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06-28-2012, 11:14 AM
Supreme Court upholds health care law Bob Egelko Updated 09:58 a.m., Thursday, June 28, 2012
(06-28) 08:56 PDT WASHINGTON -- In a divided but stunning decision, the U.S. Supreme Court on Thursday upheld virtually all of the far-reaching law crafted by President Obama to extend health coverage to most uninsured Americans.
Despite widespread predictions after oral arguments in April that the court would overturn a central provision - that the uninsured buy private coverage or pay a penalty on their tax bills - the justices ruled 5-4 that the individual mandate was within Congress' constitutional authority to levy taxes.
The only setback for the law was in its provision expanding Medicaid coverage for low-income Americans, the program known as Medi-Cal (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Medi-Cal%22) in California, to an additional 17 million individuals by easing eligibility standards. The justices said states could reject the expansion without forfeiting federal funds for their current Medicaid program.
Chief Justice John Roberts (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22John+Roberts%22), normally a member of the court's conservative bloc, wrote the majority opinion, joined by the court's four liberal justices. The four dissenters said the entire law should be held unconstitutional.
Roberts joined his fellow conservatives in rejecting the Obama administration's main argument to uphold the individual requirement to buy insurance - that it was part of Congress' power to regulate interstate commerce. That power, he said, does not authorize the federal government to require Americans to purchase products, even if their refusal imposes health care costs on other taxpayers.
The government's authority over interstate commerce "is not a general license to regulate an individual from cradle to grave," Roberts said.
But he accepted the administration's backup argument that the individual mandate could be considered a tax, since those who refused to buy insurance would have to pay more to the Internal Revenue Service (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Internal+Revenue+Service%22), starting with a $95 penalty in 2014.
"It is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income but choose to go without health insurance. Such legislation is within Congress' power to tax," Roberts wrote, a conclusion that enabled the law to survive.
The dissenting justices rejected the taxation argument and said the law was an unconstitutional encroachment on Americans' right to decide whether to purchase products.
The Constitution does not "enable the federal government to regulate all private conduct," said the dissenters, Justices Antonin Scalia (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Justices+Antonin+Scalia%22), Anthony Kennedy (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Anthony+Kennedy%22), Clarence Thomas (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Clarence+Thomas%22) and Samuel Alito (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Samuel+Alito%22).
Justices Ruth Bader Ginsburg (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Justices+Ruth+Bader+Ginsburg%22), Stephen Breyer (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Stephen+Breyer%22), Sonia Sotomayor (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Sonia+Sotomayor%22) and Elena Kagan (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Elena+Kagan%22) joined Roberts' opinion and said the law should also be upheld as government regulation of the insurance market.
Obama signed the law in March 2010 after it cleared both houses of Congress in a 10-month struggle without a single Republican vote.
The campaign for universal health coverage, offered by nearly every other industrialized country, had been waged without success for over 60 years in a nation that now has 50 million uninsured residents.
The administration rejected the preferred approach of most liberals, a Medicare (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Medicare%22)-style "single-payer" system of tax-supported federal reimbursement. Obama's (https://www.sfgate.com/barack-obama/) proposed "public option" alternative, a government-run insurance plan to compete with private insurers, was beaten back in Congress by the insurance industry.
Instead, the law aimed at extending coverage to 32 million uninsured Americans by increasing eligibility for Medicaid, the low-income program known as Medi-Cal in California, and by subsidizing private coverage for others who couldn't afford it.
The subsidies would be offered in each state through insurance "exchanges," marketplaces where individuals and small businesses could compare policies offered by competing insurers.
Key provisions of the law were drafted to take effect in 2014, including a requirement that insurers accept all customers regardless of pre-existing conditions, and the mandate that uninsured individuals buy private coverage or pay a tax penalty.
But other provisions are already in effect, one of which allows about 2.5 million young adults to remain covered by their parents' policies until age 26.
The law has also banned sex discrimination in insurance rates, eliminated lifetime dollar limits on individual insurance benefits, and barred insurers from canceling coverage when a policy-holder becomes ill, except in cases of fraud. Other new provisions expand Medicare prescription drug coverage for seniors and provide them with free preventive checkups and services.
The legal challenge centered on the requirement to purchase insurance or pay a penalty.
The concept of compelling the uninsured to enter the private market, as the cornerstone of universal coverage, originated with the conservative Heritage Foundation (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Heritage+Foundation%22) in 1989 as an alternative to Democratic proposals for a government-supervised system. It was also the core of the ground-breaking Massachusetts health care law signed in 2006 by Gov. Mitt Romney (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Mitt+Romney%22).
But opponents, including the 26 states that sued to overturn the law, argued that the requirement was an unprecedented federal mandate to buy a private product and an unwarranted intrusion on private decision-making. If the government can make people buy health coverage, they argued, it can also tell them what food products to buy for their own good.
The administration and its supporters countered that health insurance is part of the national economy, and that a decision to go without insurance is an economic decision that often forces taxpayers to pick up the tab for the person's unpaid medical bills - a cost that now runs $43 billion annually.
The ruling in National Federation of Independent Businesses (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22National+Federation+of+Independent+Businesses%22) vs. Sebelius, 11-393, can be viewed at https:// sfg.ly/LiLtGY (https://sfg.ly/LiLtGY).
Dan Freedman (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Dan+Freedman%22), national editor in the Hearst Washington bureau (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Hearst+Washington+bureau%22), contributed to this report.
*
Bob Egelko is a San Francisco Chronicle (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22San+Francisco+Chronicle%22) staff writer. E-mail: [email protected]
Ads by Yahoo! (https://searchmarketing.yahoo.com/srch/contentmatch.php)
(06-28) 08:56 PDT WASHINGTON -- In a divided but stunning decision, the U.S. Supreme Court on Thursday upheld virtually all of the far-reaching law crafted by President Obama to extend health coverage to most uninsured Americans.
Despite widespread predictions after oral arguments in April that the court would overturn a central provision - that the uninsured buy private coverage or pay a penalty on their tax bills - the justices ruled 5-4 that the individual mandate was within Congress' constitutional authority to levy taxes.
The only setback for the law was in its provision expanding Medicaid coverage for low-income Americans, the program known as Medi-Cal (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Medi-Cal%22) in California, to an additional 17 million individuals by easing eligibility standards. The justices said states could reject the expansion without forfeiting federal funds for their current Medicaid program.
Chief Justice John Roberts (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22John+Roberts%22), normally a member of the court's conservative bloc, wrote the majority opinion, joined by the court's four liberal justices. The four dissenters said the entire law should be held unconstitutional.
Roberts joined his fellow conservatives in rejecting the Obama administration's main argument to uphold the individual requirement to buy insurance - that it was part of Congress' power to regulate interstate commerce. That power, he said, does not authorize the federal government to require Americans to purchase products, even if their refusal imposes health care costs on other taxpayers.
The government's authority over interstate commerce "is not a general license to regulate an individual from cradle to grave," Roberts said.
But he accepted the administration's backup argument that the individual mandate could be considered a tax, since those who refused to buy insurance would have to pay more to the Internal Revenue Service (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Internal+Revenue+Service%22), starting with a $95 penalty in 2014.
"It is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income but choose to go without health insurance. Such legislation is within Congress' power to tax," Roberts wrote, a conclusion that enabled the law to survive.
The dissenting justices rejected the taxation argument and said the law was an unconstitutional encroachment on Americans' right to decide whether to purchase products.
The Constitution does not "enable the federal government to regulate all private conduct," said the dissenters, Justices Antonin Scalia (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Justices+Antonin+Scalia%22), Anthony Kennedy (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Anthony+Kennedy%22), Clarence Thomas (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Clarence+Thomas%22) and Samuel Alito (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Samuel+Alito%22).
Justices Ruth Bader Ginsburg (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Justices+Ruth+Bader+Ginsburg%22), Stephen Breyer (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Stephen+Breyer%22), Sonia Sotomayor (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Sonia+Sotomayor%22) and Elena Kagan (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Elena+Kagan%22) joined Roberts' opinion and said the law should also be upheld as government regulation of the insurance market.
Obama signed the law in March 2010 after it cleared both houses of Congress in a 10-month struggle without a single Republican vote.
The campaign for universal health coverage, offered by nearly every other industrialized country, had been waged without success for over 60 years in a nation that now has 50 million uninsured residents.
The administration rejected the preferred approach of most liberals, a Medicare (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Medicare%22)-style "single-payer" system of tax-supported federal reimbursement. Obama's (https://www.sfgate.com/barack-obama/) proposed "public option" alternative, a government-run insurance plan to compete with private insurers, was beaten back in Congress by the insurance industry.
Instead, the law aimed at extending coverage to 32 million uninsured Americans by increasing eligibility for Medicaid, the low-income program known as Medi-Cal in California, and by subsidizing private coverage for others who couldn't afford it.
The subsidies would be offered in each state through insurance "exchanges," marketplaces where individuals and small businesses could compare policies offered by competing insurers.
Key provisions of the law were drafted to take effect in 2014, including a requirement that insurers accept all customers regardless of pre-existing conditions, and the mandate that uninsured individuals buy private coverage or pay a tax penalty.
But other provisions are already in effect, one of which allows about 2.5 million young adults to remain covered by their parents' policies until age 26.
The law has also banned sex discrimination in insurance rates, eliminated lifetime dollar limits on individual insurance benefits, and barred insurers from canceling coverage when a policy-holder becomes ill, except in cases of fraud. Other new provisions expand Medicare prescription drug coverage for seniors and provide them with free preventive checkups and services.
The legal challenge centered on the requirement to purchase insurance or pay a penalty.
The concept of compelling the uninsured to enter the private market, as the cornerstone of universal coverage, originated with the conservative Heritage Foundation (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Heritage+Foundation%22) in 1989 as an alternative to Democratic proposals for a government-supervised system. It was also the core of the ground-breaking Massachusetts health care law signed in 2006 by Gov. Mitt Romney (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Mitt+Romney%22).
But opponents, including the 26 states that sued to overturn the law, argued that the requirement was an unprecedented federal mandate to buy a private product and an unwarranted intrusion on private decision-making. If the government can make people buy health coverage, they argued, it can also tell them what food products to buy for their own good.
The administration and its supporters countered that health insurance is part of the national economy, and that a decision to go without insurance is an economic decision that often forces taxpayers to pick up the tab for the person's unpaid medical bills - a cost that now runs $43 billion annually.
The ruling in National Federation of Independent Businesses (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22National+Federation+of+Independent+Businesses%22) vs. Sebelius, 11-393, can be viewed at https:// sfg.ly/LiLtGY (https://sfg.ly/LiLtGY).
Dan Freedman (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Dan+Freedman%22), national editor in the Hearst Washington bureau (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22Hearst+Washington+bureau%22), contributed to this report.
*
Bob Egelko is a San Francisco Chronicle (https://www.sfgate.com/?controllerName=search&action=search&channel=health&search=1&inlineLink=1&query=%22San+Francisco+Chronicle%22) staff writer. E-mail: [email protected]
Ads by Yahoo! (https://searchmarketing.yahoo.com/srch/contentmatch.php)