Academic journal article Journal of Law and Health

Presidents Adams and Jefferson, with a Few Others, Discuss Health Reform with a Disabled Lawyer

Academic journal article Journal of Law and Health

Presidents Adams and Jefferson, with a Few Others, Discuss Health Reform with a Disabled Lawyer

Article excerpt



Pondering two busts of Presidents Adams and Jefferson, (1) a Washington lawyer with a disability is suddenly interrupted from the reflection. (2) Long-time colleagues and passionate, if sometimes disgruntled, friends, (3) Presidents Adams and Jefferson request that they adjourn to a local tavern for dinner. (4) The Presidents propound an inquiry while imbibing a Fuller's London Porter. (5) What are the issues with which the American people are grappling? The size of, as well as the proper role of, government is as much an issue for the American people now as it was in the Presidents' time. (6) Specifically, Washington lawyers still constitute strategic actors within executive, legislative, and judicial forums. This Article discusses the interaction of Washington lawyers in these branches of government regarding healthcare law and policy. (7) The Article discusses how access to technology inhibits a disabled lawyer from equal involvement in the governmental process. (8) The Article also thematically presents the position Presidents Adam and Jefferson would likely harbor on healthcare reform. Public discourse must be more intellectual like that of the founding generation, (9) and it should be improved in its civility. (10)


The United States spends, as a percentage of Gross Domestic Product, more on healthcare services than any other industrialized nation, with annual expenditures equaling $1.6 trillion. (11) Since 2008 when President Obama campaigned on healthcare reform, (12) and since 2009 when he sought the enactment of healthcare reform, (13) health law and policy, namely healthcare reform, has been the subject of copious debate. (14) President Obama signed healthcare reform into law on March 23, 2010, now in its second anniversary. (15)

The Patient Protection and Affordable Care Act, (16) as amended by the Health Care and Education Reconciliation Act of 2010, (17) (hereinafter "healthcare reform" or "the Act," respectively) has been the subject of regulatory or litigious action and conflict within the three branches of government. (18) Healthcare reform has the affect of attempting to address issues of quality, access, and cost. (19) The purpose of the complex omnibus statute is to address flaws with health insurance, including the many millions of "uninsured Americans and the escalating costs they impose on the health care system." (20) Healthcare reform imposes myriad new mandates on individuals, states, and the private sector, providing for or attempting to provide for: (1) expanded health insurance to the uninsured; (2) reduced spending in such federal health insurance programs as Medicare; and (3) substantive and extensive changes in the private health insurance industry. (21) By 2019, when all of the healthcare-reform provisions will be in effect, an additional 32 million people will purportedly have health insurance coverage. (22)

The Individual Mandate, a principle integral to healthcare reform, (23) requires all citizens and legal residents to carry health insurance. (24) Beginning after 2013, if an individual violates this requirement, he or she must pay a monthly penalty of $7.91 per family member (not to exceed $285 per family). (25) Starting in 2014, individuals who are required to have insurance can either keep employer-based health insurance or benefit from new state exchanges that will be established by each state or by a regional coalition of states. (26) "Health insurance Exchanges are [the Act's] attempt to address historical flaws in the individual and small-group health insurance markets." (27) State operated exchanges will be systems through which private insurers provide plans. (28)

Not all individuals are eligible for the exchanges. (29) The self-employed, those who work for employers with less than 100 employees, and individuals who are retired but not eligible for federal insurance programs, can participate in the state exchanges. …

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