Supreme Court upholds requirement that most Americans have health insurance

June 28, 2012

Julie Pace and Steve Peoples, Associated Press and CityRoom

A supporter of the Affordable Care Act reacts to news the Supreme Court had upheld most of the law’s provisions.

Update Thursday June 28 10:05 a.m. 

Read the full text of the decision.

The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.

The decision means the huge overhaul, still only partly in effect, will 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 also hands 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.

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"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."
- Chief Justice John Roberts

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.

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.

"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.

Republican campaign strategists said presidential candidate Mitt Romney will use the court'sruling 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."

Illinois reacts: Quinn "thrilled" with health care ruiling

Illinois officials must decide how to implement key provisions of President Barack Obama's health care overhaul now that the U.S. Supreme Court upheld the law's individual insurance requirement.

That includes developing an online insurance marketplace where people and small businesses can comparison shop for insurance beginning in 2014.

Gov. Pat Quinn's administration wouldn't answer questions about Illinois' plans, but aides say he's "thrilled" by the ruling.

A lawmaker who led work on implementing the state's insurance exchange has said Illinoiswon't be able to meet a Nov. 16 deadline to get it set up.

Democratic Rep. Frank Mautino told The Associated Press this week that Illinois must consider a federal-state partnership to meet the requirement.

Illinois officials estimate about 800,000 now-uninsured residents would get public or private health insurance.

Republicans plan to continue campaigning against health care law 

Republican campaign strategists say Mitt Romney will use today's Supreme Court ruling to continue campaigning against "Obamacare." They say he will be attacking the president's signature health care program as a tax increase.

Veteran Republican campaign adviser Terry Holt says, "Obama might have his law, but the GOP has a cause." He says the decision will rally Republican support for an appeal of what Holt says "could well be called the largest tax increase in American history."

Romney has said this week that if the law were to be upheld, Americans would need to elect a president who would repeal it.

House Speaker John Boehner says the Supreme Court ruling shows the need to repeal the law. The Ohio Republican says in a statement that the law is hurting the economy by increasing health care costs and making it difficult for small businesses to hire.

He says the court's ruling demands repeal of the entire law.

Boehner say Americans want a common-sense approach to health care. He says Republicans are ready to work with a president who's willing to listen to the people and "will not repeat the mistakes that gave our country 'Obamacare.'"

What's next?

The 2010 health care law will continue phasing in as planned. It's expected to bring coverage to about 30 million uninsured people, so that more than nine in ten eligible Americans will be covered.

Some parts are already in effect: Young adults can stay on their parents' insurance up to age 26. Insurers can't deny coverage to children with health problems. Limits on how much policies will pay out to each person over a lifetime are eliminated. Hundreds of older people already are saving money through improved Medicare prescription benefits. And co-payments for preventive care for all ages have been eliminated.

Starting in 2014, almost everyone will be required to be insured or pay a fine. There are subsidies to help people who can't afford coverage. Most employers will face fines if they don't offer coverage for their workers. Newly created insurance markets will make it easier for individuals and small businesses to buy affordable coverage. And Medicaid will be expanded to cover more low-income people.

Insurers will be prohibited from denying coverage to people with medical problems or charging those people more. They won't be able to charge women more, either. During the transition to 2014, a special program for people with pre-existing health problems helps these people get coverage.

An assortment of tax increases, health industry fees and Medicare cuts will help pay for the changes.

Is the issue settled?

Not necessarily. Although the court found it constitutional, the health care law still could be changed by Congress. Romney and Republican congressional candidates are campaigning on promises to repeal it if elected in November.

Some parts of the law are popular, but others — especially the mandate that virtually everyone have insurance coverage — are not.

Also, an estimated 26 million people will remain without health coverage once the law is fully implemented, including illegal immigrants, people who don't sign up and elect to face the fine instead, and those who can't afford it even with the subsidies.

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Update June 28 8:31 a.m.

Political uncertainty weighed heavy before ruiling

"My guess is they're not sleeping real well at the White House tonight," presumptive Republican presidential nominee Mitt Romney told supporters Wednesday in northern Virginia.

Anticipation of Thursday's decision could be equally unnerving for Romney, whose opposition to the law has become a central pillar of his campaign.

Neither candidate has any direct influence over the ruling. The court could uphold the health care law, strike it down or deem the requirement that most Americans carry health insurance unconstitutional while retaining other aspects of the law.

The announcement is expected to be followed almost immediately by a barrage of advertisements and fundraising appeals from Democrats and Republicans, all trying to cast the decision in the most advantageous light for their candidates.

The Obama campaign began trying to raise money off the ruling even before it was announced. In a Thursday morning fundraising email with the subject line "Today's Decision," Obama campaign manager Jim Messina told supporters "no matter what, today is an important day to have Barack Obama's back."

The Democratic Congressional Campaign Committee also issued a fundraising appeal for a "health care rapid response fund," telling supporters by email Wednesday that, however the court rules, "Democrats are in for a tough fight."

Secrecy has marked each campaign's planning for the critical moment.

Obama is scheduled to be in the Oval Office with Vice President Joe Biden when the ruling is announced. The president is certain to respond to the decision, but his specific plans to do so were unclear. Romney's campaign has refused to disclose the location of a Capitol Hill venue where he will face reporters shortly after the announcement.

It is clear, however, that the Supreme Court's ruling on Obama's sweeping federal health care law will shape the contours of the presidential campaign through the summer and fall. Both Obama and his Republican rival are primed to use the outcome — whatever it is — for political gain.

Obama has expressed confidence the court will uphold his signature legislative initiative. But he won't be shocked if a conservative majority overturns the most controversial provision, those familiar with his thinking say. Romney aides say the Republican candidate will get a political boost if the court strikes down the measure. But they don't want celebrations that could alienate voters who could lose health care benefits as a result of the decision.

The court's ruling could have a far-reaching impact on the nation's health care system. If thelaw is upheld, about 30 million of the 50 million uninsured Americans would get coverage in 2014 when a big expansion begins.

Overturning all or part of the law could leave as uninsured the more than 3 million young adults who gained coverage through a provision allowing them to stay on their parents' insurance up to age 26, according to the Health and Human Services Department. Another 60,000 people who gained coverage through a plan for those with pre-existing conditions may not be able to get coverage elsewhere if the entire law is struck down.

Obama recently has avoided mentioning the impending court ruling directly, but during campaign events this week he has vigorously defended the health care overhaul as critical to the public's health and well-being.

"I think it was the right thing to do. I know it was the right thing to do," he told supporters in Boston.

Romney, who as Massachusetts governor signed a health care law on which the Obama's federal law was modeled, has focused more than usual on the Supreme Court ruling this week. In campaign appearances in Virginia, New Jersey and New York, he offered supporters and donors a preview of his likely response to the decision and said Obama's first term would be essentially wasted if the law is overturned.

If the court upholds the law, Romney told supporters at a northern Virginia electronics manufacturer Wednesday, it's still bad policy. "And that'll mean if I'm elected president we're going to repeal it and replace it," he said.

And if the court strikes down the law, Romney said, "They're going to be doing some of my work for me."

Obama advisers say the Supreme Court showed reasonableness earlier this week in a ruling on an Arizona immigration case, and they see it as a hopeful sign for how the court might rule on health care.

If the court upholds the law, Obama could get an election-year gust of wind at his back, with his vision and leadership validated. If the court strikes down the overhaul, the White House would seek to cast the decision as detrimental to millions of Americans by highlighting popular elements of the law that would disappear, such as preventive care and coverage for young adults on parents' plans.

The Romney campaign has coordinated its response directly with the Republican National Committee and House Republicans, who have agreed not to "spike the ball" — as one Republican put it — should the law be struck down. His campaign worries that an over-celebratory tone may turn off voters affected by the decision.

Indeed, the stakes are high for both candidates. Polling suggests that most Americans oppose the law, but an overwhelming majority want Congress and the president to find a new remedy if it's struck down.

Romney so far has spent little time crafting a comprehensive plan to replace the overhaul. And the Obama campaign already has seized on Romney's opposition to the most popular provisions in the law. For example, Romney would not prevent health care companies from denying coverage to new customers with medical conditions. Nor would he force them to cover young adults on their parents' plans through age 26.

Still, both sides will use it to raise money and motivate supporters. And outside groups are ready to unleash a flood of advertisements following the ruling, including a 16-state, $7 million ad buy from the conservative political action group Americans for Prosperity.


AP White House Correspondent Ben Feller contributed to this report.

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