High court upholds key part of Obama health law

Evan Vucci/The Associated Press

William Temple, of Brunswick, Ga., waits outside the Supreme Court a landmark decision on health care on Thursday, June 28, 2012 in Washington.

WASHINGTON (AP) — 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.

Evan Vucci/The Associated Press

Claire McAndrew of Washington, left, and Donny Kirsch of Washington, celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the courts' ruling on health care.

David Goldman/The Associated Press

Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the court's ruling was announced.

David Goldman/The Associated Press

Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the court's ruling.

David Goldman/The Associated Press

Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the court's ruling was announced.

AP file photo/Pablo Martinez Monsivais

FILE - This Oct. 8, 2010 file photo shows the justices of the U.S. Supreme Court at the Supreme Court in Washington. Seated from left are Associate Justices Clarence Thomas, and Antonin Scalia, Chief Justice John Roberts, Associate Justices Anthony M. Kennedy and Ruth Bader Ginsburg. Standing, from left are Associate Justices Sonia Sotomayor, Stephen Breyer, Samuel Alito Jr., and Elena Kagan. The Supreme Court on Thursday, June 28, 2012, upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.

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. "

Stocks of hospital companies rose after the decision was announced, while shares of insurers fell sharply. Shares of drugmakers and device makers fell slightly.

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.

The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Majority Leader Eric Cantor, R-Va., 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, R-Ohio, 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, D-Nev., 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.

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 copayments 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.

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.

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."

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.

In the courtroom Thursday were retired Justice John Paul Stevens and the wives of Roberts, Alito, Breyer, Kennedy and Thomas.

__

Associated Press writers Ricardo Alonso-Zaldivar, Charles Babington, Jessica Gresko, Jesse J. Holland and David Espo contributed to this report.

Find a link to the opinion here: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

The Supreme Court's live chat from the decision:

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Comments

CLAIRE GAMACHE's picture

A tax on who?

The law is only a tax if you can afford health care and refuse to sign up for it choosing instead to mooch off the rest of us should you get sick or have an accident. For the person who has health insurance it will most likely mean a refund since the law requires insurance companies to spend 85% of what they charge in premiums for your health care. If they charge more they have to refund it. Mainers are looking at hundreds of thousands of dollars in refunds. If you lose your job you won't have to worry about getting sick and going bankrupt because you have no health insurance and if you are 55 and lose your job you don't have to worry that you will never have health insurance again.

MARK GRAVE's picture

We’ll see as time goes by

We’ll see as time goes by whether all these claims about reducing costs come to fruition, such as those same claims made about Medicare and Medicare part D.

Like most federal programs, ObummerCare costs are likely underestimated, so I we can expect to actually pay more.

Steve  Dosh's picture

High court upholds key part of Obama health law

All 12:30 Thursday HST • ?
The Executive Officer proposes , this particular Congress disposes , and the Supreme Court interprets the laws
† y v m Chief Justice Roberts . As you said early in your tenure , this Supreme Court was not to be partisan
The lesson to be learned in this -- his story , as it were -- is that all Justices become more liberal over time
They all have , historically ( and sometimes hysterically )
Read up now - http://en.wikipedia.org/wiki/Obamacare
Aloha from the birth state of our President , Dr. Dosh

Zack Lenhert's picture

"Republicans, Leukemia Team

"Republicans, Leukemia Team Up To Repeal Health Care Law"

http://www.theonion.com/articles/republicans-leukemia-team-up-to-repeal-...

hahaha

Now the GOP has to campaign on taking insurance away from the sick and poor. How well is that gonna go over?

Romney: "I will repeal Obamacare on day one."

Obama: You want to take insurance coverage away from people with pre-existing conditions? or children under 26 on their parents coverage?

Zack Lenhert's picture

"Denying insurance to

"Denying insurance to Americans with preexisting conditions and ensuring that low-income Americans stand no chance of receiving quality health care are just a few of the core beliefs that the GOP and leukemia share."

"While chronic leukemia was reportedly worried about how its association with the Republican Party would affect its public image, the destructive pathogen was ultimately swayed by language in the final bill that offers small business owners tax incentives to provide health care to their employees."

too funny.

CLAIRE GAMACHE's picture

The cost

I am hearing really wild speculation about the costs of the health care bill. One guy says a gazillion dollars and the next guy says 50 gazillion dollars. No one mentions how much of an increase in the cost of health care we have suffered through in the last 20 years and what's in store for us if we do nothing. Talk about gazillions! Until I hear that the folks in Massachusetts hate their plan so much that they are voting in someone to repeal it I am taking all this panicky talk with a grain of salt. I have no doubt that cost containment will be a challenge but it is hopeless without a regulated marketplace.. Romney says that on his plan children will be able to stay on their parent's insurance and insurance companies will not be able to kick people off their plans because they got sick and they won't be charging women more than men and so on. It sounds like the same plan to me except it won't have the word Obama on it.

Mike Lachance's picture

It's Official.

This is now the biggest Tax Increase in U.S. History.
Ever.

Another trophy for Obama and the Dem. controlled Senate.

Zack Lenhert's picture

I already pay for my health

I already pay for my health insurance... how much will my taxes go up?

Mike Lachance's picture

Until....

Your employer is forced to change policies.. or the terms of your policy change... then guess what... you DO NOT get to keep your existing policy. At that point you either take the Obama Care or take the TAX penalty for failing to buy a Govt product.

Dont believe it? Look it up.

Taxing us for nothing (literally) is the epitome of Liberal Economics.

Zack Lenhert's picture

MAYBE my employer needs to

MAYBE my employer needs to change their policy. Sounds like a lot of speculation and scare tactics. I have looked it up and I'm not convinced.

PS. There is no Gov't product. We're mandated to buy private insurance, unless you can't afford it in which case you would be covered by the expansion of medicaid. Olympia Snowe got the public option removed from the bill before it passed. Look it up.

MARK GRAVE's picture

God save my freedom and the

God save my freedom and the little money I have left in my wallet.

Steve  Dosh's picture

Mark 12:22 hst

Mark 12:22 hst Thursday
Freddom ain't ƒree . b t w - Have you served n e where at n e time ?
Some of us have . ....
Freedom and responsibility go together like hand in glove . .
Happy Fourth of July weekend
/s Dr. Dosh F S O ( ret. - Africa, Guatemala & Miicronesia )

MARK GRAVE's picture

To help satisfy your

To help satisfy your machismo, I served 10-years and fought in desert storm.

That said, a true hero does not have to air his actions in the public square. I did what I did, and that is the end of it; however, whether I served or not has nothing to do with people’s free exercise of their opinions.

In my opinion, people who are compelled to display their service record in the public square are mentally imbalanced and have a need to seek attention. We can see this same behavior in both police and fire service personal.
Don’t tell us what you have done in the past, ask yourself what will you do in the future – never look back; keep looking forward.

Mike Lachance's picture

I just got motivated to VOTE

I was gonna sit out the upcoming general election...
I was uninspired and without motivation.

This news is a game changer.
The gloves of the voters just came off.

Zack Lenhert's picture

I just got motivated to vote

I just got motivated to vote too. I guess that means we probably cancel each other out though.

Jason Theriault's picture

(No subject)

MARK GRAVE's picture

What’s that? Do I smell shit?

What’s that?
Do I smell shit? Yep.

BTW you were wrong. The government cannot use the commerce clause to force economic activity. That said, supreme court found a way around that didn’t they.

Steve  Dosh's picture

Mark , ? noon hst

Mark , ? noon hst Thursday
We - a l l - got good B S sniffers and you are full of it ?
Yes , the government can use the commerce clause to force economic activity and they do it all the time
24 x 7 in fact
Take the Baby Bells ® fer instance ( Judge Green , 1 9 8 6 ) under Raygun [ sic.]
also : http://www.ftc.gov/opa/2005/09/alohapetrol.shtm
? Steve Dosh , former fed .

MARK GRAVE's picture

Perhaps you are inhaling too

Perhaps you are inhaling too much VOG.

Just today the Supreme Court ruled that congress cannot force people to enter into a market... That is why Chief Justice rewrote Obamacare legislation from the bench by claiming the penalty is a tax.

"In its decision Thursday, five justices, including Roberts, ruled that the health reform law’s requirement for all Americans to purchase health insurance runs afoul of the Constitution’s Commerce Clause. Basically, the court ruled that Congress can regulate existing interstate commercial activity, but it can’t directly force people to enter into a market (by, say, requiring them to purchase health insurance). “The power to regulate commerce,” Roberts wrote, “presupposes the existence of commercial activity to be regulated.”"

You have provided not reference to the contrary. Careful, there is sulfur in the air.

Jason Theriault's picture

Wrong

MARK GRAVE's picture

Therefore one must wonder why

Therefore one must wonder why this Supreme Court ruled the individual mandate was not constitutional based on the commerce clause, but considered a levied tax it was constitutional.

Jason Theriault's picture

Because what is constitutional changes.

Because what is constitutional changes.

MARK GRAVE's picture

The constitution is iron clad

The constitution is iron clad and only can change under the well defined amendment process. Unfortunate the interpretation is perverted at times to suite the political climate.

Moreover, Chief Justice Roberts broadly interpreted “penalty” to be synonymous with taxes. In my opinion, the English language is clear, so was the administration’s position that this is a penalty, not a tax.
It astounds me that one man can change the definition, only congress can define a tax… where is the congressional opposition?

MARK GRAVE's picture

The constitution is iron clad

The constitution is iron clad and only can change under the well defined amendment process. Unfortunate the interpretation is perverted at times to suite the political climate.

Moreover, Chief Justice Roberts broadly interpreted “penalty” to me synonymous with taxes. In my opinion, the English language is clear, so was the administration’s position that this is a penalty, not a tax.
It astounds me that one man can change the definition, only congress can define a tax… where is the congressional opposition?

Jason Theriault's picture

Really?

We'll see how much of a game changer it is. If Romney goes bananas railing about it, they can point to RomneyCare and say "How is it diffrent from what you did"

Those that really hated Obama and ACA were not going to vote for him regardless, and I think both bases are charged at this point.

Mike Lachance's picture

The Commerce Clause has been

The Commerce Clause has been ruled by the SCOTUS as not related to this bill. They are designating it as a TAX. As a tax, this is the biggest tax increase on the middle class in US History. SCOTUS says it is a tax and does not fall under the Commerce Clause. Therefore Obama has just been designated as President, to be behind the biggest tax increase on the middle class (and working lower class Americans in US History.

Romneys plan In Massachusetts wasa State plan, and is allowed under States's rights. The dems who pushed this through Congress steadfastly denied it as being a tax, adamantly defended it as legal under the Commerce Clause and rebuffed all who called it a back door tax. The SCOTUS has now made it clear that it is a TAX since it is not legal under the Commerce Clause.

Romneys plan is in a different category, and while I do not agree with the Massachusetts plan he helped shape, I do see the clear differences.

Romney just got a huge BUMP.

Jason Theriault's picture

Only a tax if you don't have insurance

Only a tax if you don't have insurance.

And we'll see who has the bump. See, there is a flip side to this coin. Obama can now start campaigning on this. Before, if he said "The ACA is one of the biggest things I did as president" and it got repealed, he looks bad. Now, he can wade right into it. Talk up it benefits and how Romney's plan is very similar. I know, Romney's plan was on a state level. But he isn't arguing the scale is bad, he arguing the policy is bad. So either he is lying now or he passed a law he thought was bad policy.

Either way, it won't be good for Romney because it takes attention off the economy, which is still weak, and is Obama's weakest point.

CLAIRE GAMACHE's picture

Different how?

Other than being implemented in the State of Massachusetts it is the same Heritage Foundation first proposed by Richard Nixon. It features an individual mandate and insurance exchanges and state financing for people who cannot afford the premiums. Substantially the same plan. What is different is that Romney is now running for president.

Mike Lachance's picture

I could care less about

I could care less about Nixon.
State vs Fed. Thats how this is different. That being said, a State plan is not something I want, but if its gonna happen that how it must happen. Clear differences Claire.

I dont want either plan. But my Vote in NOv will reflect the fact that States, not the Fed should be the ones to handle this kinda issue.

Tony Morin's picture

????

You think SCOTUS upholding the ACA will result in a bump for Romney?? You must have just come out of the "no spin" zone.

Mike Lachance's picture

Duh.

Tony, "spin" however you want. I was NOT going to vote in Nov. Not. As in No. As in Stay Home. As in not even lift a finger for Romney.

You can deny all you like, but as of today I am in campaign mode, and i WILL be voting in Nov. I WILL be talking about this election. I will lift more than a finger... more than two feet....

If you think my energizing today is isolated think again.

Tony Morin's picture

I see

If by "huge bump" you meant Mike Lachance's vote, then I admit you were right.

CLAIRE GAMACHE's picture

Wow

I guess I have to eat my hat. Three times in one week this court comes out in favor of the federal government and against states rights. We will hear a lot of moaning about the cost of this law but taxes isn't just about paying it's also about getting. This is what we are getting. Access to health care for 30 million uninsured Americans and lower premiums through exchanges. Businesses and individuals will be dealing with a regulated marketplace ( the end of charity care and sky high premiums for poor coverage and other expensive hospital and insurance company abuses). Insurers will no longer be able to deny coverage for a pre-existing condition. Tax credits for small businesses that offer insurance. Assistance for businesses that provide health benefits to early retirees. Affordable health care for lower income Americans by extending Medicaid. No more charging women more than men for the same services. Young Americans will be able to stay on their parents' plans . Seniors will get discounts on brand-name drugs. Temporary coverage for the sickest Americans who have exceeded their lifetime limits. And just so you know insurance exchanges and individual mandates were first proposed by that great socialist Richard Nixon and put in effect by Romney. The democrat's plan was single payer . This is a Republican plan.

Mike Lachance's picture

"This is a Republican

"This is a Republican plan."

Perhaps the most ridiculous statement made in months.

Jason Theriault's picture

(No subject)

Jason Theriault's picture

Wha

May I ask, disagreeing person, what you disagree with?

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