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Supreme Court: Affordable Care Act Is Constitutional 2416

This morning the U.S. Supreme Court ruled 5-4 that the Affordable Care Act is constitutional. The health insurance mandate, also known as "Obamacare" was found to be "permissible under Congress's taxing authority." The full ruling (PDF) is now available, and the court's opinion begins on page 7. Amy Howe from SCOTUSblog summarized the ruling thus: "The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding." Further coverage is available from CNN, the NY Times, and Fox.
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Supreme Court: Affordable Care Act Is Constitutional

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  • by Anonymous Coward on Thursday June 28, 2012 @12:18PM (#40479495)

    First dissent

  • by timeOday ( 582209 ) on Thursday June 28, 2012 @12:21PM (#40479527)
    I already have health insurance. It's expensive and overly complicated, but I do have it. So, will this actually change anything for people like me? Hopefully I won't be picking up the tab for so many others who opted not to buy insurance before getting sick. But otherwise I don't see a huge impact.
    • Good question (Score:5, Informative)

      by Tancred ( 3904 ) on Thursday June 28, 2012 @12:28PM (#40479661)

      The individual mandate was designed (by Republican think tanks) to avoid freeloaders, who we've all been paying for when they show up in the emergency room.

      I also have insurance and the 2 big things it does for me are that it'll be tougher for an insurance company to deny benefits based on a pre-existing condition (which has been interpreted ludicrously loosely at times) and that if I (or someone close to me) ever does have huge medical bills, it will be less likely to bankrupt me.

    • by letsief ( 1053922 ) on Thursday June 28, 2012 @12:28PM (#40479683)

      You were already doing that before, partly through your taxes, partly through effectively paying higher amounts to hospitals, in order to compensate hospitals for the all the ER visits they get from people without insurance (and thus likely never pay). You potentially could have ended up in the situation you were worried about if the Supreme Court struck down the individual mandate, but kept the rest of the law.

    • by fermion ( 181285 ) on Thursday June 28, 2012 @12:31PM (#40479753) Homepage Journal
      The theory is that health care will be cheaper overall because everyone will have to pay for thier healthcare. We will not have situations where a 30 year old chooses not to have health insurance because work does nor provide such a benifit, then has a major illness that the taxpayers fund the care of.

      In Texas the state created a socialist program in which everyone who drives a car has to have insurance. The argument that having a car is a choice was hogwash, you have to have a car in texas. The government basically decided the insurance companies were to profit, but did crate a pool that one could use for insurance of last resort. The result is a new $400 expense to owning a car. The other result is that uninsured motorist insurance is very cheap, and I am not paying for others people accidents. If it is good in TX, it is good everywhere.

    • by sammy baby ( 14909 ) on Thursday June 28, 2012 @12:43PM (#40480011) Journal

      Wow, are you likely to get an earful over this. Here's my perspective (not a neutral one):

      The "individual mandate" part of the Affordable Care Act (ACA) requires you to carry health care insurance. However, supporters claim that because the risk associated to insurers is now spread out over a much larger segment of the population (those who would normally decline health insurance are obviously less likely to need it), the cost to individuals in terms of premiums is likely to decline. In other words, they're betting that the cost of your insurance is likely to decline. Personally, I think that's likely... for insurers, anyway. Whether insurers pass these cost savings to individuals is a craps shoot. When Massachusetts (under, ahem, Governor Romney) passed a law with an individual mandate, premiums fell something like 40% at the same time that it was rising nationally.

      Another big part of the bill is the "pre-existing condition" clause: basically, an insurer cannot deny you coverage because you already have a medical condition that they don't want to cover. There was some worry among ACA boosters that the court might strike down the "individual mandate" part without the "pre-existing condition" part, which would have been catastrophic to the risk pools: seven states have tried passing pre-existing condition laws without the individual mandate, and it went very badly for all of them []. So if it turns out that you come down with some kind of chronic or severe condition, it can no longer be used as a reason for an insurer to deny you insurance.

    • by dkleinsc ( 563838 ) on Thursday June 28, 2012 @12:43PM (#40480035) Homepage

      So, will this actually change anything for people like me?

      Like anything else complicated, it depends. Some things it does that could affect you:
      * If you have any kids ages 18-26 you have the option of putting them on your group insurance plan, which you couldn't always do before this was passed.
      * If you work full-time for a company that has more than 25 employees, they have to offer you health insurance benefits. If you don't work for that kind of company, they're setting up an insurance exchange where you can easily compare and buy insurance.
      * If it does what the people who designed it think it will do, it will reduce the number of people who show up at ERs without insurance, and significantly increase the chance of poorer people getting preventative care.
      * It prevents your insurance company from refusing to cover something by claiming it's a pre-existing condition, and from cutting you off because you got sick.
      * The part that people are up in arms about is that if you don't somehow acquire health insurance, you pay a tax penalty.
      * If you were poor, the government would pay for your health insurance. I doubt this is relevant to you.

      This is more-or-less identical to the plan passed in Massachusetts several years ago, and signed into law by one Mitt Romney. The studies vary as to how useful it was (mostly depending on the political slant of those doing the study).

  • Public option (Score:5, Insightful)

    by betterunixthanunix ( 980855 ) on Thursday June 28, 2012 @12:21PM (#40479533)
    What ever happened to the public option? You know, cutting the profit motive out of funding health care, so that people do not have to fight with their insurance companies or with hospitals just to get the treatment they need?
    • +1 (Score:5, Insightful)

      by Tancred ( 3904 ) on Thursday June 28, 2012 @12:23PM (#40479567)

      Medical insurance is not only incredibly frustrating to deal with, but a huge unnecessary expense in the system.

    • Re:Public option (Score:5, Informative)

      by SpaceWiz ( 54904 ) on Thursday June 28, 2012 @12:24PM (#40479581)

      It took a lot of political capital to even get this passed. The public option was removed to make it passable.

      • Re:Public option (Score:5, Insightful)

        by NoNonAlphaCharsHere ( 2201864 ) on Thursday June 28, 2012 @12:31PM (#40479747)
        And by that you mean "acceptable to the health insurance lobby". Partly I blame this as a failure of marketing. Had they simply touted the public option as "Medicare for everybody" we'd have that instead of this hlaf-assed compromise.
      • Re:Public option (Score:5, Informative)

        by Art Challenor ( 2621733 ) on Thursday June 28, 2012 @12:42PM (#40479993)
        Actually, there's a lot of opposition to the healthcare reform. The right oppose it for ideological reasons, and many on the left because it falls too far short of the universal health care that any civilized country should have.

        Interestingly, the right's opposition is purely an ideological objection to "Obamacare". Opposition is 56% to 44% BUT if you ask about the different pieces (Reuters-Ipsos poll), 80% of Rebublicans favor creating "insurance pools", 52% favor letting kids stay on their parent's healthcare until age 26, 78% favor banning insurance from denying coverage for "pre-existing" conditions and 82% favor banning insurance companies from dropping sick people. The numbers are, of course, much higher amongst independents/democrats.

        So, the right wing objects to Obamacare while favoring all the major provisions.
      • Re:Public option (Score:5, Insightful)

        by betterunixthanunix ( 980855 ) on Thursday June 28, 2012 @12:45PM (#40480061)
        Without the public option, this bill is just a way to further cement and inflate the profits of health insurance companies -- which, last I checked, were the "bad guys" who refuse to cover the cost of necessary treatment. Your ability to have your medical treatments paid for depends on whether or not you can afford deductibles, premiums, co-pays, "co-insurance" (which is obviously different from co-pay), and tests, prescriptions, or treatments that the insurance company will not even both to cover (in the words of Aetna: this is not covered because it is an integral part of a covered procedure).

        That is the sort of thing that comes out of a for-profit system -- the health insurance companies turn their greatest profits when they are not paying for treatment, and so they do everything they can to avoid paying.

        No, the public option is not perfect -- it invites fraud of various kinds, it is an open target for politicians who think a government should not be in the position of keeping its citizens alive and healthy, and it would likely replace the current bureaucracy with another. It is still better than a system where banks, investment companies, and disconnected investors become wealthier when sick people are denied medical care.
    • Re:Public option (Score:5, Insightful)

      by Anonymous Coward on Thursday June 28, 2012 @12:24PM (#40479591)

      What ever happened to the public option? You know, cutting the profit motive out of funding health care, so that people do not have to fight with their insurance companies or with hospitals just to get the treatment they need?

      Because half the country is convinced that allowing giant corporations to profit off the sick is the only non-"socialist" option.

    • Re:Public option (Score:5, Interesting)

      by Tumbleweed ( 3706 ) * on Thursday June 28, 2012 @12:29PM (#40479691)
      What, you mean the OTHER Republican-originated plan that the Republicans blocked so that Obama couldn't look good by doing his job? What the hell do you think happened to it? It went the way of other Republican-originated ideas that are now demonized by the Republicans once a Democrat signs onto it, like cap and trade, etc.
    • Re:Public option (Score:5, Interesting)

      by JaredOfEuropa ( 526365 ) on Thursday June 28, 2012 @12:32PM (#40479777) Journal
      Big mistake to have that removed. Your health care system now looks a little like ours in the Netherlands, and we are seeing what one would expect to see with mandatory health care insurance: premiums go up every year, and not just because of a greater overall demand. The cold truth is that insurers, collectively, have zero interest in keeping healthcare cost down. On the contrary, they'd rather charge you $600/month rather than $300 to cover the same package, unless there is some real competition amongst insurers. Over here, there really isn't.

      I'm no fan of our social-democrat party, but I do agree with an idea they floated the other day: as insurance is mandatory, the insurers add no value whatsoever. They do add a considerable amount of overhead and a staggering amount of red tape and bureaucracy in health care. Cut them out of the deal, let the government handle health care payments and collect premiums (as they already do for part of the basic package).
  • by DigiShaman ( 671371 ) on Thursday June 28, 2012 @12:25PM (#40479603) Homepage

    It's not a tax. Obama even said so []. We have a honest man in the house. Why are you all doubting him?

  • by Apharmd ( 2640859 ) on Thursday June 28, 2012 @12:26PM (#40479629)
    Quite surprising to see Roberts cross the aisle on this decision. For all of its flaws (and there are many), the Affordable Care Act is a step in the right direction. Health care is one of the major issues of our time, and it's not realistic to suppose that a single piece of legislation can resolve it.
  • by Anonymous Coward on Thursday June 28, 2012 @12:27PM (#40479653)

    The whole problem with this is the insurance angle. This becomes a guaranteed income stream for private insurance companies. They have so many ways to hide their finances, people will pay ever higher costs for reduced care. There are a thousand studies saying health care costs will increase in the future, not including inflation. There are many ways the government could improve health care and reduce the cost of it, but this is not it. If the government was the insurance company that would be different, all they would have to do is add .5 % to the current medicare deduction. Simple. Let anyone that wants join a government health plan (with no existing condition clause). Simple.

  • It's not a mandate (Score:5, Informative)

    by mathimus1863 ( 1120437 ) on Thursday June 28, 2012 @12:31PM (#40479755)
    It's a new tax to cover the healthcare costs of those who end up in the hospital without insurance.

    You can get a tax break for having your own insurance, as proof that you won't be costing taxpayers anything when you end up defaulting on $200k of hospital bills after an accident.

    I don't know why the democrats couldn't shape the message that way. That's really what it is, and sounds better than "pay up or pay up".
  • Justice Roberts Gem (Score:5, Interesting)

    by chill ( 34294 ) on Thursday June 28, 2012 @12:46PM (#40480107) Journal

    Justice Roberts had this little gem hidden in his commentary.

    "The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause.That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it.

    But in the odious 1942 Wickard V Filburn [] case the Court ruled exactly the opposite. The Court decided that Filburn's wheat growing activities reduced the amount of wheat he would buy for chicken feed on the open market, and because wheat was traded nationally, Filburn's production of more wheat than he was allotted was affecting interstate commerce. Thus, Filburn's production could be regulated by the federal government.

    In essence, they ruled that he can't grow wheat for his own use he MUST BUY IT IN THE MARKET.

    I wonder if this ruling can be used as precedent to challenge Wickard v Filburn?

  • by imuffin ( 196159 ) on Thursday June 28, 2012 @12:53PM (#40480255)
    My favorite is the conservatives who, upset that the SCOTUS upheld the individual mandate, say they're moving to Canada [] because America is just too socialist.
  • by uslurper ( 459546 ) on Thursday June 28, 2012 @01:36PM (#40481381)

    I am surprised and disappointed by this ruling. But not for the reasons you might expect.

    I want the US to have universal health care, but I think the mandate was a back-asswards way of getting it and I dont think it will be successful.
    It would have been far better to just make it a tax. This mandate only helps the health insurance industry slow its inevitable downward spiral.

    Accoding to a 2007 study by Kaiser Permanente, []
    Healthcare spending has risen steadily and has outpaced wages. This means that less and less people can afford healthcare, and in turn less people will be purchasing insurance. Of course this is cyclical, since with less people buying insurance, the insurance sompanies will ahve to increase their premiums.
    And so the health insurance industry is already in a downward spiral that will eventually collapse.

    I fear that the health insurance mandate will not stop this downward spiral, since it will be less expensive for healthy people to just pay the fine than to buy insurance. Eventually, the US government will have to intervene.

    Taxpayers already pay for a large percentage of the populations medical services. If you count Medicare, Medicaid, Federal, State, and Local governments, that makes up over 100 million users, or 30% of the population. As less people can afford healthcare, the government will be shouldering a higher percentage.

    Dont fool yourself. You are paying for this one way or another. Either by taxes, or by rising insurance costs. If your company is paying the premiums, you may want to ask them why you did not get a raise this year and they will tell you it was eaten up by premiums. insurance is after all a 'tax' that you pay in order for 'services' to be available when you need them. The healthy people end up paying for the sick people with chronic problems caused by obesity, diabetes, heart disease, lung and liver diseases, all could be prevented by good diet, exercise, and staying away from drugs, alcohol, tobacco, fat, and sugar. How does that make you feel when your hard earned dollars are going to pay for someones lung cancer treatment who has chain-smoked for 20 years?

    Not that I am bitter or anything. i paid more for health care in the last 5 years than I did in taxes. The last 2 years I paid more in health care than I did for my mortgage. And that is with an employer sponsored plan and a healthy family. But the good news is that this will HAVE to change. We know it and there is a clear path to where we need to go. In the next 5-10 years we will have universal healthcare whether we vote for it or not.

Life in the state of nature is solitary, poor, nasty, brutish, and short. - Thomas Hobbes, Leviathan