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High court upholds key part of Obama health law

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. AP Photo/David Goldman)

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. AP Photo/David Goldman)

Reader poll

Do you agree with the Supreme Court's decision?

  • Yes 24%
  • No 73%
  • I'm unfamiliar with the details 3%

323 total votes.

A look at where Georgia stands on implementing President Barack Obama's federal health care overhaul

NUMBER OF UNINSURED: 1,905,000 state residents are uninsured, or 19 percent.

WHERE THE STATE STANDS: Georgia has not implemented the health care exchanges. State lawmakers have introduced bills that would either allow or hinder implementation of the law, though none have passed.

WHAT HAPPENS NOW: Gov. Nathan Deal, a Republican, opposes the health care overhaul and voted against it while a congressman. But Deal has said he would prefer that Georgia authorities, not the federal government, implement the exchanges if the law is upheld.

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.

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.

Comments

FordGalaxy 2 years, 4 months ago

Well, your Congress can now force you, under penalty of fine or jail time, to purchase a product. Congress has never had the right, but now they do. This may very well be the one of the most destructive court ruling in the history of our nation.

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BurritoJones 2 years, 4 months ago

Only in America would it be considered 'destructive' to make sure that everyone has access to a doctor.

But you're right. Because all the other legally required insurances, licenses and qualifications we have in place have clearly wreaked havoc upon our country.

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FordGalaxy 2 years, 4 months ago

Who doesn't have access to a doctor? Even when I didn't have health insurance I could still see a doctor, or go to the ER if necessary. The insurance most often compared to the individual mandate is auto insurance. But you only have to purchase auto insurance if you buy a car. So city-dwellers without a car don't have to purchase it. It basically functions as part fo a contract you enter into with the state to use state-maintained roads.

The individual mandate is a different animal altogether. The power of Congress has been greatly expanded by this ruling. Never mind that in 2009 Barack Obama himself said the individual mandate is NOT a tax. The court jsut said it was okay, so long as it was a tax.

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charlesg 2 years, 4 months ago

To continue your city-dweller car insurance example, it would still be constitutional (according to the ruling), and within congress' power, for congress to pass a tax to give incentive to purchase car insurance. Whether or not it's part of the 'use the roads' contract, it's still under the power to levy a tax. And you're right, no matter how Obama (or any other Representative) classified it, "the law must be struck downbecause Congress used the wrong labels" is incorrect.

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charlesg 2 years, 4 months ago

Go back and read pages 30-35 of Roberts' decision, and you'll see that this is a tax, whereas a "penalty of fine or jail time" would in fact be a punishment of unlawful behavior. Not purchasing insurance, as this law is worded, doesn't constitute unlawful behavior.

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Cleanupguy 2 years, 4 months ago

Given that health care in this country costs an average of two and a half times as much as the rest of the world while we remain very near the bottom of the longevity pile, and that taxpayers are forced to cover the costs of those less responsible people that get their care for free in emergency rooms (illegals included), this is a great extremely conservative Republican plan. OK, so strikingly similar plans were proposed in 1993 and again in 1999 by the latter party, one of which was proposed by current the Speaker of the House. His plan required a whatcha call TAX on those that did not participate - imagine that! Even Gingrich once lectured on this as a responsible conservative necessity, and Mr. Romney's plan was copied for this one. Looks like we have agreement at last, hyprocisy aside. Please remember that LIFE comes before liberty and the pursuit of happiness.

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FordGalaxy 2 years, 4 months ago

Life may come before liberty and the pursuit of happiness in the way the words were penned down, but what is one without the other two? How happy would you be to be alive if someone was holding you prisoner somewhere without any hope of escape? How happy would you be to be alive if you were essentially brain dead but your body was still performing the automatic tasks that it goes through (breathing, heart beating, etc.)?

I have no problem with wanting more Americans to be insured to cover their own costs. But to put it out as a product that must be pruchased or face fine or jail time is not right. It empowers Congress in a way that Congress should never have been empowered.

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toby 2 years, 4 months ago

Then why does the rest of the world come here for medical treatment? And the last I heard, the USA was no where near the bottom of longevity. If we lived shorter lives, we wouldn't be in the shape we are. I think Judge Roberts did what he did so the masses will vote the current president out. Call it backhanded but may be very effective. We will see. Stay tuned.

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Cleanupguy 2 years, 4 months ago

Sorry to hear that your memory is so selective. Google "the cost of care national geographic magazine" and you'll see a nice graphic summarizing the facts. Yes, we're nearer the bottom than the top in longevity, with costs far above everywhere else. We're indeed great at certain very expensive treatments but near dead last at preventitive care that would have avoided much of the need for those treatments in the first place. Note on the graphic that the highest longevity corresponds with the most preventative care.

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kevin 2 years, 4 months ago

I hope you are correct in Nov. Also need to replace Liberal in the Senate with GOP. A clean-sweep and we will take back our Constitution.

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toby 2 years, 4 months ago

If I want no insurance and I pay the cash price to a doctor (which is 1/2 the insurance price) why will I be forced to buy this? If I have been getting free healthcare already, where do I get the money to pay for this? I'm confused. I am young and single and no kids and have not been sick in years. Why do I need insurance? Why did the greatness president, that the media said we have ever had, do this to us poor people? Why Mr. president? Why? When I can't pay for this and can't pay the penalty, do I go to jail? Looks like slavery has come back to America. We are slaves to government. I remember the day that government works for the people. And now we work for them. UFB!

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Sandykin 2 years, 4 months ago

I can tell you why you have to have insurance. Your premiums cover everyone else too. So, you know that fat guy that eats big mac and fries every day for lunch, yeah that one with the clogged arteries and high blood pressure. You're paying for his doctor visits and his medicines. Never mind that you take care of your own body and don't have such troubles - your premiums are needed to cover his medical care because, unlike you, he doesn't make the effort to eat properly and safe guard his own health.

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kevin 2 years, 4 months ago

Because Obama feels he can do anything since the majority voted for him and Senate Liberals in 2008. Ms. Nancy has to go as well.

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Cleanupguy 2 years, 4 months ago

WOW - having actually READ the law, I find the typical mis-information about it blinding. I don't recall seeing anything about "jail time", but I believe that subsidies for those that cannot pay are included. You might want to check all that it out before jumping to conclusions (might break a leg and need health care). Tom Jefferson was quite clear regarding why life came before all else - might want to check that out as well (without life, the brain-dead question would be a moot point, for example). Jeeesh!

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FordGalaxy 2 years, 4 months ago

The fact remains that Congress can now legally force you to buy a product and they can penalize you if you do not. We shouldn't be comfortable with our government having that kind of power.

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Cleanupguy 2 years, 4 months ago

Quick! Lock the barn door - the cattle have escaped! This is all a moot point now - the time for outrage would have been several years ago, before this became a done deal.

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kevin 2 years, 4 months ago

so why did so many vote for an inexperienced idiot activist?

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jack 2 years, 4 months ago

I'm going to start saving now for that Chevy Volt.

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kevin 2 years, 4 months ago

great. Buy 2 or 3 and save us the tax money from the government buying them from Chevrolet.

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jack 2 years, 4 months ago

Sorry Kevin. You'll have to pay for your own state-mandated, clean-energy, union-made, government-approved Volt.

Or pay a hefty tax.

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kevin 2 years, 4 months ago

everybody makes mistakes (supreme court). When the GOP wins enough seats in the Senate to take it over, then ObamaCare TAX can be repealed. Now Obama can be held to the reality that he has severely TAXED the middle class the most since we are the majority in this country. Politicians have always made the middle class pay the most to support the government. Who else has more money? Small businesses are now doomed. I see the unemployment rate rising and the stock market crashing. Again the middle class are the ones mostly affected. And you know what, they are the same "class" of people that voted for the Liberals in the first place. I hope all those that vote for the Liberals got they change they wanted and are losing all their retirement money and jobs.

Doctors are already being made to ask you what specific tests you want done because all of the "standard" tests done in the past are NOT covered anymore. I see all the medicals bills rising for the middle class the most. This is another additional hidden cost of the new law that mostly middle class patients will pay in addition to higher premiums. Thank you all for the tax and higher premiums. I hope you all get to pay lots more.

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Jan 2 years, 4 months ago

Delighted to see you support raising taxes for incomes over $1 million per year!

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kevin 2 years, 4 months ago

I didn't say that if you read closely. I only stated a fact that the middle class (in total) has to be the ones who pay for most everything in this country. The rich don't. I don't want a tax increase of any kind on anyone, but tax decreases.

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Sandykin 2 years, 4 months ago

Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." ==> When you can afford neither the insurance nor tax imposed because you don't have the insurance, please explain how that's a victory.

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Jan 2 years, 4 months ago

If you can't afford the insurance, then you are not paying taxes. The law specifically states that the IRS is not allowed to put liens on your property for the collection of the tax so you will be allowed to continue to use emergency room services, not pay your bill and have those of us that are responsible in handling our health care pick up the slack for you. So you believe our system should cater to free loaders.

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charlesg 2 years, 4 months ago

Jan, there you go again, actually reading the law instead of sharing a knee-jerk opinion. When will you ever learn that this type of behavior is frowned upon?

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Sandykin 2 years, 4 months ago

I'm willing to bet you work for somebody rather than be self employed. If you were self-employed you would know exactly how expensive private insurance has become since Obamacare was enacted. It's not irresponsibility here. It's economics. We do earn an income and we do pay taxes. Just don't have an extra $1000 each month for insurance for a family of 5.

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Jan 2 years, 4 months ago

First, full disclosure, I am on Medicare (yes - that "horrible" socialism" and am enjoying better coverage than I had before, and my employer had a better than average policy. Second, your claim of $1000 per month required for family coverage is more than double the average family coverage costs of $414 per month in 2011. Assuming you have employees, you would be able to negotiate for even lower rates if you were willing to help your employees with lower cost insurance, even if the full cost was passed on to them. Since they are required to be covered, you would be helping them to lower their costs.

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kevin 2 years, 4 months ago

yes, we will pay the premiums for those that can't. Wonderful way to govern your people and get away with it!

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Mack711 2 years, 4 months ago

We, the middle class, will now be paying for the ones who will not work to provide for their own needs. How can the government take over private business? But they just did and now it will get even worse. We are becoming a 4 world nation.

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Cleanupguy 2 years, 4 months ago

Exactly wrong. We already pay for those that don't pay their own way, whether they can or cannot afford it, including illegal immigrants. Don't believe it? Visit the the Gwinnett Medical emergency waiting room any Saturday evening. Shortly everyone will have to contribue what they can, which is a heckuva lot more than the zero they pay now. Check the numbers - this is expected to return a slight net DECREASE in the deficit.

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kevin 2 years, 4 months ago

and we will be now paying for their free medical insurance as well. What if their medical costs more that the policy will pay for? Are the poor still going to come up with money or we will be paying that part as well? No one knows because of the 2,500 pg fiasco. Bet the taxpayer pays for every penny. So you remark is moot point. We pay either way but now, the insurance premiums will be even higher because of the millions unhealthy people (pigs, smokers, rug uses, ugly, etc) using the system and taking my doctor away from me. But don't worry. They are "rushing" new doctors because the good ones will opt out the medicare system and you will be using poorly trained doctors that will be experimenting on you. Just wait.

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kevin 2 years, 4 months ago

"upheld virtually all " This means that some of it was thrown out. The whole bill was NOT left as passed, or I should say, run down the Democrats' throats.

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Say_that_again 2 years, 4 months ago

Delighted to see that it wasn't "...run down Democrats' throats." That part about the expansion of medicaid where current funding cannot be withheld while additional funding can be withheld if states fail to implement the medicaid improvements. Thanks for the laugh!! Now let me hear how you feel violated because the government want let you buy shoulder fired rocket launchers that can take down airplanes!

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