Health Reform on Primary Care, Its Constitutionality

After 45 years, finally, significant health care legislation has become law. The law overall will improve American health care, and serve its purposes in improving access and lowering total costs (albeit more limited). I will discuss two aspects of health care reform: first, the law's impact on primary care and PC physicians; second, the law's constitutionality amid potential legal challenges.

The law will alleviate the shortage of primary care physicians, but will have negligible impact on the primary care system. The increased enrollment in health insurance will lead to greater demand for primary care, especially from new Medicaid patients. Furthermore, the government is adding incentives to medical school graduates to go into primary care, and existing physicians or medical entrepreneurs to do so. Thus, more primary care physicians will be part of the U.S. health care workforce, something urgently needed. On the other hand, existing financing mechanisms for primary care and the role of primary care in the provider and payer systems remain unchanged. Without reform from within, such as stronger gatekeeper models, greater care coordination, and chronic disease management, primary care will not undergo needed change as a whole. Perhaps the influx of physicians, increase in demand, and insurance reforms will have long-term beneficial effects on primary care, but much change will have to come from within.

Suits have already been filed alleging the unconstitutionality of the law, but the courts are highly unlikely to strike it down. The most contentious provision is the federal mandate on purchasing health insurance, something heretofore unknown in American law. The Supreme Court may grant certiorari, but will uphold the provisions for two main reasons. First, the Commerce Clause grants Congress much power and leeway to regulate economic activity that has even a slight nexus to "interstate commerce". Health insurance, along with its broad externalities, certainly falls under that umbrella. Second, the courts have given strong deference to legislative actions and policy, especially in the social and economic realms. The courts know they are limited in expertise in such broad areas, and lack the popular mandate found in the other branches. I think opponents may have a strong argument, especially using the due process clause and Tenth Amendment, but not enough for a winning one.