It’s rare that I start an article with a disclaimer and a where I’m coming from statement, but here goes.
I’ve never supported President Obama’s Affordable Care Act (ACA). I felt betrayed when he took the single-payer option off the table before discussion even began and again when he took the public option for the exchanges off the table. I firmly believe that the US needs a single-payer healthcare program and that what’s commonly called “Medicare For All” isn’t good enough. Medicare is an 80 percent health insurance program, as is Minnesota’s high-risk pool, the Minnesota Comprehensive Health Care Association (MCHA). My wife and I were “covered” under MCHA when I was diagnosed with end-stage renal disease (permanent and incurable kidney failure) in February 2000. The 20 percent of my healthcare costs that weren’t covered by our MCHA insurance policy bankrupted us within two years. I’ve been an in-center hemodialysis patient since February 2000 and while all end-stage renal disease patients on dialysis qualify for Medicare coverage (.pdf; 762KB), I continue to remain on private insurance. Accordingly, I have plenty of skin in this particular game. Furthermore, I haven’t finished reading the decision and dissenting opinions. I’ll update this article or publish additional articles if warranted.
In a surprising 5-4 decision, the US Supreme Court upheld the constitutionality of the Affordable Care Act (.pdf; 799KB). Even more surprising, the majority decision was written by conservative Chief Justice John Roberts. In the nuanced decision, it’s clear that the court’s majority see the expansion of healthcare insurance coverage to virtually all Americans not at all as a mandate to purchase insurance, but rather as a tax for not doing so.
Amy Howe, the editor of SCOTUSblog distilled the essence of the decision in a single, elegant graf (scroll to the 10:32 mark):
“In Plain English: 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.”
Howe goes on to clarify the Medicaid bit at the 10:24 mark of the SCOTUSblog live coverage section:
“Another way to think about Medicaid: the Constitution requires that states have a choice about whether to participate in the expansion of eligibility; if they decide not to, they can continue to receive funds for the rest of the program.”
Charles Ornstein, writing for ProPublica, has an excellent analysis of which states will refuse the Medicaid expansion bit of the ACA.
The Supremes apparently rejected the Obama administration’s first two arguments—that ACA is constitutional on the basis of the Commerce Clause or the Necessary and Proper Clause—and accepted the third: ACA is constitutional because it’s a tax. This may be interpreted by some as a warning to the US Congress about its authority—or, more accurately its lack of authority—to pass social welfare laws.
Roberts was quite careful to note the decision was not a reflection on the law’s quality, only its legality:
“We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”
In its decision, the majority admirably drew a clear line demarcating the responsibilities of the judicial and legislative branches of the US government.
It’s important to note that no US Supreme Court has overturned a president’s signature legislation in more than 75 years. President Obama was quick to address the decision.
The Republican response to the decision was particularly dicey. Mitt Romney bemoaned the increase in taxes, cuts to Medicare, loss of existing insurance, and pledged to repeal the Affordable Care Act.
US House of Representatives Speaker John Boehner (R-Ohio) responded by saying the ACA “is hurting our economy by driving up health costs and making it harder for small businesses to hire.” Boehner, like Romney, promises a repeal.
US Senate majority leader Mitch McConnell (R-Kentucky) claims “the supposed cure has proved to be worse than the disease,” and pledges full repeal. I’m starting to sense a pattern here.
After all, the right-wingers are going to have a terribly hard time explaining how a healthcare reform package that originated in one of their premier think tanks—and that they universally supported until an African American president scooped it out from under them—is suddenly bad policy. Imagine this exchange in a presidential debate:
Romney: Elect me and I’ll overturn Obamacare; this election is a mandate on healthcare.
Obama: Obamacare is Romneycare: You passed the same law while governor of Massachusetts.
Romney: That was then; this is now.
Obama: Were you stupid then or lying now?
The corporate cable broadcast media was a clownshow, with both CNN and Fox incorrectly reporting that the individual mandate had been struck down as unconstitutional. Here’s the media story in images:
President Obama’s Dewey moment.
CNN’s website incorrectly reporting ACA found unconstitutional.
CNN incorrectly reporting ACA found unconstitutional.
Fox incorrectly reporting ACA found unconstitutional.
Nancy Pelosi and John Boehner react to US Supreme Court upholding ACA [Source: Non-bylined AP photographer].
And then there were the absolutely hilarious tweets from the right-wingnut larvae asserting they’re moving to Canada as a result of the Supreme’s decision. For those of you without a scorecard, Canada enjoys a truly socialized healthcare system.
Clownshow aside, and even though I remain strongly opposed to President Obama’s Affordable Care Act, I’m tremendously pleased that so many American citizens previously without healthcare insurance will likely have it in a couple of years. As Andy Kroll and Nick Baumann, writing for Mother Jones report, the ACA has a handful of provisions that will make a seriously positive impact on the lives of the majority of Americans:
- No annual or lifetime health insurance coverage limits
- No preexisting condition exclusion for children (permanently) and adults (expires in 2014 when insurance exchanges become available)
- No health insurance coverage rescissions (the dropping of the insured when they get sick)
- The youngs can stay on their parents insurance until they’re 26
- An eventual closing of the doughnut hole in Medicare prescription drug coverage (initially, the ACA provides only US$250 toward the doughnut hole that exists between US$2,700 and US$6,200 in Medicare prescription drug expenses)
- Preventive care benefits for Medicare beneficiaries
- Up to 50 precent tax credits for small businesses that offer health insurance to employees
- Insurers are required to reveal overhead expenses and rebate unusually high administrative costs to policy holders
Update: Thursday, 28 June 2012 5:32PM CDT: Adam Peck, writing for ThinkProgress, provides graphical evidence of how Huffington Post and Time also were absolutely wrong in their initial coverage of the US Supreme Court decision.
Update: Friday, 29 June 2012 10:34AM CDT: US Supreme Court Chief Justice John Roberts, partially buried the lede in the first graf on page six of the finding, writing only for himself:
“Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.”
I’m fairly certain this isn’t what he meant, but as I tweeted earlier this morning, I remain fully and alarmingly convinced the American citizenry is in deep, deep trouble when a right-wing healthcare plan in 1989—the Heritage Foundation’s “Assuring Affordable Health Care for All Americans;” a plan formulated as a reaction to the near-left’s single-payer, universal coverage with employer mandate offering—is now seen as “socialism.”
The Heritage Foundation’s plan was introduced—virtually in its entirety, including the individual mandate—in the 1993 Health Equity and Access Reform Today (HEART) Act introduced by John Chafee (R-Rhode Island). The Republican’s bill was introduced as a response to President Bill Clinton’s healthcare reform bill.