High court upholds Obama health law

By: MARK SHERMAN, Associated Press
By: MARK SHERMAN, Associated Press

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.

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.

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. "

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.

Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.

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.

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.




Visit AP's Google Plus page at 4 p.m. EDT for a Google Hangout video chat where AP reporters will be discussing the impact of today's ruling and taking your questions: -http://apne.ws/LgPvzL

(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

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  • by noname on Jul 1, 2012 at 06:28 PM
    What about those families that both parents work, but make just a little to much for sooner care, but can't afford health care for there children. They work numerous jobs full and part time. but still can't afford health care. what about those parents who do everything right and still can't pay for good health care for the kids. what do you tell them people. Not everybody can get health care from the state and not everybody can afford to add the children to there job insurance.
  • by bud Location: denison on Jun 30, 2012 at 05:59 AM
    Think about it 3500 a year from the tax returns of folks that caint afford it times aprox.. 350million = taxes increase for the goverment , remember the congress still got there raise this year.
    • reply
      by Logic on Jul 2, 2012 at 07:30 AM in reply to bud
      How did you come up with these numbers? Where did you get 350 million? And who told you they can garnish wages? I have a Cigna PPO plan for my entire family that only costs about 3000 a year, and it is considered one of the better plans in the industry...so something is screwy with your figures.
  • by Anonymous on Jun 29, 2012 at 08:33 PM
    If anybody knew anything about this bill at all, they would understand how it positively effects individuals every single day. But instead of having any rational discussion about this bill and what it means for us, they'd rather talk extensively in talking points and preconceived notions about something they know absolutely nothing about.
  • by tommy Location: texoma on Jun 29, 2012 at 04:49 PM
    wasnt the health care plan from the start hitlery clintons idea ? or some other clown of the more desireables,as they consider themselves,i guess the poor people who cant afford to pay the insurance premium,will no doubt be thrown in jail,and after that happens and they lose their under paid job in the first place,and cant pay,i guess its back to jail again, i know a man who has been out of work for a year and is still trying to get another job,i guess if it wasnt already inacted,that that mean his new residence would be the county jail ? oh that will help him out,as if things arent bad enough on him,oh by the way,it isnt that he isnt trying to find work,i guess its always the poor that have to pay the rotten price when a nightmare idea like this health care,is forced on the people,what is sad is they prop it up as a good thing when its,a money making scheme,and always ends up a horrible backwards mistake,FOR THE PEOPLE but NOT BY THE PEOPLE.
    • reply
      by Logic on Jul 2, 2012 at 07:16 AM in reply to tommy
      Obamacare as we know it started in The Heritage Foundation a conservative thinktank. It was first implemented by Romney and Massachusetts now has over 98% of its population covered. The individual mandate , that people have to be responsible for their own health care, is a conservative concept. Surprised they are so ashamed of it now...
  • by paychecktopaycheck on Jun 29, 2012 at 12:24 PM
    Logic, thank you for explaining things that are so obvious. I can't afford health insurance for my family, but I make too much money for medicaid. Guess Romney 2012 isn't worried about me.
    • reply
      by Logic on Jul 2, 2012 at 06:59 AM in reply to paychecktopaycheck
      Well you have the internet. Soon the State of Texas will be posting a website with every medical insurer in the State to make it easier for you to find an affordable plan. You might not get the best coverage, and the Copays will be high, but at least its something if you need to take your family to the hospital...otherwise what do you do now with no health insurance? Just go to the hospital and pay cash when they send the bill? If you can't afford insurance I doubt you can afford to write a 5 thousand dollar check to a hospital either right? So the hospital bills go unpaid and you start getting collection notices...right? This is a typical scenario and the reason for the individual mandate...
  • by Mike H. on Jun 29, 2012 at 10:01 AM
    Wow...look at that Stock Market soar the day after the court ruling!!! People suddenly want to invest in Americas future!!! I am very optimistic today!
  • by Bea Location: Mayberry on Jun 29, 2012 at 08:37 AM
    Thank God for men that stand behind their word, I am very much impress by our Chief Justice Roberts, he was able to put politics aside and give a judgement based on the CONSTITUTION, AS ROBERTS STATED "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," I agree with our President "Whatever the politics, today's decision was a victory for people all over this country.
    • reply
      by Joey on Jul 4, 2012 at 11:20 AM in reply to Bea
      Don't be so quick to praise Justice Roberts. He's the same guy who gave us the Citizens United ruling that allows those with wealth (both foreign and domestic)to buy elections. You will notice that he interperted the "penalty" aspect of the AFHCA as a "tax". That interpertation has already been highlighted in the campaign for President. Just check some of the comments about it on this site. No, I'm afraid the chief justice may have come across looking better to some on the left, but sustaining this health care law along with the tax label that it's been tagged with is a political maneuver, and will likely bring about massive voter turnout among the tea party types.
      • reply
        by Bea on Jul 5, 2012 at 08:22 AM in reply to Joey
        Joey, I understand your concern in reference to the possible increase voter turnout by those of the tea party callibar, but I have a feeling that what we have seen in Roberts (preservation) is exactly what we will see in those that this bill will affect and will also come out and vote. Roberts decision truthfully was not a surprise, the integrity of the Supreme Court was more important than a political stand, at this particular time,their decision had to be constutionally sound, some are very particular in what carriage they ride.....
  • by Romney 2012 on Jun 29, 2012 at 05:43 AM
    This is a good thing overall because it will continue to prevent job growth as no one is going to hire with this massive new tax burden and all of the unknowns. It will also help run the deficit up beyond recognition (already there actually). Maybe the dolts who supported this monstrous "pass it to see what's in it" bill will finally understand. If they don't, maybe a 6-month wait for a basic procedure (if the government decides you need it) or the fact that they are in good health, excercise, and eat right, yet they are paying the same premium as the obese slob lying on the couch doing nothing, will make them understand. Obama has got to go!
    • reply
      by Logic on Jun 29, 2012 at 07:26 AM in reply to Romney 2012
      What are you talking about??? Do you have medical insurance now? If so, all you can expect is your premiums to go down as more and more people become insured. And your coverage will not change. Nor your choice of doctor. NOTHING changes for those currently insured. 6-month wait? Why? If you have Cigna, Blue-Cross or any other insurance now, how does the government control what they pay for? You want death panels? Try Insurance underwriters. You know, the way things were before Obamacare. When they could cancel your policy you been paying for years on a pre-existing condition clause. They can't do that now. Lives will be saved. Besides, your man Romney LOVES the individual mandate. Watch this 27 second video where he explains the benefits of the individual mandate and how it will bring your insurance costs down...http://www.youtube.com/watch?v=Lmihmlb1LBY (Copy and paste to your browser)
      • reply
        by Anonymous on Jun 29, 2012 at 01:07 PM in reply to Logic
        Do you always believe everything you hear on TV??? There is NO way premiums will go down. In fact, this law has already caused many people's insurance to go up. It seems a foreign concept to so many of you, but SOMEONE has to pay for all of this "free" insurance for those who can't afford it (many in this economy and due to Obama increasing welfare individuals to 17 million). Just wait until 2014 gets here and see what your costs are! Many will not even get insurance because employers will not be able to afford it. Also, it should be common sense that putting everyone on a "budget" insurance plan will decrease the quality. Do we need reform? Absolutely! Have the republicans properly addressed it? No, they have not. Is Obamacare the solution? Not by any stretch!
        • reply
          by Logic on Jul 2, 2012 at 06:50 AM in reply to
          I believe in the law of supply and demand. And you blame Obama for increasing welfare individuals, but he has done no such thing. The poor economy has simply driven more people across the welfare threshhold. The fact that more people now qualify for welfare is a reflection of the economy. As the economy continues to improve these numbers will go down. As far as premiums going up, I can only speak for my own experience. Mine have not. And yes, as more people get insurance, premiums go down...just like car insurance. I cannot wait until Obama eats Romney alive in the debates on Obomneycare...it will be something to see.
        • reply
          by Mike H. on Jul 2, 2012 at 07:08 AM in reply to
          Nobody with health insurance now has to go on some "budget" plan. If you have insurance NOTHING changes. You keep the doctor of your choice and the insurance you are paying for determines your coverage, not the government. If you want to call Medicaid a "budget" insurance then OK...it has been that since it was created and good luck even finding a doctor that accepts it! The quality of service is determined by quality of doctors and staff. Did you know we have a shortage or doctors and nurses? Plenty of job opportunities in the medical field...which is why we need to continue to provide affordable loans and grants to kids wanting to pursue that career.
      • reply
        by Anonymous on Jun 30, 2012 at 06:44 AM in reply to Logic
        Romney loves the individual mandate? Evidently not as he is going to overturn it! If he did at one time, he doesn't "love it" now. I guess he's has "eveolved" on the issue, you know, like Obama has "evolved" on gay marriage, govt. transparency, taking large campaign donations (he was REALLY against that....when Bush did it), increasing the debt ceiling (also against it when Bush did it), gitmo, the war, the Bush tax cuts, etc. Wow! I am running out of room on here. Romney 2012!!
        • reply
          by Logic on Jul 2, 2012 at 07:21 AM in reply to
          Well put your faith in Etch-a-Sketch...do you really know WHAT he is going to do? Conservatives thought they had the Supreme Court locked up and Roberts switched on them...I'd prepare for more of that if I were you.
      • reply
        by Mercy on Jun 30, 2012 at 06:49 AM in reply to Logic
        Logic, I highly doubt the medical insurance will go down. When the bill was signed within weeks , our insurance (through an employer)sent us a new card. Our co pay use to be $15,now it's $25.Prescriptions that use to cost us $10 , are now $20. The coverage actually was less then we originally had.My doctor stop taking Sooner Care ,who is to say the next time I go to the doc, he stops taking insurance, and demands cash upon service. Which I may not have on hand. This bill just made things unpredictable for a lot of people.
        • reply
          by Logic on Jul 2, 2012 at 07:27 AM in reply to Mercy
          My copay on prescription went up also...10 dollars. But still...25 dollars for prescriptions that sometimes cost several hundred is awesome don't you think. My cable bill went up 30 dollars the past year. Electric went up an average 20 a month. Water bill went up 15 dollars a month.Vehicle Registration went up 10 dollars this year. The price of a movie ticket in Sherman went up 2 dollars. Are we to attribute all these increases to Obomneycare?
    • reply
      by Anonymous on Jun 29, 2012 at 08:35 PM in reply to Romney 2012
      Massive tax burdens? It imposes a 10% tax on tanning salons, a .9% tax on individuals in the top income bracket, and a fee of no more than $700 to individuals who can afford health insurance, but don't purchase it. And according to CBO projections, this bill ought to pay itself off by the year 2021. What MASSIVE tax do you speak of?
  • by Logic on Jun 28, 2012 at 04:40 PM
    Now Romney, Obama and the Supreme Court support it...where is a sociopathic conservative suppose to go? Wait...did I say Romney supports it? Well he did when HE implemented it as governor! 27 Second video about to hit your TV here: http://www.youtube.com/watch?v=Lmihmlb1LBY By the time all these Romney videos come out between now and election day, Romney is going to be the MORE LIBERAL of the candidates! LOL!
  • by freeloader on Jun 28, 2012 at 04:34 PM
    I'm so happy cause now I can get that big screen tv and some 24 in wheels for my ride now that ill have free healthcare and food stamps! Whoooohoooooo! Rofl
    • reply
      by Logic on Jun 29, 2012 at 07:16 AM in reply to freeloader
      ??? So you assume that a person on welfare previously was paying for health insurance, but now that it is free they can use that money to buy a TV? What planet you living on?
      • reply
        by Reason on Jun 29, 2012 at 10:50 AM in reply to Logic
        Oh, he lives on this planet. We have become the planet of GOP morons who love to make up idiotic garbage about what they imagine the scary Liberals are doing to them.
      • reply
        by Anonymous on Jun 29, 2012 at 01:08 PM in reply to Logic
        No, previously the deadbeats didn't have insurance because they didn't work or care if they had it or not. Why shoudl they, if they get sick, the government will pick up the tab!
        • reply
          by Logic on Jul 2, 2012 at 06:53 AM in reply to
          Well, so you support the individual mandate to get more people insured and take personal responsibility toward their own medical care then right?
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