia. Inside the operating theater, there were multiple procedures going on at the same time. In one corner of the room, a woman was having a lumpectomy under local anesthesia. In the center of the room, a man was under general anesthesia having an open cholecystectomy. Finally, off to the side of the room a woman was getting a carpal tunnel release.
I wasn’t sure what to expect when I arrived at Mahamodara Maternity Hospital. The tuk tuk dropped us off outside of what appeared to be fortress walls. We were met by our Duke coordinator and led through the gate, past a building that was in disrepair and dilapidated. We traversed through a labyrinth of crumbling plaster and boarded up windows. There was a smell of mildew lingering in the air. I thought to myself, “Women come here to give birth”? Once we rounded a corner, I noticed an area to my right which looked as if it should have been full of expectant women, but was eerily vacant. It was then I realized what I was seeing was the shell of the Mahamodara which stood during the 2004 tsunami. I stared into the ward, and could imagine this area full of pregnant women and newborns on that day, and could almost feel their terror. I was told the hospital was hit by 3 waves. The first wave destroyed the “fortress” walls that I had seen earlier, but these barriers had lessened the impact to the building. It flooded the first level and knocked out the electricity. The doctors and staff evacuated the mothers and infants, some to higher ground, and others to Karapitiya Hospital. The second wave was estimated between 20-30 feet high. There are many stories of heroic men and women from that day, including one physician who calmly completed a Cesarean section by flashlight after the first wave hit. He then safely evacuated the mother and child. Due to lack of funds to demolish the building, it now stands as a temporary memorial.

Huffington Post

POSTED ON FEBRUARY 3, 2012, AT 9:47 AM

This post is part of a series on childhood poverty in the United States in partnership with Save the Children and Julianne Moore. Moore leads the organization’s Valentine’s Day campaign, through which cards are sold to support the fight against poverty in the U.S. To learn more or to purchase the cards, click here.

More than one in five American children lives in poverty. In my home state Tennessee it is an astounding one in four.

And it’s only getting worse. Less than four years ago, the national number was one in six children. Childhood poverty has increased 18% since 2000, as 2.5 million more children live in poverty today. But those are just cold, hard numbers. It’s what happens to kids who happen to be born into poverty that matters.

Childhood poverty does not just mean a family of four makes below $23,050 a year (it’s estimated that a family needs over twice that income to actually meet basic needs). No, childhood poverty limits access to the simplest, most basic things such as healthy foods, books, the Internet, and a secure place to play, exercise, or even sleep.

It means poor children,nearly half of whom are overweight, grow up with worse health.

It means at the age of four, poor children are already 18 months behind developmentally.

It means without early education programs, poorer children struggle and are 25% more likely to drop out of high school.

It means they are more likely to become teen parents, commit a violent crime, and be unemployed as adults.

It is a sad fact that at birth, one in five Americans today is well behind in the pursuit of happiness. The evidence increasingly points to the fact that once a child falls behind in the crucial early years, they may never catch up.

As a doctor, I focus on the devastating, long-lasting impact poverty has on a child’s health. Simply put, on average, the lower on the “socio-economic ladder” a child falls, the shorter life he will live. Americans in the lowest income category are more than three times more likely to die before the age of 65 than those in the highest income bracket.

For a child, a healthy body, a strong heart, normal development, and progressive learning all require adequate and balanced nutrition. But poor families too often don’t have access to nearby, affordable healthy foods. This stands as a major reason that debilitating chronic conditions like obesity and diabetes disproportionately afflict these impoverished youths.

“Food deserts” are those all too frequent regions of a city or rural areas, wherever poverty may exist, where affordable, healthy, fresh and nutritious foods are nowhere to be found. A 2011 Food Trust Report found that nearly one million Tennesseans, including 200,000 children, live in communities underserved by healthy food-providing supermarkets.

Across America 23.5 million live in areas that lack stores selling affordable, nutritious food. Without access to healthy foods, the cheap, fried, over-processed foods that accelerate the path to obesity become the mainstay diet. And the cause of early death.

This can be fixed. And an effective way to do so is for enterprising grocery retailers to partner with others in the private sector.

For example, just this year the Partnership for a Healthier America secured commitments from seven leading grocery companies to build new stores in areas where they’re needed most. All told, these commitments will bring fresh, affordable foods to ten million people!

Calhoun Enterprises alone will be building ten new stores in Alabama and Tennessee, creating 500 new jobs while figuratively bringing water to these deserts. And forward-thinking companies are increasingly learning that such “social partnering” not only helps the health and welfare of millions of Americans, but it also improves their own bottom lines.

And our government can also be a lot smarter. For many impoverished children, the majority of their meals, breakfast, lunch and even an afternoon snack, come from their schools. In 2010, almost half of all Tennessee students received government-subsidized school lunches. However, for longer life and better learning, we as tax-paying parents and citizens must insist on trading out pizza and tater tots for more whole grains, fresh fruit and vegetables.

Tennessee has recently started on this process. In June of last year, Tennessee, along with Kentucky and Illinois, joined a USDA pilot program for the “Community Eligibility Option,” allowing kids in low-income areas to skip the applications and red tape and receive the benefits of a free, healthy breakfast and lunch at their schools.

Nationally, last month the Obama administration overhauled the school lunch program for the first time in 15 years. Overall the menu will include items with less sodium, more whole grains and a greater selection of fruits and vegetables. Don’t worry, pizza will still be on the menu, but made with better ingredients.

Partnerships that focus on health and nutrition between the public and private sector, and between faith-based and secular nonprofits, will help lift children from the dire consequences of poverty.

America is the wealthiest nation in the world. The most technologically advanced. The most generous and accepting. We are the fastest car on the fastest track. We cannot afford to leave more than a fifth of our children behind.

Subscribe to our newsletter to recieve the latest updates.