U.S. health-care overhaul upheld by Supreme Court

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The U.S. Supreme Court has upheld the core of President Barack Obama’s health-care overhaul, giving him an election-year triumph and preserving most of a law that would expand insurance to millions of people and transform an industry that makes up 18 percent of the nation’s economy.

The justices, voting 5-4, said Congress has the power to make Americans carry insurance or pay a penalty. That requirement is at the center of the law, which also forces insurers to cover people with pre-existing health conditions. The court limited the law’s extension of the Medicaid program for the poor by saying the federal government can’t threaten to withhold existing money from states that don’t fully comply.

The ruling frames the health-care issue for this year’s elections and is a victory of symbolism as well as substance for Obama. Chief Justice John Roberts, a Republican appointee, joined four Democratic-selected justices to give the president a majority on a law that has divided the country along ideological and partisan lines throughout his presidency.

Roberts, writing for the court, said Congress had the authority to impose the insurance requirement under its power to levy taxes.

While the federal government “does not have the power to order people to buy health insurance,” Roberts wrote, “the federal government does have the power to impose a tax on those without health insurance.” The law “is therefore constitutional because it can reasonably be read as a tax.”

The decision on the Patient Protection and Affordable Care Act is the climax to an epic legal fight that featured the longest courtroom arguments in 44 years, a record number of briefs and extraordinary public interest in a Supreme Court case. The case tested both the constitutional powers of Congress and the willingness of the Roberts court to overrule the other two branches of the federal government.

Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito dissented, saying they would have struck down the entire statute.

“The fragmentation of power produced by the structure of our government is central to liberty, and when we destroy it, we place liberty at peril,” the dissenters wrote. “Today’s decision should have vindicated, should have taught, this truth; instead, our judgment today has disregarded it.”

Among the majority, Justices Ruth Bader Ginsburg and Sonia Sotomayor voted to uphold the entire statute. Justices Stephen Breyer and Elena Kagan agreed with Roberts in limiting the Medicaid expansion.

The dispute marked the first time the Supreme Court had considered a president’s defining legislative accomplishment in the middle of his re-election campaign. The Supreme Court hadn’t considered a law of comparable scope since the justices overturned part of the National Industrial Recovery Act in 1935 during President Franklin Roosevelt’s New Deal.

The law marks the biggest change to the U.S. health system since Medicare and Medicaid were established in 1965. The law was designed to expand coverage to at least 30 million people -- primarily by expanding Medicaid and setting up online markets where consumers could buy insurance -- while controlling the soaring costs of health care.

Republicans, including presidential candidate Mitt Romney, have called for repeal of the law.

The law was challenged by 26 Republican-controlled states and a small-business trade group. They contended the measure exceeded Congress’s constitutional powers to regulate interstate commerce and impose taxes.

“The battle isn’t over,” said Republican Attorneys General Association Chairman Scott Pruitt of Oklahoma, in a statement. “It now is up to the political process to repeal the act and replace it with measures that address the health-care crisis within the confines of the Constitution.”

Roberts rejected the commerce argument while voting to uphold the law under Congress’s taxing power.

“It may often be a reasonable financial decision to make the payment rather than purchase insurance,” Roberts wrote. “Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new.”

The insurance mandate requires Americans to get coverage by 2014 or pay a penalty. The concept was championed by Republicans years ago as an alternative to Democratic proposals for a single government-run health system.

The Medicaid expansion was designed to extend eligibility to those with incomes up to 138 percent of the federal poverty line. States that didn’t comply with the new expansion would have lost all or part of their share of federal Medicaid funding.

Roberts said Congress can require states to meet conditions to receive new Medicaid money, though it can’t take away existing funding.

“The financial ‘inducement’ Congress has chosen is much more than ‘relatively mild encouragement’ — it is a gun to the head,” Roberts wrote. “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.”

The ruling removes some of the uncertainty the health industry had faced about the future of government policy. By upholding the individual mandate, the court left intact a provision that will give insurers such as UnitedHealth Group Inc. millions of relatively healthy, low-cost policyholders.

Some parts of the law have already gone into effect, including provisions that close a gap in prescription-drug coverage under Medicare, allow 2.5 million young adults to stay on their parents’ insurance until age 26, and provide free mammograms, colonoscopies and flu shots.

The health-care measure’s enactment in March 2010 marked the culmination of decades of efforts by Democrats and Republicans alike to put in place a universal health care program. For Obama, congressional approval marked a victory that had eluded presidents from Harry Truman to Bill Clinton.

Passage in the Democratic-controlled Congress came only after months of lobbying, deal-making and parliamentary maneuvering. In the end, not a single Republican voted in favor of the law. The measure passed the House by a 219-212 tally.

From the beginning, the law divided the public, with opposition fueling the Tea Party movement and helping produce the 2010 Republican takeover of the House. A Bloomberg National Poll conducted in March found that 37 percent of respondents said the law should be repealed, 11 percent said it should be left alone and 46 percent said it may need small modifications.


  • Cliff Notes
    Republican - assumes that an America is smart enough to choose what they do with their money, capable of doing their due diligence when deciding what to invest in, where to buy insurance, give to charity, and is fiscally responsible enough to live within their means rich or poor. They don't want government taking their money, wasting a large portion on non productive government job salaries while using the rest to give to those who decide they want to rely on government. Republicans understand competition is what drives a market. Liberal - think everyone is entitled and be equal and don't have the ability to choose for themselves how to best spend their money. They would rather give everything to the government and then have Obama divy this up and tell you what to buy and when. Lack critical thinking skills, don't understand where money comes from and think everything should just be free. No clue what debt is or what it means to save for the future. When times are tough they believe the solution is to print more money. Unfortunately their won't be anyone there to bail out America when other countries stop buying our debt...but liberals can't see past tomorrow.
  • Bernie
    I bet you think that the "government" should provide everything to everbody. Hey I can't afford a nice house and my friend can - that's not fair!! Let's legislate that everyone is afforded the same house, those who can't buy one will be given one by the government (paid for by someone else), heck why stop there..food, tennis shoes, cell phones........
  • Get the Facts Right
    Your employer pays the other half of the tax. The old argument of not paying SS taxes by choice is a lame one. Most people wouldn't do anything except spend it. The ACA is but the first step to a single payer system and should be. What do you think Medicare is?
  • Reply to: Socialism is not digital
    You are really lame. Social Security is paid for by you the worker. Unfortunately, there are manuy who did not work for theirs. If you had placed the same amount of money in the bank and CD's for 45 years you would be worth over a million dollars.
    • surgery
      I don't as much of a problem with us being forced to have health insurnace as I do it becoming a government ran health insurance. I was dx with cancer in March of this year and had surgery the next month and am now cancer free. I doubt that I would get surgery as fast with Obamacare.
    • JOBS
      I wonder how this will effect the job market? I'm concerned that small businesses will let go of some of their employees or not hire anymore. I think the unemployement numbers will go up. Hope I'm wrong.
    • Church goers have issues with Socialism
      Thunder - The difference is the church-goers are giving what they want to give to those they choose to give it to. No one is FORCING them to give up their money. Obamacare on the other hand FORCES us to pay however much money "they" decide "they" will need to pay for the health care to those "they" decide need it most. And, not all will be covered. That is the dirty little secret. Also, WHO gets to decide whether or not your parents should receive that hip replacement or heart transplant they need? Can you see that it will be others who decide the fate of all? A scenerio: Your father cannot have the heart transplant that he so desparately needs because WE (whoever WE is!) really need that money for the younger crowd. Your father has lived a good life. It's just that there is only so much money to go around. We will make sure he is comfortable for what little time he has left by giving him soothing drugs. End of scenario. Do you see any problem with this? And don't think these Death Panels won't happen. It is not government's place to force us to buy anything. Period!
    • JOBS
      I wonder how this will effect the job market? I'm concerned that small businesses will let go of some of their employees or not hire anymore. I think the unemployement numbers will go up. Hope I'm wrong.
    • ?
      Enough of the 'socialism' nonsense...under the current system we ALL pay (in one way or another) for people that do not have insurance...
    • American Healthcare System
      So from now on: it's the American healthcare system.
    • The old days
      How terrible it is to be subject to the oppressive regime of communist Britain.
    • Except...
      Except the tie breaking vote was the Bush appointed Chief Justice, so...
    • Thanks to those who pay
      I just want to thank all the hard working people out there who take so many of your dollars and give them to the government to disperse to those without insurance. i am able to now use my welfare checks to but my smokes while i no longer worry about the quality of my health as I'm guaranteed insurance. I'm sure those that workout and eat healthy won't mind that i eat lard for breakfast, pack of smokes for lunch, and i considered channel surfing exercise and we're all paying the same amount. Thanks to Obama and his welfare...i mean tax or Obamacare.
    • questions
      does this now mean that even if i do not own a car governemnt can order me to buy insurance for it
    • Really
      The govt "requires" that you have car insurance but many people don't, so those who do pay an "Uninsured" motorists premium on their policy. The govt does not require that you have homeowner's insurance, your mortgage holder does, otherwise you take the chance of a loss. On car insurance, driving a car on public roads is a privilege, so the "required" insurance is to protect everyone. I don't see how you can compare this with health insurance.
      • Socialism is not digital
        I smirk when I see people comment regarding socialism. They throw it around like it's an all or nothing deal. It's not digital (e.g. on or off). Social Security is socialism. Additionally, why do conservatives who go to chruch and do all sorts of charity within those groups have such issues with socialism in broder scope?
        • Not Sure What To Think
          SamSueBlu, As far as I know it will be affordable; very affordable. We'll put it on the national credit card. You don't have the option to buy anything else. The penalty will be more than opting ... wait a minute ... you can't opt out. One size fits all. This is socialism; isn't it great?
        • Appoint Me; Support You
          Like the Governor's election as Purdue President; our President appoints members to the Supreme Court and they, in turn, rub his back too. Different parties, same game.
          • Not Sure What To Think
            I really like the idea of being able to have insurance, but I also what to be able to afford it. I have pre-existing health problems and am not able to purchase a policy I can afford and have the coverage I need for what I already have. I just don't want to loose everything I have to be a ble to pay for health insurance. I am definatley going to have to do more research on my options. Does anyone even know what the penalty for not having health care is going to be? Will it be more affordable than purchasing the health insurance?
            • Hmmm...
              As long as this law applies to EVERYONE - including Congress - I have no problem with it. Congress should have the same restrictions imposed upon them as everyone else does. Just because they are wealthy (because they use our taxes to line their pockets) shouldn't give them the right to be exempt from the policies enforced upon the rest of us!
            • What do you call...
              A bunch of selfish people who know little as to what socialism really is? Republicans. Those of you touting that this is the downfall of America are fear mongering and mostly liars. The US is one of the last 1st world, industrialized countries to have healthcare provided for all. Are the Brits socialist? How about the Canadians? The Swedes? How about Brazil? All have equal healthcare opportunities for their citizens. Are you sure they are socialist countries? Quit your lying and quit being crazy about becoming socialist. It's not happening.
            • HURRAY
              Yea, My SO can get new hips and new teeth and treatment for her fibromyalgia now because she isn't covered by my company policy which I get as a benefit at $2500 per year, the same amount my colleague gets for herself, her husband, and her 1 year old kid. I wonder if I'll have to quit smokin', quit drinkin' Big Gulps, and start exercising now. This is probably a good thing for everyone; it's a right now, something to do with right to life and the pursuit of happiness; I'm not sure about the liberty thing, though. Can you spell BFD? That's bigger than the now nearly 16x10^12 national debt.
            • Fight or Switch
              We are doomed as a free society and a country. Our elected leaders have nearly taken us back to the point where we were prior to the revolution. Certainly the socialist and communist are reveling in their victory. Must we have another revolution to remain free? Whats next? Our guns and cars. Will we be implanted with microchips like pets for quick identification? The government has finally become an enemy of the people and the freedom that is our rich history.
              • just beginning
                This is a good first step, but there is a lot of work left to do. We all know that healthcare cost is the main cause of our current and future budget deficit (which is currently financed in an unsustainable way). So, we need to have a frank discussion what kind of country do we want. Do we want to have social safety nets or not? If we do, the only way to pay for it is through higher taxes and better cost control. That's why I'm suggesting that when so called Financial Armageddon comes (1.1.13), we do nothing. We don't extend Bush tax-cuts, and we let "savage" spending cuts go through across the board. This is not an ideal solution, but I'm sure it would better than whatever "compromise" they come up with in Washington.
              • Thank You!
                It's "funny" how so many folks are OK with government requiring you to have insurance on your material possessions (home insurance and car insurance) but get so upset when the discussion turns to protecting and caring for human life. There are many people that need afordable, quality health care. There are folks in very poor health, working through their illness simply because they can't afford to retire due to lack of affordable health coverage in the gap between early retirement and Medicare/Medicaid assistance. This is a historic day for inclusion. This ruling is a positive step toward encouraging Americans to pariticipate in becoming a healthy nation. Thank you, Mr. President!
                • good news for the GOP
                  Given that a majority of Americans do not want the government in control of their healthcare - The republicans will campaign effectively on the repeal of Obamacare.
                • Victory for the President
                  Everyone should have healthcare.
                • this is not health care
                  derekis not health Care. This is forced insurance at gunpoint achieved by a very well funded lobby. If the law forced salary restrictions on insurance companies and made them nonprofits with limited ways to waste money then this would be good for healthcare. I've now lost faith in the judicial system here.
                • Great news!
                  Hooray for Roberts! Now let's just see if the Republicans will trot out their usual accusation of "Activist Judge", as they do for every judge that votes for a human rights issue.
                • All Noise
                  This is all mostly noise. Businesses that have been aggressive are flourishing right now. Some company leaders are using this as an excuse not to grow their businesses and they will suffer. Let's get this behind us and get the ball rolling with healthcare reform and let's work together to make it work versus fighting about it. The vocal minority will always be heard - think critically about what they are saying.
                • Much Needed and Long Overdue
                  Providing for the basic health care needs of its citizens is the just, moral and humane thing for a country to do, so it is wonderful to see this hurdle surmounted.
                • Here's come Socialisim
                  What a dark day for the people and businesses who will have to pay. The judges certainly don't have to worry about such things. This will add further to the implosion of our economy.

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