Poll: Opinions on Reform Law Remain Unchanged, Knowledge Increases

While public opinion on the federal health reform law has remained static over the last month, more people are aware of the mandate requiring individuals to obtain health insurance or pay a fine, according to the Kaiser Family Foundation's monthly tracking poll, the Wall Street Journal's "Health Blog" reports (Radnofsky, "Health Blog," Wall Street Journal, 4/24).

The Kaiser Health Tracking Poll surveyed 1,210 adults in early April about their views on the overhaul. Three out of four U.S. residents know about the individual requirement, compared with 64% in March -- before oral arguments began in the Supreme Court (Bristol, CQ HealthBeat, 4/24).

According to National Journal, both support and opposition to the law has remained at about 40% since the overhaul was passed. However, 70% of respondents oppose the individual mandate (Sanger-Katz, National Journal, 4/24). The poll also found that the partisan gap in views of the health reform law is growing, with 70% of Democrats supporting the overhaul, compared with just 7% of Republicans.

When it comes to court proceedings surrounding the act, the survey found that:

• 31% of all respondents are confident in the justices' ability to make decisions based on legal analysis rather than political ideologies, compared with 23% in March;
• 43% of Republicans have "a great deal" or "quite a lot" of confidence in the court, an increase of 19 percentage points over March; and
• 29% of Democrats have confidence in the court, the same as in March (CQ HealthBeat, 4/24).

Supreme Court Decision Could Mean Third Party, Courts Decide Fate of Remaining Provisions

In related news, legal experts fear that if the Supreme Court strikes down only part of the federal health reform law, it could result in the court appointing a third party to sort through the remainder of the law or at least another year of legal proceedings before the rules of the U.S. health care system are decided, Politico reports.

During oral arguments in the case, Justice Stephen Breyer touched on the idea of a third party when he asked Paul Clement, the lead attorney for the plaintiffs, if the court should "appoint a special master" or "go back to the district court?"

According to Politico, a "special master" would be responsible for sorting through the 2,700-page law under the justices' supervision.

Meanwhile, if the Supreme Court sent the case back to the 11th Circuit Court of Appeals, the appeals court then could hand it off to a district court. District courts can consider factual questions, such as how essential the individual mandate is to the overhaul's other provisions.

A third possibility is that the justices strike down the individual mandate and order Congress to rewrite the law.

Despite those options, legal experts believe the Supreme Court has a strong interest in making a decision quickly and avoiding dragging the courts too far into a case that is fundamentally Congress' job (Feder, Politico, 4/23).

Experts Concerned Striking Down Overhaul Could Undo Medicare, Affect Entire System

In related news, many health experts worry that striking down the entire health reform law could put Medicare at risk, NPR's "Shots" reports.

The overhaul adjusted payment rates for nearly every type of health care provider who treats Medicare beneficiaries, according to "Shots." Sara Rosenbaum, a professor of health law and policy at George Washington University, said that if the law is found unconstitutional, all of the changes made under the health reform law do not "exist anymore because the law doesn't exist." She added, "You have agencies sitting on two years of policies that are up in smoke. Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid." That lack of payment could affect the entire health care system, according to "Shots."

Gail Wilensky, former head of Medicare and Medicaid, said in the past CMS has faced similar small-scale experiences when Congress has failed to fix a problem in the Medicare formula for paying doctors and caused brief lapses in funding. However, this "would be much bigger. And it would be extremely disruptive," Wilensky said (Rovner, "Shots," NPR, 4/24).