News in Contect

Supreme Court on the Affordable Health Care Act and Same-Sex Marriage

In two major decisions, the Supreme Court advanced access to health care and human rights. King v Burwell upheld the use of federal tax credits to help people in need purchase health insurance through federal insurance exchanges established under the Affordable Care Act (ACA). Obergefell v Hodges affirmed that same-sex marriage is a federal right protected by the Constitution. Hastings Center scholars and publications provide context and point to next steps.

Health Insurance Subsidies

The ACA “relies on three primary strategies for expanding health insurance coverage,” explains Michael Gusmano, a research scholar at The Hastings Center who studies health care equity.One of the strategies is to provide subsidies (in the form of IRS tax credits) for individuals with incomes below 400 percent of the federal poverty level. King v Burwell “allows the implementation of the ACA to continue,” he writes. “It does not, however, overcome the many substantive and political problems of the law.” He says that the law “does little to curb the cost of health care in the U.S., and this is a threat to its success.” Read more in his commentary in Bioethics Forum, the blog of the Hastings Center Report.

Same-Sex Marriage

The decision on same-sex marriage was unquestionably a landmark for expanding human rights, but tremendous hurdles in human rights in general and access to care in particular confront  lesbians, gays, bisexuals, transgender, and queer individuals. These are discussed in detail in a special report published by The Hastings Center, LGBT Bioethics: Visibility, Disparities, and Dialogue.The editors outline injustices in “the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities.” In suggesting what bioethics can do to help ameliorate these injustices, they point to what it has done to help other vulnerable populations: effecting policies to reduce abuses of research participants and helping to establish the ethical and legal framework concerning end-of-life care. Several commentaries focus on specific populations: children and adolescents, LGBT seniors, LGBT veterans, and LGBT patients in the public safety net.

What are the best ways to close the gap in health disparities for LGBT people? Have the most cogent arguments been advanced? For a discussion of these and other questions, see LGBT Health and Human Rights: New Ideas for Dynamic Times, the webcast of a Hastings Center symposium The contributors to the special report and the symposium include award-winning author Andrew Solomon and leaders in health care, law, and ethics.