Her Biopsy Report was Benign, But the Bill is a Spot of Contention.

Her Biopsy Report was Benign, But the Bill is a Spot of Contention.

While living in Detroit earlier this year, Brianna Snitchler wanted a cyst removed from her abdomen. But her doctor wanted the growth checked for cancer first. (Callie Richmond for KHN)

 

Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.

Snitchler was on top of her finances: Her student loan balance was down and her credit score was up.

“I had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,” Snitchler, 27, said.

For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler’s concerns about her mental and physical health.

One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn’t hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.

“People would always call it out and be alarmed by it,” she recalled.

Before having the cyst removed, Snitchler’s doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry Ford Health System’s main hospital.

The procedure was “uneventful,” with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.

Then the bill came.

The Patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealthcare insurance plan.

Total Bill: $3,357.52, including a $2,170 facility fee listed as “operating room services.” The balance included a biopsy, ultrasound, physician charges and lab tests.

Service Provider: Henry Ford Health System in Detroit.

Medical Procedure: Ultrasound-guided needle biopsy of a cyst.

What Gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.



Snitchler said the bill turned out to be far more than what she budgeted for. Her insurance plan from UnitedHealthcare had a high-deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.

“She shrugged it off,” Snitchler’s partner, Emi Aguilar, recalled. “But I could see that she was upset in her eyes.”

Snitchler panicked when she realized the bill threatened the couple’s financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.

In an email, Henry Ford spokesman David Olejarz said the “procedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.”

“We perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,” Olejarz wrote.

The initial bill from Henry Ford referred to “operating room services.” The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they’ve been blindsided by these fees.

Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.

But the way hospitals calculate facility fees is “a black box,” said Ted Doolittle, with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.

“It’s somewhat akin to a cover charge” at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.

Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut “should never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,” Doolittle said.

In Michigan, there’s no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.

Brianna Snitchler’s procedure took place on campus at Henry Ford’s main hospital site. When she got her bill, with its mention of “operating room services,” she was baffled. Snitchler said the room had “crazy medical equipment,” but she was still in her street clothes as a nurse numbed her cyst and she was sent home in a matter of minutes.

With Snitchler’s permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.

Weiss said it probably wasn’t medically necessary for Snitchler to go to the hospital to receive good care. “Not all surgical procedures have to be done at a surgical center,” he said, noting that biopsies often can be done in an office-based treatment center.

Resolution: Hoping for a reasonable explanation — or even the discovery of a mistake — Snitchler called her insurance company and the hospital.

A representative at Henry Ford told her on the phone that the hospital isn’t “legally required” to inform patients of fees ahead of time.

In an email, Henry Ford spokesman Olejarz apologized for that response: “We’ll use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.”

He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.

Asked if Snitchler’s ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, “Can’t say at this point.”

In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.

For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.

“You should always negotiate; you should always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work. People should not be shy about it.”

“We are happy to work out a flexible payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News first inquired about Snitchler’s bill.

The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you’d face.

Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.

If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Her Biopsy Report was Benign, But the Bill is a Spot of Contention.

Her Biopsy Report was Benign, But the Bill is a Spot of Contention.

 While living in Detroit earlier this year, Brianna Snitchler wanted a cyst removed from her abdomen. But her doctor wanted the growth checked for cancer first. (Callie Richmond for KHN)

 

Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.

Snitchler was on top of her finances: Her student loan balance was down and her credit score was up.

“I had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,” Snitchler, 27, said.

For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler’s concerns about her mental and physical health.

One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn’t hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.

“People would always call it out and be alarmed by it,” she recalled.

Before having the cyst removed, Snitchler’s doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry Ford Health System’s main hospital.

The procedure was “uneventful,” with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.

Then the bill came.

The Patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealthcare insurance plan.

Total Bill: $3,357.52, including a $2,170 facility fee listed as “operating room services.” The balance included a biopsy, ultrasound, physician charges and lab tests.

Service Provider: Henry Ford Health System in Detroit.

Medical Procedure: Ultrasound-guided needle biopsy of a cyst.

What Gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.



Snitchler said the bill turned out to be far more than what she budgeted for. Her insurance plan from UnitedHealthcare had a high-deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.

“She shrugged it off,” Snitchler’s partner, Emi Aguilar, recalled. “But I could see that she was upset in her eyes.”

Snitchler panicked when she realized the bill threatened the couple’s financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.

In an email, Henry Ford spokesman David Olejarz said the “procedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.”

“We perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,” Olejarz wrote.

The initial bill from Henry Ford referred to “operating room services.” The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they’ve been blindsided by these fees.

Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.

But the way hospitals calculate facility fees is “a black box,” said Ted Doolittle, with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.

“It’s somewhat akin to a cover charge” at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.

Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut “should never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,” Doolittle said.

In Michigan, there’s no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.

Brianna Snitchler’s procedure took place on campus at Henry Ford’s main hospital site. When she got her bill, with its mention of “operating room services,” she was baffled. Snitchler said the room had “crazy medical equipment,” but she was still in her street clothes as a nurse numbed her cyst and she was sent home in a matter of minutes.

With Snitchler’s permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.

Weiss said it probably wasn’t medically necessary for Snitchler to go to the hospital to receive good care. “Not all surgical procedures have to be done at a surgical center,” he said, noting that biopsies often can be done in an office-based treatment center.

Resolution: Hoping for a reasonable explanation — or even the discovery of a mistake — Snitchler called her insurance company and the hospital.

A representative at Henry Ford told her on the phone that the hospital isn’t “legally required” to inform patients of fees ahead of time.

In an email, Henry Ford spokesman Olejarz apologized for that response: “We’ll use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.”

He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.

Asked if Snitchler’s ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, “Can’t say at this point.”

In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.

For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.

“You should always negotiate; you should always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work. People should not be shy about it.”

“We are happy to work out a flexible payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News first inquired about Snitchler’s bill.

The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you’d face.

Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.

If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Is Black Church Culture Unhealthy?

Is Black Church Culture Unhealthy?

“Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own…. Therefore honor God with your body.” 1 Cor. 6:19-20

It is well known that blacks live sicker and die younger than any other racial group. Look no farther than the church with the pastor battling hypertension and diabetes or the congregation with several obese members sitting in the pews. It would seem that the black church in America would be the leading ally supporting the nation’s first black president in the debate over access to affordable healthcare. It would seem that the black church would lead the way toward healthier eating and living.

Could it be that black church culture is leading us astray?

I thought about this during a recent conference in Baltimore on black global health. The International Conference on Health in the African Diaspora, hosted by the Johns Hopkins Center for Health Disparities Solutions, brought together healthcare professionals and researchers, from across the Western Hemisphere to discuss common health problems among the descendants of African slaves. Black Arts Movement icon Sonia Sanchez set the tone as the keynote speaker July 4, inspiring the crowd with a special poem for the occasion. The award-winning author participated throughout the weeklong conference.

Listening to a sister from Brazil and a brother from Peru discuss high rates of obesity, diabetes, infant deaths and the spread of HIV/AIDS among blacks in their countries sounded like the health crisis of black New York, Chicago, or the Mississippi Delta. Modern racism and the legacy of slavery haunt all of us. Participants also shared solutions and pledged to work together. In fact, according to Dr. Thomas LaVeist, a book and curriculum addressing these health themes are being created for the public and for high school and college educators. Thomas, who happens to be my brother, directs the Hopkins center and is the mastermind behind the conference, which is scheduled to take place every two years.

Solutions are basically what government and institutions can do to end racism and ensure all people have access to quality affordable healthcare and what blacks can do themselves to care for their “temples of the Holy Spirit.”

The black church should be more outspoken in support of increased access to quality affordable care. Our cousins from Canada and Central and South America, who for the most part receive varying degrees well-executed and poorly-executed universal healthcare, are puzzled as to why we richer Americans are debating what the rest of the industrialized world has long settled — that healthcare access is a God-given human right, not a privilege to be determined by profit-seeking private insurance companies.

After the conference, Thomas told me that the Catholic Church (obviously many Catholics are also black) has been the most vocal Christians on healthcare, mainly around the debate on whether Catholic organizations should be mandated to support abortions for employees (some evangelical Protestant organizations have recently joined that fight, too). Thomas suggested the traditional black church denominations could find their unified voice by calling for all Americans to be insured (Obama’s Affordable Care Act would still leave 20 million people uninsured). However, regardless of what the government does, black churches should lead by example with healthier eating and living, he said.

BAD FOR THE SOUL? Black churches are routinely feeding their people unhealthy soul food staples such as fried chicken and macaroni and cheese. Is that biblical?

“Black church culture is out of alignment with some biblical teachings, particularly when it comes to how we eat,” my brother said. “Church culture has got us drinking Kool-Aid, eating white bread, fried chicken, large servings of macaroni and cheese and collard greens drenched with salty hog maws (foods that are high in sugar, salt, calories, and carbohydrates that trigger health problems). We’re eating this in the church basement at dinner and at church conventions! Meanwhile, the Bible teaches against gluttony.”

Don’t judge or condemn those who are obese, but encourage and show everyone how to eat healthy, Thomas added. He cited Pastor Michael Minor of Oak Hill Baptist Church in the Mississippi Delta as pushing the healthy eating message that all black churches should adopt. The Delta is one of America’s poorest areas and leads the nation in obesity, diabetes, and heart disease rates. In 2011, Pastor Minor, known as “the Southern pastor who banned fried chicken in his church,” banished all unhealthy foods and insisted soul food meals be prepared in healthier ways; many of his members are losing weight and improving their overall health. Other churches across the country such as, First Baptist Church of Glenarden in Upper Marlboro, Maryland, are on similar missions.

Ask yourself, when it comes to health, what is the black church best known for?

What might the state of black health in America (and the African diaspora) be if your answer was healthy eating and living?

‘Obamacare’ Is About Access, Not Excess

‘Obamacare’ Is About Access, Not Excess

MASS REPEAL: Calls for the dismantling of President Obama’s signature healthcare legislation have gone into overdrive since the Supreme Court ruled the law as constitutional last month. (Jonathan Ernst/Newscom)

The federal government has not taken over health care. The federal government has taken over access to health care. There is a difference.

When I was a student at Morehouse College in the early 1970s, activists launched a campaign to address the shortage of African American doctors in the state of Georgia. They produced bumper stickers that asked “Only 100 Black doctors in Georgia?” with a map of the state’s 139 counties in the background. With many of those 100 doctors concentrated in urban areas such as Atlanta, people voiced clear concern over access to health care for thousands of African Americans in rural, poor and remote areas. Morehouse College President Hugh Gloster responded to this concern by founding the Morehouse School of Medicine, which joined Howard University Medical School, Meharry Medical College and the Charles Drew School of Medicine (similarly founded to address access issues in the Los Angeles area) as the nation’s only predominantly Black medical schools.

Were the government to have taken over health care, the government would be proffering medical diagnoses, prescribing medicine, and performing surgery. This is not the case. What the Supreme Court’s ruling upheld on June 28 was not government-controlled health care, but a federal system that expands access to health care for millions of Americans, mostly poor and many people of color. In a country where national strength finds measure on barometers of military might and economic prosperity, Scripture connects a nation’s well being to its care for the poor. In the fifth chapter of the biblical book bearing his name, Jeremiah challenges his nation, saying:

5:26 For among my people are found wicked men: they lay wait, as he that setteth snares; they set a trap, they catch men.

5:27 As a cage is full of birds, so are their houses full of deceit: therefore they are become great, and waxen rich.

5:28 They are waxen fat, they shine: yea, they overpass the deeds of the wicked: they judge not the cause, the cause of the fatherless, yet they prosper; and the right of the needy do they not judge.

5:29 Shall I not visit for these things? saith the Lord: shall not my soul be avenged on such a nation as this?

And among the judgments God speaks through Ezekiel, health care stands prominently:

34:4 The diseased have ye not strengthened, neither have ye healed that which was sick, neither have ye bound up that which was broken, neither have ye brought again that which was driven away, neither have ye sought that which was lost; but with force and with cruelty have ye ruled them.

Interestingly, the arguments against the healthcare reform upheld by the Supreme Court do focus on the problem of systemic access, and the price to be paid for it — whether the price is monetary in the form of the penalty for failure to carry health insurance or individual liberty in the form of governmental coercion. Yet in both cases, the plight of the poor and needy, the sick and infirm, goes unaddressed. How to make health care accessible for those on the margins of society receives little attention from those who would dismantle “Obamacare.” Promises to repeal the legislation without offering a clear alternative for how we as a nation make health care available and accessible to all persons reduces “the least of these” to political pawns, whose lives represent fodder for a political machine designed to appeal to the self-interests of America’s middle class.

UPHOLDING THE LAW: Supporters of President Obama’s healthcare reform rallied outside the Supreme Court chambers prior to the Court’s historic ruling on June 28. (Jonathan Ernst/Newscom)

Such a move must be resisted by President Obama and supporters of the legislation. The president campaigned for much of 2008 by appealing to that same middle class. He has lost some of their support with his championing of this version of reform, but that is precisely because our electoral system makes it difficult to appeal to a moral high ground as a strategy for garnering support (unless the issues revolve around sexuality and/or abortion). Some who have been disappointed by the president but still support him for reelection need to become more vocal in raising this issue above individual self interest to the moral high ground, much as Jim Wallis and Sojourners put forth the notion that poverty is a moral issue in the 2004 presidential campaign.

The question of access to health care ought matter significantly to people of faith. But it is easy to see how a church whose own theology promises personal prosperity apart from systemic issues of justice can miss the mark of its high calling to care for the poor. Indeed, it is as if a central claim of many messages draws directly from the Rev. Frederick J. Eikerenkoetter, better known as Reverend Ike: “The best thing you can do for the poor is not be one of them.”

Our ministry to the sick must move beyond prayer and visitation, and our work amongst the poor requires more than acts of charity. Justice questions continue to loom large in a nation with rampant inequality in quality of life, minimized access to maximal care, and economic stumbling blocks that tie the quality of health to possession of wealth. The spiritual gift of healing is not restricted to those in a specific economic category. If God’s divine, miraculous intervention to bring healing cannot be tied to social status, why should not a national healthcare philosophy be similarly non-discriminatory?

The Supreme Court ruling on the constitutionality of the Affordable Care Act provides the opportunity for the various agencies: government, hospitals, physicians, pharmaceutical companies, insurance companies, and employers to move with plans for implementation. It is good news for many who currently have little if any access to health care.

While many decry the “intrusion of big government,” an unanswered question for Christians who have opposed healthcare reform is “how has the church mobilized on behalf of the sick and the poor?” In other words, could it be that the intrusion of “big government” in part reflects a gaping hole in our mission to care for the least of these through ministries of mercy, prayer for healing, and advocacy for the oppressed? Are we so busy with “destiny and prosperity” that our attentions have been taken from our responsibilities to fulfill Jesus mission in Luke 4 and Matthew 25?

‘Obamacare’ Prevails: Supreme Court Upholds Healthcare Law

‘Obamacare’ Prevails: Supreme Court Upholds Healthcare Law

In a 5-4 vote, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act today, including the controversial individual mandate that requires all Americans to buy health insurance beginning in 2014. However, the ruling limited the federal government’s power to punish states for not expanding Medicaid coverage, as the ACA required.

“The Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form,” Lyle Denniston, the 81-year-old reporter, wrote on SCOTUS blog today.

The immediate sense is that this is a major victory for President Barack Obama and the signature legislation from his first term in office. “Whatever the politics,” the president said after the ruling, “today’s decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court’s decision to uphold it.”

But the decision also was an indication that the Supreme Court perhaps isn’t as predictably partisan as many believed prior to the announcement. Breaking with the court’s other conservative justices, Chief Justice Roberts announced the judgment that allows the law to go forward with its mission of covering more than 30 million uninsured Americans. Many observers speculate that Roberts’s ruling reflected his attempt to avoid going down in history as an activist chief justice on what might be the most important decision of his tenure.

UrbanFaith spoke to a variety of legal and medical experts about what the implications of today’s decision may be.

BERNARD JAMES: “An extraordinarily important substantive issue about the power of Congress under the Commerce Clause.”

Bernard James, professor of law at Pepperdine University in Malibu, California, along with three other sources UrbanFaith talked to earlier this week, expected the individual mandate to be struck down, but said the ruling has the potential to answer “an extraordinarily important substantive issue about the power of Congress under the Commerce Clause.”

The Commerce Clause refers to Article 1, Section 8, Clause 3 of the U.S. Constitution. It gives Congress the power to regulate commerce with foreign nations and among the states.

“Once it’s clear what the Commerce Clause permits and what it requires, not just health care, but all other subjects on the current agenda for this Congress will be more easily pondered and legislated,” said James.

“There were not five votes to uphold [the individual mandate] on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power,” editor Amy Howe wrote on the SCOTUS blog. “Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose,” she wrote in her summary of the ruling.

JAMES A. DAVIDS: “This is like federalism on steroids.”

James A. Davids, former president of the Christian Legal Society and a joint professor at the Robertson School of Government and the School of Law at Regent University in Virginia Beach, Virginia, said that ever since the New Deal was implemented in the 1930s, the Supreme Court has viewed federal power “expansively.” That vision of federal power was “tweaked” under the Renquist court, Davids said, in its rulings on two bills, the Violence Against Women Act of 1994 and the Gun-Free School Zones Act of 1990. As with today’s ruling, the court said then that there may be good reasons to enact these laws, but not under the Commerce Clause. “There were exceptions going into the power of the government under the Renquist court, under federalism issues, and this is like federalism on steroids,” said Davids.

Davids also said the Rehnquist court ruled that it was constitutional for the federal government to withhold highway funding from South Dakota when the state refused to comply with the National Minimum Drinking Age Act. In this case, the Court said current Medicaid funding cannot be revoked, but new funding can be withheld.

“Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding,” Chief Justice Roberts wrote in his opinion. Roberts, who was appointed by President George W. Bush, cast the deciding vote to uphold the ACA.

DR. BEN CARSON:“We got what could be expected” from politicians.

For Dr. Ben Carson, the world-famous neurosurgeon and director of pediatric neurosurgery at Johns Hopkins Children’s Center in Baltimore, Maryland, the outcome of today’s decision doesn’t change much. “The impetus behind the bill was the fact that we had these escalating costs and people who weren’t adequately covered … even though we spend twice as much per capita on healthcare as anybody else in the world,” said Carson.

He supports the concept of health-care reform, but doesn’t think the ACA was done right and compared the effort to hiring pundits to rebuild a bridge instead of hiring structural engineers. “It was done by politicians and special interest groups as opposed to by people who actually know what the problem is and know how to deal with it,” said Carson. “We got what could be expected in that situation.”

Escalating beaurocracy and a lack of comprehensive electronic medical records make the practice of medicine more difficult than it once was, Carson said. In his new book, America the Beautiful: Rediscovering What Made This Nation Great, he includes a chapter on health-care reform. He suggests using “health stamps” to incentivize the uninsured to use  clinics rather than emergency rooms for their primary care. This would lead not only to cost savings, but to better care for patients with chronic illnesses, Carson said.

He also advocates Tort reform to rein in the costs of medical malpractice suits. “We’re the country in the world that has the biggest problem with that. Is it because we have the worst doctors? Of course not. It’s because of special interest groups. The Trial Lawyers Association. We will not deal with them. Every time it has come up before Congress, the House has passed it, but the Senate will not vote on it, because there are some filibustering senators who are in the hip pocket of the Trial Lawyers Association,” said Carson.

Finally, Carson said we have to come to grips with the fact that insurers make money by denying people care. “That’s a basic inherent conflict of interest. We have to find a way to deal with that,” he said.

TONY MEGGS: “We’re grateful that congress, both left and right, saw healthcare sharing ministries like ours … as being part of the solution.”

Some Christians, especially the self-employed and small business workers, are participating in medical cost sharing ministries like Medi-Share because they can’t afford the high cost of individual health insurance plans. Today’s ruling won’t have a direct impact on them, said Tony Meggs, the president and CEO of Medi-Share’s parent organization, Christian Care Ministry.

As part of an alliance of three cost sharing organizations, Medi-Share lobbied for and won an exemption from the individual mandate for its members. “We’re grateful that Congress, both left and right, saw healthcare sharing ministries like ours and the other two ministries as being part of the solution,” said Meggs.

His organization’s 19-year history of paying every eligible bill (approaching $700 million to date) and its focus on wellness and preventative care helped convince legislators that cost-sharing ministry members deserved an exemption, he said.

“They understand that they need to bend the cost curve in some way in getting people to make better choices in terms of how they live their lives. From a diet and exercise perspective, those are things that Congress was interested in, and so I think it was a combination of [that and] the fact that we’ve been here for a long time. This is how we help people. It’s credible. We’re not scamming people,” said Meggs.

Medi-Share’s steady growth “accelerated” after the ACA was enacted, Meggs said, and he expects that growth to continue because he says there is about a 40 percent cost difference between an individual health insurance plan and a monthly Medi-Share contribution.

There are differences, however. Medi-Share participants must sign a statement of faith and agree not to abuse drugs or alcohol or engage in extra-marital sex, Meggs said. Medical problems resulting from violations of these agreements are not generally “shared,” nor are mental health problems or some pre-existing conditions. Additionally, insurance companies are contractually obligated to pay for eligible services, but “sharing” medical expenses is voluntary for Medi-Share members. “There’s no guarantee. There’s no contract. Our program is strictly voluntary, but what I can tell you is that over a 19 year history, a 100 percent of every eligible bill that we’ve ever published has been shared,” said Meggs

What about you?

How will today’s ruling impact your family’s health decisions?