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High court upholds Obama health law

Posted June 28, 2012

— The Supreme Court on Thursday upheld virtually all of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that nearly every American have health insurance.

The 5-4 decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.

The ruling hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call "Obamacare," arguing that the ruling characterized the penalty against people who refuse to get insurance as a tax.

Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if elected in November.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. Roberts explained at length the court's view of the mandate as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.

Even though Congress called it a penalty, not a tax, Roberts said, "The payment is collected solely by the IRS through the normal means of taxation."

Roberts also made plain the court's rejection of the administration's claim that Congress had the power under the Constitution's commerce clause to put the mandate in place. The power to regulate interstate commerce power, he said, "does not authorize the mandate."

The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.

The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

Kennedy summarized the dissent in court. "In our view, the act before us is invalid in its entirety," he said.

The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."

In all, the justices spelled out their views in six opinions totaling 187 pages. Roberts, Kennedy and Ginsburg spent 51 minutes summarizing their views in the packed courtroom.

Ruling loaded with political implications

The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Majority Leader Eric Cantor said Thursday the House will vote the week of July 9 on whether to repeal the law, though such efforts have virtually no chance in the Democratic-controlled Senate.

House Speaker John Boehner said the health care law makes it harder for small businesses to hire workers. "Today's ruling underscores the urgency of repealing this harmful law in its entirety," he said.

But Senate Majority Leader Harry Reid heaped praise on the court's decision and the 2010 law in a Senate speech. "Passing the Affordable Care Act was the greatest single step in generations toward ensuring access to affordable, quality health care for every American, regardless of where they live or how much money they make," he said.

Congresswoman Renee Ellmers Ellmers: Ruling backs belief that health care law is a tax

Health care law backers rally after ruling Health care law backers rally after ruling

After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Democrats said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.

"Mitt Romney is the intellectual godfather of Obamacare," said Democratic consultant Jim Manley. "The bigger issue is the rising cost of health care, and this bill is designed to deal with it."

More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.

There's also an added safety net for all Americans, insured and uninsured. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections, now standard in most big employer plans, will be available to all, including people who get laid off, or leave a corporate job to launch their own small business.

Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no co-payments for preventive care. But hospitals, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.

Illegal immigrants are not entitled to the new insurance coverage under the law, and will remain one of the biggest groups uninsured.

Obama's law is by no means the last word on health care. Experts expect costs to keep rising, meaning that lawmakers will have to revisit the issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-income people.

States need to start preparing

The health care overhaul focus will now quickly shift from Washington to state capitals. Only 14 states, plus Washington, D.C., have adopted plans to set up the new health insurance markets called for under the law. Called exchanges, the new markets are supposed to be up and running on Jan. 1, 2014. People buying coverage individually, as well as small businesses, will be able to shop for private coverage from a range of competing insurers.

Most Republican-led states, including large ones such as Texas and Florida, have been counting on the law to be overturned and have failed to do the considerable spade work needed to set up exchanges. There's a real question about whether they can meet the deadline, and if they don't, Washington will step in and run their exchanges for them.

North Carolina legislative leaders said they plan to adjourn as scheduled next week and not address establishing a health benefits exchange in the state. The House passed legislation last year to enable the exchange, but it has languished in the Senate.

In contrast to the states, health insurance companies, major employers, and big hospital systems are among the best prepared. Many of the changes called for in the law were already being demanded by employers trying to get better value for their private health insurance dollars.

"The main driver here is financial," said Dr. Toby Cosgrove, CEO of the Cleveland Clinic, which has pioneered some of the changes. "The factors driving health care reform are not new, and they are not going to go away."

Health policy expert says GOP, Dems need to work on more reforms Health policy expert says GOP, Dems need to work on more reforms

The Medicaid expansion would cover an estimated 17 million people who earn too much to qualify for assistance but not enough to afford insurance. The federal and state governments share the cost, and Washington regularly imposes conditions on the states in exchange for money.

Roberts said Congress' ability to impose those conditions has its limits. "In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement' — it is a gun to the head," he said.

The law says the Health and Human Services Department can withhold a state's entire Medicaid allotment if the state doesn't comply with the health care law's Medicaid provisions.

Even while ruling out that level of coercion, however, Roberts said nothing prevents the federal government from offering money to accomplish the expansion and withholding that money from states that don't meet certain conditions.

"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," he said.

Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision. She said Congress' constitutional authority to regulate interstate commerce supports the individual mandate. She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.

"So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions," Ginsburg said in a statement she, too, read from the bench.

Uninsured rejoice in decision

Annie Segrest of Durham said a wave of relief swept over her when she heard the court's ruling.

The 25-year-old calls herself a "double beneficiary" of the health care law. She's one of 95,000 young adults in North Carolina who can stay on their parents' health plan until age 26, and she also has an auto-immune disease that could scare insurance companies off if the law weren't in effect.

"I have a pre-existing condition," Segrest said. "I would either be denied affordable coverage or coverage at all, which would've put me in a bad situation."

Supporters of the law rallied at the State Capitol in Raleigh, vowing to fight efforts to repeal it.

David McLennan Political scientist says ruling will be prominent in presidential campaign

Economist says ruling will benefit most Americans Economist says ruling will benefit most Americans

"This is not the end of the fight to ensure all North Carolinians have access to quality, affordable health insurance. This is only the beginning," said Adam Linker, policy analyst for the North Carolina Health Access Coalition.

Felicia Willems, whose 5-year-old son was born with a painful vascular tumor that required chemotherapy, said she lost her health coverage when she quit her job to take care of him.

"It was a huge concern to us if this law was repealed because then the insurance plan could drop him because of pre-existing condition," Willems said.

Backers said the law protects American families and holds insurance companies accountable.

"No longer will women be charged more for insurance than men. No longer will sick patients be denied coverage," said Mary McMillan, state director of the AFL-CIO. "Working families have played by rules, but insurance companies have not."

Segrest, who is a social worker, said the law's benefits go well beyond her, noting that she works with families who struggle with health care costs.

"I think that it will give coverage to a large amount of people who don't have access to it, and that's going to change a lot of lives," she said.

"I'm the first person to say Obamacare's not perfect," Willems said. "We've got a long way to go – still a lot of people who need coverage, especially with the Medicaid exemption – but it's a great start."

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  • happymoccasins2009 Jun 29, 5:55 p.m.

    How is this new law going to affect those who are unemployed and have no source of income, not even unemployment?

    How are they going to pay a fine if they have no source of income?

  • TruthBKnown Banned Again02 Jun 29, 4:31 p.m.

    There needs to be a Constitutional amendment that disallows the use of taxation for the purposes of encouraging behavior that would be a violation of the Constitution if they tried to force the behavior directly.

    If they cannot Constitutionally force you to buy health insurance, they should not be allowed to tax you for not buying health insurance.

    If they cannot Constitutionally force you to join a gym, they should not be allowed to tax you for not joining a gym.

    If they cannot Constitutionally force you to eat broccoli, they should not be allowed to tax you for not eating broccoli.

    And on and on and on... it would be a pretty simple amendment to make. But I strongly suspect that neither party wants to do that. They like the power they have over us by being able to control our wallets.

  • lovelarvae Jun 29, 3:15 p.m.

    "So if you don't join a gym, you have to pay a tax."

    That is a serious question. Here's one of the first google hits when I took a look. This from a liberal blogger at washington post, even.

    "Barry Friedman, a New York University law professor who wrote a brief supporting Obamacare, argued that by affirming the ability to regulate with taxing power, the decision created a precedent for future regulation along these lines. “They can’t make you eat broccoli, but they can tax you for not eating it,” Friedman joked, by way of summarizing the meaning of the decision."

    http://www.washingtonpost.com/blogs/plum-line/post/broccoli-tyranny-lives/2012/06/28/gJQAwxRQ9V_blog.html

  • TruthBKnown Banned Again02 Jun 29, 2:55 p.m.

    Serious question. Since making this thing a tax is the key to it being "Constitutional", does that mean the federal government can do any old thing they want now, and just call it a tax?

    Example, could the government decide that people need to exercise at a gym in order to be less of a health burden to the system. So if you don't join a gym, you have to pay a tax.

    This is something that needs to be changed in the Constitution if that is the case. The process for levying a tax needs to be tightened up to prevent this sort of bad behavior on the part of politicians.

  • lumberman Jun 29, 12:59 p.m.

    I do wish there were some way we could get a genius like Thrall Voljin hooked up with Obama then we would have all our problems solved ? Hardy har har

  • MakoII Jun 29, 12:23 p.m.

    unc70,

    I know someone going to Davidson who pays 14k after their financial aid package.

    NCSU? 14k

    Davidson normally costs 52k. So it goes to show you that Public Education may not be the cheapest option depending on your grades etc.

    UNC? 20k I understand right now. That's not cushy off campus housing either...

  • unc70 Jun 29, 12:08 p.m.

    NC Constitution regarding higher education;

    "The General Assembly shall provide that the benefits of The University of North Carolina and other public institutions of higher education, as far as practicable, be extended to the people of the State free of expense."

  • MakoII Jun 29, 11:50 a.m.

    jeffjohnson123,

    How did Obama "lose" on the Arizona case? SCOTUS struck it down almost entirely. The one part it didn't was already SCOTUS law, and even then they felt the need to warn against profiling.

    How can striking down 3/4ths of Arizona's statute be a "lose" for Obama? I'm confused by that characterization. Seems like quite the "win" to me.

  • Thrall-Voljin 2012 Jun 29, 11:43 a.m.

    "His LOSS on the immigration bill in Arizona has motivated him to manipulate federal support and open a hotline to help illegals in Arizona"

    You mean the loss where 3 out of 4 points were shot down by SCotUS, and the 4th point has no real teeth anymore? that loss? ROFL!

  • jeffjohnson123 Jun 29, 11:30 a.m.

    I guess this 'win' for Obama is making him even more brazen. His LOSS on the immigration bill in Arizona has motivated him to manipulate federal support and open a hotline to help illegals in Arizona.

    He is subversively underminining our democratic process. ODictator cares nothing for America or its history.

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