In the days since the U.S. Supreme Court substantially upheld the constitutionality of the Patient Protection and Affordable Care Act, there has been much analysis of the court's reasoning, along with speculation about its likely impact on Americans and the economy. But what about its potential effect on the Jewish community?
Of course, much of ACA will affect all Americans, not only Jews — notably the affordable health insurance coverage that will become available to many millions who don't have it now. Other changes have the potential for improving the quality of our health care while restraining increases in its cost.
But it is likely to affect the Jewish community on two interrelated levels:
· On the individual level, directly and indirectly through our family members, friends, co-workers and potentially as business owners or investors;
· On the institutions of the organized Jewish community that provide some form of health care for acute or chronic conditions, including hospitals, mental health providers, nursing homes and social service agencies.
What makes us different in this context? Demographically, the Jewish community is somewhat older, wealthier (except for our elderly) and better educated than the American average. Consequently, we are likely to be disproportionally affected by changes in health law and regulations that affect the elderly and unemployed college graduates (for example, the ACA's provision, which already went into effect, that enables children under the age of 26 to remain on their parents' health insurance policies).
At the charitable level, our communal institutions depend more heavily than others on philanthropic contributions to pay the costs of unreimbursed care to impoverished individuals and families.
Since elderly persons are particularly susceptible to chronic illness, which requires expensive long-term care, and since this care for people who cannot afford it is primarily paid by Medicaid, these individuals and our community could benefit from the ACA enhancements to that system.
However, it remains to be seen whether these enhancements (or other Medicaid support for the disabled and low-income children and adults) will actually materialize. The Supreme Court's ruling that states don't have to participate in the expansion of Medicaid as called for under the health care legislation appears to increase the likelihood that some states will elect not to participate. Indeed, the governors of Pennsylvania and New Jersey have expressed strong reservations about doing so.
Meanwhile, the agencies in the Jewish Federation system that currently provide unreimbursed care to patients without insurance will likely find more of them able to pay, whether through the expansion of Medicaid to those whose incomes do not exceed 133 percent of the federal poverty level or through the other types of insurance that are projected to become more affordable. However, it's possible that the dollars saved by Jewish agencies could be offset by the impending cuts in Medicare funding.
I am not a completely unbiased commentator, since I benefit from ACA's phase-out of the notorious Medicaid Part D "doughnut hole," and will probably receive more of its benefits as I continue to age. But won't most of us benefit now or in the future from one or more of the health care legislation's provisions?
On the down side, I — and perhaps many of you — could be subjected to increased financial obligations that may not be offset entirely by the promised financial rewards. For example, I will be required to pay an increased Medicare tax if my legal and mediation practice should generate more income than specified in the ACA, and the firm with which I am affiliated will become subject to a penalty if the number of its employees exceeds 50 and we don't offer them health insurance.
Personally, I find these small prices to pay for a healthier community, a goal that we should all be able to support regardless of our politics.
James Rosenstein is a co-chair of the Jewish Federation of Greater Philadelphia's Coordinating Council for the Elderly and recently served as a co-chair of the Health & Long-Term Care Work Group of the Jewish Federations of North America.