Despite what CNN and Fox News reported at first Thursday morning before correcting themselves, the Supreme Court has upheld the most crucial aspects of the Affordable Care Act, including the individual mandate, in a 5-4 decision with the deciding opinion coming from conservative Chief Justice John Roberts.
What caught CNN and Fox News in a bit of inaccurate reporting was the opening sentence of Roberts’ decision. Reading on would have enabled them to see that Roberts said that the individual mandate is constitutional, thus keeping this particular ruling from becoming a decision based more on politics than constitutionality.
“The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause,” Roberts wrote. “That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, 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’s power to tax.”
Justice Ruth Bader Ginsburg took it a step further in her opinion, written separately for the four liberal justices, saying they would have upheld it based on the Commerce Clause as well.
“Unlike the market for almost any other product or service, the market for medical care is one in which all individuals inevitably participate,” she wrote. “Virtually every person residing in the United States, sooner or later, will visit a doctor or other health care professional.”
The four dissenting justices wrote, “The Court regards its strained statutory interpretation as judicial modesty. It is not. It amounts instead to a vast judicial overreaching.”
Taking it to a political level, they added that the decision “creates a debilitated, inoperable version of health-care regulation that Congress did not enact and the public does not expect. It makes enactment of sensible health-care regulation more difficult, since Congress cannot start afresh but must take as its point of departure a jumble of now senseless provisions, provisions that certain interests favored under the Court’s new design will struggle to retain. And it leaves the public and the States to expend vast sums of money on requirements that may or may not survive the necessary congressional revision.”
This is not a perfect law. It actually gives enough business to the health insurance companies that they should be jumping for joy. It still leaves too many Americans uninsured. But it at least gives something to work with and improve upon.
If you ask me, a single payer system would be the better solution with lower administrative costs, those costs being one of the bigger culprits leading to the health care cost mess that we’ve been in that’s brought the U.S. to this point. Yet the mention of the words “single payer” or “universal care” brings out cries of “socialism.” Had the Supreme Court struck down the individual mandate, the best option then may have been to fight like never before to get universal care, and I can pretty much guarantee that the majority of American voters would have voted in lawmakers willing to do just that.
What’s the reaction from America’s physicians’?
“The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy.
“The AMA remains committed to working on behalf of America’s physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation’s health care system.
“This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents’ health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans.
“The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork. It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.” — Jeremy Lazarus, M.D., President, American Medical Association
“The American Academy of Family Physicians is eager to move forward with needed health system reforms now that the Supreme Court has ruled. As a result, more Americans will have access to meaningful insurance coverage and to the primary care physicians who are key to high quality, affordable health services.
“Broad, individual responsibility for health care is the foundation for successful implementation of the Affordable Care Act’s patient protections. Economic realities dictate that ensuring affordable coverage for all Americans depends on participation of all Americans. The 2001 Institute of Medicine Report, ‘Coverage Matters — Insurance and Health Care,’ confirms that — regardless of their insurance status — virtually all Americans use health care services. Without broad participation in a health care coverage system, health care for all cannot be obtained, let alone sustained.
“The Affordable Care Act reduces numerous financial barriers to care, by requiring coverage despite pre-existing conditions, eliminating annual and lifetime limits on benefits, and eliminating cost sharing for preventive services. It recognizes the value of primary care by bringing Medicaid payment for primary care services to Medicare levels.
“Equally important, however, are the law’s provisions that will build the primary care workforce to meet patients’ needs. The Supreme Court decision maintains already-launched initiatives that support wider implementation of the patient-centered medical home and that value primary medical care through payment incentives for primary care physicians. Programs such as the Center for Medicare & Medicaid Innovation’s Comprehensive Primary Care Initiative and Medicare’s Primary Care Incentive Payment can continue to foster a financial environment that builds the primary care physician workforce and helps ensure all Americans have access to a patient-centered medical home.
“The decision allows investment in primary care education and training with improved support for the Health Professions Grants for Family Medicine, funding for teaching health centers, establishment of the Health Care Workforce Commission, and maintenance of scholarships and loan repayment programs in the National Health Service Corps.
“The Affordable Care Act provides a foundation for reforming our health care system, but much work still lies ahead including a permanent replacement for the Sustainable Growth Rate formula and meaningful medical liability reform.
“By upholding the Affordable Care Act, the Supreme Court has ensured that Americans have access to affordable, sustainable health care coverage and that they receive high quality, coordinated and efficient care based on primary care. It is a future that family physicians happily anticipate.” — Glen Stream, MD, MBI, President, American Academy of Family Physicians
And what about Republicans’ reaction to the Supreme Court’s ruling. They stand more ready than ever to use it to help bring down President Obama in November.
“The president’s health care law is hurting our economy by driving up health costs and making it harder for small businesses to hire. Today’s ruling underscores the urgency of repealing this harmful law in its entirety. What Americans want is a common-sense, step-by-step approach to health care reform that will protect Americans’ access to the care they need, from the doctor they choose, at a lower cost. Republicans stand ready to work with a president who will listen to the people and will not repeat the mistakes that gave our country ObamaCare.” — House Speaker John Boehner, R-Ohio
“If we want to get rid of Obamacare, we’re going to have to replace President Obama.
“What the court did not do on its last day in session, I will do on my first day if elected president of the United States, and that is I will act to repeal Obamacare. Let’s make sure we understand what the court did and did not do. What the court did today was say that Obamacare does not violate the Constitution. What they did not do was say that Obamacare is good law or good policy. Obamacare was bad policy yesterday, it’s bad policy today. Obamacare was bad law yesterday, it’s bad law today.” — Presumptive Republican Presidential nominee Mitt Romney
The funny thing is that so much of what makes up “ObamaCare” is what Republicans have proposed in the past. It’s only because the ACA was pushed through under an Obama administration that the staunchest conservatives are having a fit.
My bottom line is this: Anyone whining about a government takeover of health care needs to walk a few miles in the shoes of those American citizens who are facing very hard realities and are demanding a change, especially in economic times like these with unemployment rates remaining high and not projected to get lower anytime soon, wages being stagnant, health care costs forcing middle class families into bankruptcy, insurance premiums going up and facing coverage that doesn’t improve, or just no health coverage whatsoever, and collection agencies are chasing you down while trying to get money you don’t have due to circumstances beyond your control.
Walk a few miles in those shoes, and let’s see how much the whining continues.
The “politics as usual” will surely continue. The Supreme Court’s ruling Thursday won’t stop that. Thankfully, at least in this case, Chief Justice Roberts saw fit to put the American people’s health and welfare above corporate or political greed. It’s up to us as citizens and voters to uphold our responsibility to keep that corporate and political greed from eroding away a basic constitutional concept.
If we can’t do that, we will have gone from winners in this Supreme Court case to big losers overall.
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