WASHINGTON (CBSDC/AP) – The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama’s health care overhaul.
The decision means the historic overhaul will continue to go into effect over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
Chief Justice John Roberts announced the court’s judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. Roberts provided the swing vote to uphold the president’s health care law as the court ruled 5-4. 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.
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 act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding,” the dissenters said in a joint statement.
The court’s ruling has a far-reaching impact on the nation’s health care system. With the law being upheld, about 30 million of the 50 million uninsured Americans would get coverage in 2014 when a big expansion begins.
Obama, speaking from the same spot in the White House where he signed the health care bill into law more than two years ago, sought to tamp down the political implications of the court’s ruling. The decision, he said, was about upholding the fundamental principle that no one in America should fall into financial ruin because of illness.
“Whatever the politics, 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,” he said, adding that the ruling is a “victory for people all over the country.”
Romney, who spoke before the president, doubled-down on his campaign pledge to repeal the law and cast his candidacy as the next best hope for the millions of Americans who oppose it.
“If we want to get rid of Obamacare, we’re going to have to replace President Obama,” Romney said from a rooftop in Washington overlooking the U.S. Capitol. “What the court did not do on its last day in session, I will do on my first day if elected president.”
Republican campaign strategists said Romney will use the court’s ruling 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.
Larry Sabato, director of the Center of Politics at the University of Virginia, told CBSDC health care will “probably remain a secondary issue” come November.
“What seems like a huge story today probably won’t be as important as the election draws nearer,” Sabato said. “This election is still about the economy, and the state of the economy will be the biggest factor in determining the result.”
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