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Supreme Court Health Care Decision Will Define The Future Of The American Health Care System

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An odyssey that began during the presidency of Teddy Roosevelt and dominated much of President Barack Obama's first term in the White House could conclude Thursday at the Supreme Court. With it could end the best hope to date for the nearly 50 million Americans without health insurance and the hundreds of millions more burdened by rising costs.

The Supreme Court is expected to issue a decision sometime after 10 a.m. Thursday in a lawsuit brought by 26 states and the National Federation of Independent Business that challenges the constitutionality of the Affordable Care Act, the health care reform law Obama signed on March 23, 2010. Chief Justice John Roberts and his fellow justices could side with the president and allow the law to take root as intended by Congress. But the Supreme Court may elect to overturn the entire law, or just components of it, and in the process destroy or at least derail the most ambitious effort ever taken to address the shortcomings of the American health care system.

Health care has become the "issue from hell" and politicians won't tackle it again for many years if Obama's law goes down, said Drew Altman, the president and CEO of the Henry J. Kaiser Family Foundation, a health-care research institution in Menlo Park, Calif. "It's hard to imagine this Congress under almost any scenario, Democrats and Republicans in this Congress, agreeing on substantial health reform legislation."

Instead, the nation would be stuck with a status quo in which the ranks of the uninsured continue to swell, more workers lose their company health insurance, premiums rise, benefits shrink and more people skip medical treatments because of cost. Meanwhile, the nation's health care bill, which was an estimated $2.7 trillion last year, will continue to devour an ever-larger share of the economy.

A ruling against the law would be a major blow to Obama, who achieved a goal that eluded presidents from Roosevelt to Richard Nixon to Bill Clinton, though the issue bedeviled him from the start and voters remain sharply divided over it. The Supreme Court's decision will also shape public opinion about its role in American politics and redefine the limits of Congress' power. And the fate of the health care reform law will also influence the presidential contest between Obama and Mitt Romney, the presumptive Republican nominee who has vowed to repeal the law if elected. Opponents view the law as an unaffordable expansion of the federal government's role in the health care system that places burdensome regulations on health care companies, employers and citizens.

But the stakes are higher for the the tens of millions of Americans who lack access to health care. Fully overturning the Affordable Care Act would deny about 30 million uninsured Americans access to the health benefits that would have been provided under the health care reform starting in 2014. Invalidating health care reform also would eliminate consumer protections built into the law that would prohibit health insurance companies from refusing to cover people with pre-existing conditions, charging higher rates to women, kicking sick people off the rolls and setting lifetime limits on coverage of medical bills, among other practices permitted before the law took effect two years ago.

If this law goes away, so does the guarantee of access to health care for children like Wesley Josephson and Jackson Whaley who have pre-existing conditions and big medical expenses. Adults with serious illnesses like Sarah Lewis and Martha Olson would continue to face significant obstacles to finding health insurance. Older Americans like Wister Adrine and Patricia Morrison would lose extra help with their prescription drug costs.

Striking down the law would upend initiatives that aim to slow skyrocketing growth in health care costs. In addition to reducing Medicare spending by $455 billion through 2019, the health care reform law includes a plethora of programs designed to encourage medical providers to cut down on waste, improve safety and employ techniques known to be more effective. Health care reform also would levy a tax on the most expensive health insurance plans beginning in 2018 that is intended to encourage people to choose less costly plans. In addition, the law would establish an independent board tasked with constraining Medicare spending.

But the Supreme Court may not go that far and instead opt to invalidate only parts of the law. At the heart of the constitutional challenge is the health care law's so-called individual mandate, a requirement that almost all Americans obtain some form of health care coverage or face a financial penalty. The plaintiffs contend this mandate represents an overreach by the federal government into the personal and economic decisions of American consumers. The Obama administration insists it is within its rights to regulate how Americans pay for the health care services they inevitably will consume during their lives.

The Supreme Court could rule that the mandate is unconstitutional and strike it down while leaving the remainder of the law in place. But the Obama administration views the mandate as an essential counterpart to the regulations that require health insurance companies to sell plans to anyone regardless of health, age or gender and that limit those companies' ability to charge some people more than others. Cutting out the mandate alone will reduce the number of newly covered Americans and make health insurance more expensive, the administration argues, because only sick people would be motivated to purchase insurance. If the mandate goes, according to the administration, so too must those regulations.

But if the Supreme Court goes this way -- striking down the mandate and the regulations -- then health insurance companies could carry on discriminating against the sick and the old and making women pay higher premiums than men, and the number of people who would gain health insurance coverage would be millions fewer.

Political Reaction To Health Care Ruling
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The USA Today/Gallup poll is the first out of the gate with a national survey gauging reactions to Thursday's Supreme Court decision upholding the 2010 health care reform law. They found sharp division, with 46 percent agreeing and 46 percent disagreeing with the decision.


The partisan polarization in the reactions is striking. Most Democrats (79 percent) said they agree with the decision, most Republicans (83 percent) said they disagree and Independents were divided almost evenly (45 percent agree and 42 percent disagree). This result comes in response to a neutrally worded question that made no reference to President Obama, Congress or either political party.

The survey was based on 1,012 adults called by live interviewers on Thursday as part of the Gallup Daily tracking survey. Interviews were conducted with respondents on both landlines and mobile phones.

-- Mark Blumenthal

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Republican governors and officials from numerous states won't commit to expanding their Medicaid programs to more of their poorest residents after the Supreme Court ruled Thursday they could opt out. The Obama administration believes they're bluffing.

A top official at the Department of Health and Human Services predicted Friday that all states will take the federal money on the table to expand Medicaid, which is jointly funded and managed by the federal and state governments, to anyone earning up to 133 percent of the poverty threshold, which is ,856 for an individual this year. The federal government will pay the full cost of covering an estimated 17 million new Medicaid enrollees from 2014 to 2017 and 90 percent of the costs into the future.

"We believe that, now that the court has clearly ruled on the constitutionality of the Medicaid expansion, that states, in fact, will take advantage of the coverage of these individuals," Mike Hash, the interim director of Center for Consumer Information and Insurance Oversight, said during a conference call with reporters.

That's an optimistic prediction, if the early reactions from Republican governors like Bobby Jindal of Louisiana, Bob McDonnell of Virginia, Sam Brownback of Kansas and Scott Walker of Wisconsinare any guide. These and other Republican governors haven't specifically committed to refusing to cover more poor people through Medicaid, but they continue to maintain they will take no steps to implement the health care law in their states.

The administration will "keep working with states and other partners to implement the law," Health and Human Services Secretary Kathleen Sebelius said. "What we can't afford to do is spend any more time refighting political battles."

The lawsuit that could have felled Obamacare was brought by 26 states, and states will continue to be major battlegrounds on which the future of health care reform will be determined. In addition to the uncertainty about the Medicaid expansion, many states haven't taken steps to establish the health insurance "exchanges," where people can obtain health plans or Medicaid benefits. Like the Medicaid issue, some Republican governors simply refuse to take part in the health care reform. Only 14 states and the District of Columbia have begun creating exchanges, and the remainder have until Nov. 16 to submit proposals to the federal government.

Hash offered another rosy assessment on this score: "Our objective is that every state will operate a state-based exchange," he said. "We will be ready to ensure that every American has access to affordable, high-quality coverage in Jan. 1 of 2014."

-- Jeffrey Young

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HuffPost readers were still writing in on Friday with reactions to the Supreme Court's health care ruling, expressing everything from jubilation to a desire to leave the country. Read their responses below, and read more from our citizen journalists covering the election over at Off The Bus, our open-source reporting project.

I'm excited about Obamacare passing but I pray that Obama will spend the next four months educating people about the helpful things in the plan: it has already saved seniors over a billion dollars in prescription costs, for instance, and not with taxpayer money; kids up to age 26 will have coverage; and most importantly, insurance companies cannot deny coverage to people with pre-existing conditions. Once hospitals can stop charging high prices for caring for indigents in emergency rooms, I believe health costs will fall.

This is a brilliant plan. I say long live Obamacare!

-Mary Lindsay Dickinson

Personally, I have three 20-something children and without Obama's health care law, they would not be able to afford health care. I can do so through my job with this law. More broadly, this ruling restores my faith in our democracy and gives me hope for our country's future. Health care should be a right in this great country.

-Stanton Green

I have relatives in North Carolina who, after their furniture companies left for Mexico, were left without medical coverage and pensions. They made very little in wages to begin with, so their Social Security payments are abysmal.

One has cancer and her doctor has to write to a cancer care facility in New York to provide her care. With this ruling they will be able to afford insurance and get the help they need.

Please make it known that if one does not pay the "tax" or penalty, they will not be jailed, and show the small amount they will be fined! Thank you.

-Carolyn Cunningham

I am on Social Security disability benefits and Medicare. I live on less than ,000 a year and receive in food stamps per month. I live in North Carolina in Section 8 housing, and Medicaid already pays my Medicare premiums.

At first I was hoping to be covered for co-pays, but with the caveat added that states may or may not expand care, well, I may not benefit one bit. And as it is, I do my best to stay away from doctors and expensive treatments, and I often turn down care I should probably have.

What would have been nice is a needs-based Medicare system with the co-pay and premiums based on income and resources for all -- or universal health care coverage along the same lines.

-Laura Cody

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Former Rep. Anthony Weiner (D-N.Y.), who resigned in June 2011 after lewd online behavior, gave his first radio interview since the scandal to WNYC's Brian Lehrer.

He dismissed the argument over whether to call the individual mandate a tax or not, and had another idea. "I was like, let's let our Republican friends vote against the freeloader tax ... it is ironic at the end of the day that that's all people are talking about," he said.

During the health care debate, Weiner was a frequent voice in the media in support of the law, even appearing on Fox News to argue for it as the network editorialized against it.

He also said that health care advocates should not be too happy about the court. "We should not be cheering that they did the right thing, shouldn't overlook that they did consistently the wrong thing," he said. "I think there's no question that it was constitutional."

Lehrer asked if he was "dipping his toe" to test a run for public office.

"You called me, this is an issue I care deeply about ... I'm not putting my toe anywhere," he responded.

He also denied a rumor that CNN had been planning a political show in the style of "Crossfire" for him and conservative commentator Andrew Breitbart, whose site posted the lewd photos of Weiner, before he died suddenly in March. CNN has also denied plans for the show.

-- Luke Johnson

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@ samsteinhp : O'Malley on McDonnell and R Govs: "The only health care mandate they embrace are trans-vaginal probes for woman"

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@ aterkel : Clarification: Jindal said "Obamney--" then said "Obamacare instead.

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Several newspapers' editorial boards in battleground states offered their own take on the Supreme Court's decision. The Cleveland Plain Dealer's board suggested it was time to move on from the mandate debate:

What everyone, but especially the law's opponents, need to remember is that the status quo is unacceptable. Americans want coverage that's accessible and affordable. Businesses that pay for their employees' coverage need lower costs, and both they and health care providers need certainty about the rules of the road.

In that light, Obamacare's opponents should stop fighting the mandate and focus on building a workable system. In Ohio, that means Gov. John Kasich and Lt. Gov. Mary Taylor need to move ahead to design a statewide insurance exchange where consumers can shop for the best deals. In Washington, that means the Obama administration should encourage competition and innovation to fight health care inflation.

After two contentious years, the court fight is over. It's time to craft reforms that work.

The Detroit Free Press' board was even more blunt: "Don't repeal." The board writes this morning:

Improve and perfect.

But don't repeal.

That should be the mantra for health reform going forward in Washington, now that the U.S. Supreme Court has done away with the legal challenges to the president's landmark law.

The old status quo -- under which health care gobbled an ever growing percentage of the economy while the ranks of the uninsured continued to grow -- just isn't acceptable. It was crushingly expensive. And it was immoral.

The board of the Richmond Times-Dispatch expressed disappointment in the ruling:

In Kelo, the high court said government can commandeer your property. Thursday's supine surrender allows government to commandeer your paycheck, too. Many liberal commentators have condemned the Roberts court as activist. If only it were.

The Pittsburgh Post-Gazette said the ruling's fate is up to the American people:

The decision gives some 30 million uninsured people hope. It addresses the concerns of those who feared Obamacare was robbing them of freedom by reminding them that Congress certainly does have the constitutional power to levy taxes. It has also helped restore the Supreme Court's damaged reputation as an independent arbiter of the law


By the time the people next exercise their judgment, Mr. Obama and his fellow Democrats must make the case like never before that this legislation will cut health care costs and not lead to rationing of services or a shortage of doctors. Mitt Romney and the Republicans have to face the fact that the bill is constitutional and come up with an attractive plan that goes beyond just ending it.

-- Jason Cherkis

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Republican presidential nominee Mitt Romney told supporters at a fundraiser in New York on Friday morning that the Supreme Court did not do what was "necessary" when it ruled that President Obama's health care law was constitutional.

"I think many people assumed that the Supreme Court would do the work that was necessary in repealing Obamacare," Romney said, a tip of the hat to the fact that his own campaign was caught off guard by the ruling, as several of his advisers told The Huffington Post.

"It did not get that job done," Romney continued. "It instead came up with an interpretation to allow it to stand."

He added: "But the people of America, I think, recognize that this legislation is not right for America."

Romney also said that the court's decision adds "greater urgency" to the election this fall.

"I think people recognize that if you want to replace Obamacare, you’ve got to replace President Obama. And the urgency of doing that is something which is galvanizing people across the county," Romney said.

Romney spokeswoman Andrea Saul also described the election as "more urgent" in a morning round-up email to the press.

"Yesterday, the urgency of this election became even more urgent," Saul wrote.

Here is the full text of Romney's remarks on the topic, via a pool report from the fundraiser:

What happened yesterday calls for greater urgency, I believe, in the election. I think people recognize that if you want to replace Obamacare, you’ve got to replace President Obama. And the urgency of doing that is something which is galvanizing people across the county. I think many people assumed that the Supreme Court would do the work that was necessary in repealing Obamacare. It did not get that job done. It instead came up with an interpretation to allow it to stand.

But the people of America, I think, recognize that this legislation is not right for America. It will cost 0 billion in taxes, it cuts Medicare by 0 billion. The CBO has estimated that up to 20 million people will lose the health insurance they want and own as a result of it. I’m convinced it will cause premiums to go up significantly, and that it will add to the deficit by trillions of dollars. And for those reasons, among others, including the fact that you will now have a government bureaucrat between you and your doctor, I think the American people are going to do the right thing and on Nov. 6, they’re gonna vote to replace Obamacare and replace President Obama. We’re going to get that done.

-- Jon Ward

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If former GOP presidential candidate Rick Santorum is trying to be a good surrogate for Mitt Romney, he didn't succeed Thursday night during his appearance on "Piers Morgan Tonight." The former Pennsylvania senator trashed Romney's health care law that he signed as Massachusetts governor.

"I think what you're seeing is it hasn't worked in Massachusetts," he said. He added that people pay the penalty for not complying with the state's individual mandate, rather than buy insurance, because it's cheaper. According to the Associated Press, the number of people who have paid the penalty has declined in the years after the law took effect.

When asked why Romney, who Santorum has endorsed, would be a good president if his health care law "hasn't worked," Santorum defended his comments.

"What he [Romney] said is they did some things right. They did some things wrong. He learned from those mistakes. I'm using his language," Santorum said.

-- Luke Johnson

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House Majority Leader Eric Cantor (R-Va.) said on Friday that the U.S. Senate would use a budget reconciliation bill to repeal Obama's health care law.

On MSNBC's "Morning Joe," he said that since the Senate used the reconciliation process to pass the bill, then the Senate, if controlled by Republicans, will use the same process to overturn it.

He also pledged to replace the law with a "patient-based" plan.

However, ThinkProgress' Igor Volsky noted why repealing the bill through such a process would be imperfect at best:

Without the necessary 60 votes in the Senate for full repeal, Republicans are pledging to use a budget reconciliation bill to undo the ACA. But this process would only apply to the budget-related elements of the law and would thus leave many portions -- including the mandate -- intact.

-- Luke Johnson

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The New Yorker's Ryan Lizza reports:

Mitt Romney, speaking just before noon today, declared that on his first day in office, “I will act to repeal Obamacare.” I think he chose his words carefully. As President, he may indeed “act” to repeal it on Day One, but I don’t believe he will actually be able to overturn the law.

If Romney were to win in November, the first matter he’d have to deal with would be the fallout from the so-called fiscal cliff of December 31st, the day when some five hundred billion dollars worth of tax increases and spending reductions take effect, which could put the economy into another recession (if it’s not already in recession by then). This moment would perhaps be Romney’s greatest chance at repeal. Because the fiscal-cliff negotiations will be an enormous fight over the size and scope of the federal government, every government policy will theoretically be open to debate—including, Romney might insist, repeal of the A.C.A.

Click here to read more.

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Obama campaign manager Jim Messina sent out an email to supporters Thursday evening. It reads:

Friend --

It's been a good day.

But this is a three-step process.

1. Pass historic health care reform. Check.

2. Get affirmation from the highest court in the country. Check.

Step three? Win the damn election.

Mitt Romney has been clear he'd repeal Obamacare on Day One. Just another reminder of how much is at stake in November.

Donate or more today:

Let's go,


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Virginia Gov. Tim Kaine, running for senate in Virginia, sent out an email to supporters today. It reads:

The Supreme Court just upheld the individual mandate and the Affordable Care Act.

It's good news. We must continue to stand together and use the momentum from this ruling to get started on the work that remains to be done.

Not only do we need to continue to make improvements to the law and work together to find ways to reduce our health care costs, we also need to fight back against a massive effort by George Allen and right-wing special interest groups who want to roll back the progress we've made.

Today, my opponent said he wants to be the deciding vote to repeal this health care law. I want to be a vote to make it better.

They want us to go back to the days when insurance companies could refuse coverage when people get sick -- back to the days when they could discriminate against you for having a pre-existing condition. If they get their way, young people will be kicked off of their parents' plans, and health insurance premiums will rise for countless families across the country.

We can't afford to go back -- and this election could make all the difference. Can you make a contribution of or more before the FEC fundraising deadline on Saturday?

With Karl Rove and the Koch brothers flooding the airwaves with false attacks against me, I'm counting on your help right now to make our case and get our message out. In fact, just now, it is being reported that the Koch Brothers will launch millions in new ads tomorrow in swing states like Virginia attacking health care reform and those of us who support it.

I need your help to fight these attacks. We only need 206 new donors to reach our goal -- a gift of just puts us that much closer to having the resources we need.

Tim Kaine

--Jason Cherkis

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HuffPost readers are still writing in with reactions late Thursday. The responses recorded below are part of Off The Bus, HuffPost's open source reporting project.

The ruling may be too late for our household because of the timing. My husband worked 34 years for the local power company. After retiring he developed end stage renal disease. At the time he had over 0,000 remaining in his lifetime insurance plan. My husband went on home dialysis requiring a midday and overnight treatment. We were struggling trying to keep up with his health issues and mine when we received a letter stating my husband had used his lifetime benefits. We reviewed invoices and determined that the home dialysis cost over ,000 per month in addition to the oral medications. We sincerely regret the Affordable Care Act had not been enacted sooner.

Coming from a large family, I am grateful for a niece who will now have insurance coverage. She has had asthma from the time she was a toddler. About four years ago I learned she had tried to "ride out" asthma attack because she did not have insurance or medication. My sister used home remedies and a friend borrowed medication from a relative. I began praying for the health care program when Senator Kennedy was alive and trying to help President Obama get it passed because of what had happened to my niece. She is now in school to become an x-ray technician and will then have medical insurance. My fear has been what happens if she has an attack before then?

-- Irma Jenkins

This Supreme Court decision just sealed the deal for me to leave the country! This decision is the last straw for me, I will be moving from this country. Not because the Supreme Court leans so right wing but because the Democratic Party and many of the so-called progressive citizens in the U.S. are so dang stupid! I can't tolerate the ignorance on the left any longer! Obamacare is for the most part a huge gift to Big Pharma and Big Insurance period -- end of story! Mandated customers will raise the insurance rates just like it did in Massachusetts! We do not have to argue or speculate, all we have to do is take a truly objective look at what has happened in Massachusetts to all sectors of the socioeconomic strata! Insurance rates have gone up in Massachusetts -- not everyone can afford insurance and those numbers are growing every day. More importantly not everyone can even afford to go to the doctor even though they have been forced to buy insurance, so they are not actually getting health care!


If we had not tolerated anything less than single payer health care, then we all would be covered for the real emergency stuff that bankrupts millions, the kind of stuff that Western medicine is good at, attaching your legs back on when they are severed in an auto accident or starting your heart back up if you are struck by lightening -- that kind of stuff. We in America do emergency care very well and we all deserve that kind of care when we are really struck down!

But Western medicine sucks at keeping us well and managing acute low grade or chronic diseases, and we all deserve the freedom to go to alternative practitioners and get it paid for by our single payer health care coverage! I am leaving, I am going to an intelligent and progressive country where they actually understand when they are being chumped!

-- Lora Chamberlain

Makes a world of sense as we have two adult children out of college (early twenties). Our daughter had a health emergency last February that would have cost her well over K (two night stay, emergency room care). As a nanny, working three days a week and going to grad school, 20K would have destroyed her earning power for a long time.

As for pre-existing conditions, a relative has had multiple sclerosis for 20-plus years. Her husband never could switch jobs because even if it was an increase in pay/responsibility, the new company’s insurance wouldn’t cover her health bills.

It’s nice to think we’re trying to be progressive. I was prepared for the worst.

-- Diane Andrick

I am delighted with the overall decision of the supreme court today. I am a small business owner and a liberal. As an aging baby boomer (60) I will only be affected for a few more years, however I am a healthcare provider also. I have seen the results of our failed healthcare system for almost three decades now. Our system offers wonderful care for certain segments of society (those who have good insurance) and for certain kinds of medical problems (cancer, heart disease, the terminally ill, acute and severe injuries, etc.). For millions of others the promise of healthcare is remains out of reach.

The Affordable Care Act has many flaws. It carries all the scars of a failed attempt to compromise two diametrically opposed views of how to solve a very complex social/political dilemma. As a result no one was pleased with the outcome. I favored a single payer system as did most progressives. What we have is better than the conservative position of do nothing. It is a flawed step in the right direction and I applaud the president for having the courage and tenacity to stay with it to the bitter end.

The ACA will not solve many complex systemic problems with our healthcare system, but it will provide a remedy for many of its most immoral consequences. A long time ago conservatives predicted that Medicare would turn us into a socialist state. One of the spokesmen for that position was conservative icon Ronald Reagan. We have short and selective memory. The ACA and its legislative descendants will someday be as accepted and untouchable as Medicare and Social Security. Conservative attacks on the basic rationale behind the ACA are on the wrong side of history just as surely as those who oppose gay marriage and other social reforms granting basic rights to all or citizens have been. Health care should be basic right, not a commodity subject to the demands and profit goals of the marketplace. The ACA doesn't accomplish that goal, but it moves us closer.

-- Jim Snowden

This is great for our family ... I think. We just need all provisions of the Act to come into being now. This phased roll-out is killing us financially.

I am a self-employed consultant so I have to pay for my own private Blue Cross Blue Shield policy for me and my two-year-old daughter. When the bill was initially passed, our rates went through the roof. As I understand it this was because insurers were immediately required to accept people with pre-existing conditions in addition to a couple of other very expensive new requirements. But these new regulations came into play years before the mandate was to take effect, which I understand is the only way the rest of the bill is economically viable. So the insurance companies raised rates to cover these massive extra costs (no surprise there). How could the Obama administration not have predicted this? Or maybe they did but just saw it as an unfortunate political reality. Regardless, it really sucks. I only hope that rates come down once the mandate kicks in and the insurers books are flooded with new premiums (dare I be so naive). Or better yet maybe I can get into one of those private insurance pools that are supposed to be available soon, though I admit I really don't know anything about those yet.

Bottom line: I'm very happy about the law and this ruling in theory as it will surely give many more people access to health care. But whether this law is the answer to our country's health insurance problems we won't know for quite a while.

-- Brian Zellmer

-- Lucia Graves

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Rep. Charlie Rangel (D-N.Y.) is holding out on reading the Affordable Care Act's survival as a mandate for Democrats to ask for more progressive health care reform.

"Only the outcome of the November elections could tell," Rangel said Thursday, when asked whether he would strengthen the bill now that the Supreme Court has mostly upheld it.

Rangel said he was "so pleasantly surprised" when he heard the ruling and wanted to say sorry to anyone who heard his previous remarks on whether the health care reform legislation would be ruled constitutional.

"If I could apologize about some of the things that I said about the direction in which the Supreme Court is going, I would be glad to do it," Rangel said. "I do hope that this decision, although split, that the court can become even-handed in these type of cases."

-- Patrick Svitek

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Frank Rich writes in New York Magazine that he thinks the SCOTUS ruling allows the president an opportunity to resell health care reform. He writes:

"That the law was largely upheld allows Obama the miraculous opportunity to get right what he screwed up before and after the bill was passed: a fresh chance to explain to voters exactly what this bill is and what is good about it."

Whatever Obama's new message might be, the president may not be able to overcome the money advantage his opponents have. The New York Times recently reported the conservatives have far outspent the democrats in the health care reform battles:

In all, about 5 million has been spent on ads attacking the law since its passage in March 2010, according to a recent survey by Kantar Media’s Campaign Media Analysis Group. Only million has been spent on advertising supporting it.

-- Jason Cherkis

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@ andreamsaul : Just crossed million in donations & 20,000+ donors for #FullRepeal of Obamacare. #Mitt2012

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Sen. Sherrod Brown (D-Ohio) sent his supporters a message seeking campaign contributions pegged to the SCOTUS ruling. The Brown campaign writes:

Today was a great day for millions of Americans.

But the special interests and the far right aren’t about to give up in their effort to erase basic protections for middle class families -- and they aren’t going to let up in their attacks on me.

Make no mistake, they are about to pile on to the million they’ve already spent to defeat us. Click here to help us fight back.

The truth is I need you on my side before the deadline -- it’s just a few days away.

We don’t need to out-raise the millions in Citizens United cash being spent against us, we just need to raise enough to win.

And if you donate now to help us reach our goal this quarter, that’s exactly what you’ll be doing.

Thank you for all you do for our grassroots organization.


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Divided in their reactions, some small business owners say the Supreme Court's decision will enable them to offer their employees affordable health coverage, while others say it will force them to start cutting jobs.

Click here to read more.

-- Janean Chun

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Shortly after the Supreme Court upheld the constitutionality of the Affordable Care Act, Democratic Senatorial Campaign Committee Chair Patty Murray (D-Wash.) sent an email to supporters asking for donations.

"It's a historic day in America: the Supreme Court just upheld President Obama’s health care reform," she wrote. "But, mark my words: Mitt Romney and the GOP will do everything in their power to shred Obamacare. Right now Romney is polling only two points behind President Obama, and he has already pledged to repeal it on day one if he gets elected."

People who donated or more will receive an "I Heart Obamacare" sticker:

The DSCC refused to say how much money it had raised, although spokesman Shripal Shah said "thousands" of people would be getting stickers.

The group also launched a national ad campaign on Thursday morning, with ads on Facebook and Google directing viewers to a pro-Obamacare petition.

The campaign began shortly after the Supreme Court decision was announced and will run for a few weeks.

-- Amanda Terkel

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Religious leaders and pundits reacted swiftly to the Supreme Court's ruling on the America's Affordable Health Choices Act or 'Obamacare.'

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First Lady Michelle Obama praised the court's ruling Thursday while speaking in Memphis, Tenn.

"When it comes to health care, please, please tell people about the historic reform this president passed,” she said. “Tell them that today’s Supreme Court decision was truly a victory for families all across this country."

-- Luke Johnson

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New York Times columnist Paul Krugman is on vacation, yet he blogged on the ruling with the headline "Double Scotch Time." He writes that before the decision, he was "so hyper" that he "needed medication."

"Health reform may yet be killed," he wrote. "But not today. And never mind the horserace politics: ordinary Americans have just won big."

-- Luke Johnson

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Sen. Chuck Schumer (D-N.Y.) was disappointed about one thing in the Supreme Court's health care ruling: Chief Justice John Roberts' contention that the Commerce Clause of the Constitution did not apply.

"I can say in my view that it certainly merited upholding under the Commerce Clause," Schumer told HuffPost. "I do worry in the future about the Court's limiting the Commerce Clause as a way of limiting the ability of the federal government to help average families."

He also noted that Roberts gave the impression in his confirmation hearings that Roberts believed the Commerce Clause gave Congress broad powers.

"If you read his testimony about [1942's Wickard v. Filburn] and some of the more recent commerce clause cases at the hearing, and looked at what he said here, it's quite different," Schumer said.

Roberts was actually somewhat cagey about the Commerce Clause. In the health care ruling, he said it could not be used to regulate people who were not engaging in commerce, or compel them to engage in commerce by buying insurance.

-- Mike McAuliff

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Video has been released of the press conference House Majority Leader Eric Cantor held earlier today to express his disappointment in the Supreme Court's ruling. As previously reported, he says the decision further "underscores the importance of this election."

Cantor said that he has scheduled a vote to repeal President Barack Obama's health care law for July 11.

-- Jason Cherkis

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The editorial board for the National Review joined conservatives in slamming Chief Justice John Roberts for his decision in a scathing editorial Thursday:

The Constitution does not give the Court the power to rewrite statutes, and Roberts and his colleagues have therefore done violence to it. If the law has been rendered less constitutionally obnoxious, the Court has rendered itself more so. Chief Justice Roberts cannot justly take pride in this legacy.

The Court has failed to do its duty.

-- Luke Johnson

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@ VP : Today’s decision is a really big – important – deal. Find out what it means for you: –VP

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In an email to supporters, Santorum's Patriot Voices group writes:

Today's Supreme Court ruling on ObamaCare is the worst of all outcomes. Not only are our rights being taken away and Americans are being forced to do something we don't want to do, but now we are being burdened with the biggest permanent tax increase in our nation's history.

This is a sad day, and we must fight back.

Patriot Voices believes so strongly that if we do not defeat President Obama this November and elect more conservatives in the House and Senate, our country's future prosperity is at risk.

But we need your help to make that happen.

We saw the absolute disregard President Obama showed for the Supreme Court's ruling on the Arizona immigration law, that I have no doubt that he sees today's ruling in his favor as a mandate that he can now do whatever he chooses by any means possible.

President Obama believes he is above the law, entitled to abusing his power to get what he wants, and willing to violate the constitution and the oath he was sworn to uphold. He has proven to be a very dangerous person to have this kind of power, and if he is not stopped this November, I am fearful that the make-up of this country as established by our founders will never be the same.

We at Patriot Voices will use every tool at our disposal to support candidates running in the House and Senate who have pledged to repeal ObamaCare. Will you help us in this fight? Please consider making a contribution to Patriot Voices of , or whatever you can afford so we can take our fight straight to Election Day and ensure that President Obama is only a one term president, and that we elect conservatives in the House and Senate who will stand with us in this fight.

-- Jason Cherkis

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Sen. Mike Lee (R-Utah), one of a handful of lawmakers who were actually in the Supreme Court chamber when the justices handed down their decision on the health care law, described "a palpable tension" in the air when the justices first entered the room.

"The tension remained for quite some time because it took quite a while for Chief Justice John Roberts in announcing the opinion of the court to get to the point of actually saying the mandate is going to stand, albeit as a tax," Lee said.

Lee said Roberts spent the first 15 minutes explaining why the individual mandate couldn't be upheld under the Commerce Clause and then "worked his way through" his argument about how the mandate is constitutional per the Tax Clause.

"It took him several minutes into that before people realized that was actually happening, that they were going to let it stand," Lee said. "All of a sudden you saw people raising their eyebrows, turning to their neighbors, turning to the left, turning to the right, smiling, frowning. Reacting as either horrified or overjoyed."

Lee said Sens. John Barrasso (R-Wyo.) and Orrin Hatch (R-Utah), among others, were also in the Supreme Court chamber when the decision was announced.

-- Jennifer Bendery

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HuffPost asked readers to write in with reactions to today's decision. Their verdict: Most are overjoyed, though some threatened to leave the country. The responses submitted below are part of Off The Bus, HuffPost's open-source reporting project.

Let us know how the ruling will affect your family by writing to us at (include your phone number if you are willing to be interviewed).

I'm saved! The Affordable Care Act is of utmost importance to my survival as a contributing member of society. I am uninsurable. Even before my accident last September, in the ultimate extreme of good health, I could not qualify for insurance that wasn't a group plan through my employers. Thirteen years ago, I had severe bone marrow and kidney diseases. I was told I was terminal. Fortunately, that prediction was wrong. Not only did I recover, but I went on to give up my car for a bicycle, riding hundreds of miles (probably thousands) in the Colorado Rockies. I was the epitome of health. Then, disaster struck.

While riding on Mount Evans, the highest paved road in North America, high winds pushed me over the side of the mountain. I fell 30 feet, tumbling to the granite boulders below. Had two cyclists from Switzerland not found me, I most likely would have died. I had fractured 9 vertebrae, shattered my rib cage, shattered my right shoulder blade, punctured both lungs, and my left kidney and spleen were lacerated so badly that my doctors seriously considered removing them. I later had to have four vertebrae in my neck fused in order to preserve, and hopefully recover, my failing use of my left arm and hand. I still may require further spinal surgery, as I remain in severe pain. In total, three vertebrae in my neck -- including two that would have meant instant death had they been displaced -- and six in my upper back were fractured. Without my helmet, I'd have certainly died.

I've been on medical leave ever since my accident. I've had to go onto COBRA for my insurance plan. I've been fighting with Social Security and the state for disability benefits. I've lived in fear for what my future holds for me, and in fear that without the federal mandate, I could be without insurance, out of luck, and disabled for the rest of my life.

Yet there's hope. I'm walking. I've regained some use of my left arm. I've even been back on my bicycle a few times.

-Belinda Williams

The ACA has already positively affected my family. I have a son who (at the time) was 24. I was (and am) unemployed and was forced to pay out-of-pocket for health insurance for my son. He plays soccer overseas, so the risk of him being uninsured and getting injured was too high a risk to chance. The monthly expense was also quite high. When the portion of the ACA kicked in regarding uninsured children being eligible up to age 26 to be covered under their parent's employer health insurance, we were able to sign him up for coverage under his step-father's employer insurance plan. Insurance costs: cut in half! He will be 26 in February 2013, and now with the Supreme Court ruling (and hopefully, the reelection of the president), he will be able to purchase affordable health care when the time comes.

-Elizabeth Swink

I am thrilled and relieved that the law was upheld. I have a 19-year-old daughter who is not able to be a full-time student at this time due to a pre-existing condition that would have made it very difficult for her to get insurance. I have had many sleepless nights worrying about what would happen if the law was struck down and she lost the ability to be covered until the age of 26 on our health insurance and the protection that, when she does need her own insurance, she will not be discriminated against. I intend to work hard to protect this law. I do not want our country to continue to allow people to die because they cannot purchase health insurance once they are ill.

-Theresa Glennon

In reading Dawn Garcynaski's email to you, I realized that this is exactly why the bill is unpopular. Everything she says is wrong: If it is true that she can barely afford to keep a roof over her head (unless it's a 500K+ Mcmansion), she will not pay a penalty for not having insurance -- the cut-off is around K a year or higher. She will receive huge subsidies from the government to purchase care, it will not cost her 0 to 0 a month.

This shows how misinformed the general public is about the law. While it's not perfect, its faults have been exaggerated and misconstrued. It's no wonder when the key provisions are pointed out separately, they all receive favorable ratings in the 70 percent plus.

And with the mandate, the Democrats messed up: they should have labeled it a "stop people from free loading off the system and casting YOU money fee." I'm pretty sure that'd be viewed favorably, too.

-David Storm

I only wish that this law was in place a decade ago. I am self-employed. A decade ago I had a very thin melanoma removed. There it was, the pre-existing condition. I was completely uninsurable by any other company and had no choice but to accept being pushed into higher risk pools, eventually paying high rates for huge deductibles and no coverage at all for routine and diagnostic care. Recommended preventative actions, like a colonoscopy at age 50, were delayed because we couldn't afford their cost and also because we were a little worried that if they found something, it would be another pre-existing condition that would push us into an even more unaffordable risk bracket. We knew it was a gamble, but frankly we couldn't afford the safe route. Well, the gamble went bad. My spouse was diagnosed a little over a year ago with Stage 4 colorectal cancer.

I know one cannot really know how things might have otherwise turned out, but I do know that the last decade would have been very different if this law was passed a decade ago. I would not have seen myself become locked into one carrier because of a pre-existing condition. I would not have seen my rates skyrocket as a result. Basic long-term, cost-effective preventative measures would have been covered. And we might have found my spouse's cancer at a curable stage.

So I strongly believe that, since my life would have been so much better if this law had been in place a decade ago, coming decades will be better for so many other people.

-Daniel Nolte

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HuffPost reports:

With health care reform free to move forward, there is some good news and some bad news for young people.

Young adults comprise the largest portion of the uninsured. This is partly because they make less money at the start of their careers, and so often forgo the purchase health insurance if they tend to be healthy and expect not to need such coverage any time soon.

Starting in 2014, though, young adults will be required to purchase health insurance or face a penalty from the federal government. They can also opt to remain on their parents' insurance plans until they reach the age of 26.

Click here to read more.

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In a press statement, National Nurses United argued that there continues to be a need to improve healthcare in the U.S. The union wrote: "The 175,000-member National Nurses United pledged to step up a campaign for a reform that is not based on extending the grip of a failed private insurance system."

NNU Co-President Jean Ross, RN, stated: "It is not time to stop, but a reminder to begin that effort anew."

-- Jason Cherkis

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One University of California at Berkeley professor thinks so. Professor Brad DeLong, writing on his blog, uncovered a few bits of evidence in the SCOTUS dissent that suggests the court's right-wing faction believed they were in the majority. DeLong notes:

Scalia refers to Ginsburg's concurrence -- agreeing with the Court that the mandate stands, but for different reasons than the opinion of the Court expresses -- not as a concurrence, but as a "dissent":

Our test's premise of regulated activity is not invented out of whole cloth, but rests upon the Constitution's requirement that it be commerce which is regulated. If all inactivity affecting commerce is commerce, commerce is everything. Ultimately the dissent is driven to saying that there is really no difference between action and inaction, ante, at 26, a proposition that has never recommended itself, neither to the law nor to common sense...

The professor finds a similar confusion in Thomas:

When the Scalia opinion became the Scalia dissent, Thomas forgot to change the first "joint opinion" to "joint dissent" -- although he did change the second "joint opinion" to "joint dissent".

-- Jason Cherkis

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Presumptive Republican nominee Mitt Romney's website says he will nominate judges "in the mold of Chief Justice John Roberts." Roberts ignited the fury of conservatives when he sided with the majority and upheld the constitutionality of the Affordable Care Act Thursday.

From Romney's website:

"As president, Mitt will nominate judges in the mold of Chief Justice Roberts and Justices Scalia, Thomas, and Alito. These justices hold dear what the great Chief Justice John Marshall called “the basis on which the whole American fabric has been erected”: a written Constitution, with real and determinate meaning. The judges that Mitt nominates will exhibit a genuine appreciation for the text, structure, and history of our Constitution and interpret the Constitution and the laws as they are written. And his nominees will possess a demonstrated record of adherence to these core principles."

--Sabrina Siddiqui

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Former Rep. Anthony Weiner (D-N.Y.), one of the health care law's most pugnacious defenders, gave Politicker's David Freedlander his reaction to the court's ruling.

"In these big cases, I don’t believe the law matters all that much. The court has become an extension of the political debates of the day," he said.

He later accused the president of bungling the debate. "[A] large percentage of people in the country started hitting the streets and writing their Congressman to defend the health insurance industry. That was the surest sign that we had fucked up this debate somehow."

Weiner also said that he had "fallen in love" with SCOTUSblog.

-- Luke Johnson

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HuffPost's Mark Gongloff reports:

The Supreme Court's decision to uphold President Barack Obama's health care reform law was surprising at least partly because a financial market had predicted that the opposite would happen, and financial markets can do no wrong. Crowds are wise. Markets are efficient.

Not so much, however, on the prediction market Intrade, where traders earlier this month assigned a nearly 80 percent chance that the Supreme Court would declare unconstitutional the health-care law's mandate that people buy health insurance. That had fallen to about 70 percent just before this morning's ruling, which is still a relatively sure thing.

But the individual mandate was of course upheld, meaning a lot of people making bets against it lost some money today. The contract price for betting on a mandate reversal has tumbled 97 percent today on Intrade.

Click here to read more.

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HuffPost's Mark Gongloff and Bonnie Kavoussi report:

Hope you're happy with yourself, Supreme Court. You just killed America's economy.

That was the snap conclusion CNBC and Fox Business Network reached in the minutes following the Supreme Court's surprising decision to uphold President Obama's signature health-care reform law.


But let's take a look at just how terribly damaging this ruling actually was to the stock market.

The Dow Jones Industrial Average was down about 100 points at 10:00 a.m. ET, minutes before the court's ruling was announced. It was down about 89 points at 10:20 a.m. ET, after most of the world (excluding CNN and Fox News) realized the court had upheld health care reform.

By 10:40, it is true, when CNBC was interviewing Barry Knapp, the Dow was down to its worst levels of the day, off by nearly 160 points. But it has since "rebounded," if you can call it that, to a 120-point decline.

That's not an awful lot of movement for a fairly surprising decision that will supposedly destroy the economy. And in any event there is no surer way to make an idiot of yourself than in trying to hang great significance on minute-by-minute moves in the stock market.

Click here to read more.

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HuffPost's Jennifer Bendery reports:

Rep. Raul Grijalva (D-Ariz.) said Thursday that the Supreme Court's decision to uphold the constitutionality of President Barack Obama's health care law means progressive lawmakers won't be pushing for a single-payer option anymore, though the concept will live on in their minds.

The idea of a single-payer option, such as a Medicare-for-all approach to health care, will continue to be "a fundamental political point that we all support," said Grijalva, co-chairman of the Congressional Progressive Caucus. "But the reality of what just happened today probably puts the emphasis on making the law work as opposed to trying to get a new plan."

Click here to read more.

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HuffPost's Dan Froomkin reports:

The Supreme Court on Thursday upheld the Affordable Care Act's individual mandate, but not before rejecting the government's main argument -- that it was valid under the Constitution's Commerce Clause.

The majority opinion written by Chief Justice John Roberts bluntly insisted that the clause does not vest Congress with "police powers … to regulate an individual from cradle to grave." It also explicitly embraced the conservative argument regarding health care and broccoli.

Click here to read more.

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Last week, Indiana GOP Senate candidate Richard Mourdock had an embarrassing stumble when his campaign accidentally released four videos reacting to all the possible scenarios in the Supreme Court's yet-to-be-announced decision on health care reform.

When reporters noticed the misstep, the campaign took them down.

On Thursday, Mourdock's campaign put out a statement, saying he was "disappointed" that the Affordable Care Act would be allowed to "stand as a massive tax on Americans."

On his YouTube page, however, there were no video reactions from Mourdock.

The Mourdock campaign did not return a request for comment as to whether it would be posting one of the four videos.

-- Amanda Terkel

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HuffPost's Janell Ross reports:

The court’s decision will be dissected today by legal scholars, health care experts, sharp-tonged commentators and ordinary Americans. But what may not be so widely discussed or understood is the sweeping effect that the court’s decision will likely have on minority health in the United States, according to health care economists and policy analysts. That broad benefit to minorities is a point the Obama administration itself has made -- though somewhat infrequently -- and one that's likely to be invoked more often after the favorable ruling, as the presidential election fight intensifies.

Black and Latino Americans are expected to see substantial gains in insurance coverage under the ACA. The bill was designed to offer the greatest assistance to those with low and moderate incomes. And with income, race and ethnicity still closely linked in the United States, just over 48 percent of the nearly 24 million people likely to gain health insurance as the law’s provisions are implemented across the country will be people of color, according to a May Urban Institute analysis.

Click here to read more.

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HuffPost reports:

In a surprise move, Tea Party godfather Rick Santelli said conservatives should respect the Supreme Court's decision on health care.

"You know what, the Supreme Court did what it thought best. I believe in that process, whether I agree with it or not," said Rick Santelli, CNBC's on-air editor, on CNBC on Thursday after the Supreme Court ruled in a 5-4 decision that the Affordable Care Act was constitutional. "I challenge the conservatives in Congress to take this decision with respect. With respect!"

Click here to read more.

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Politico's Jake Sherman reports:

In a closed door House GOP meeting Thursday, Indiana congressman and gubernatorial candidate Mike Pence likened the Supreme Court's ruling upholding the Democratic health care law to the Sept. 11 terrorist attacks, according to several sources present.

He immediately apologized.

Click here to read more.

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Don't expect the cost of health care to get cheaper as a result of the Supreme Court's decision largely to uphold the Affordable Care Act and its individual insurance mandate.

In fact, health care costs will likely keep rising, just as they have for some time.

Click here to read more.

-- Emily Cohn

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Senator Rand Paul's (R-Ky.) statement, via Mike Riggs at

“Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional. While the court may have erroneously come to the conclusion that the law is allowable, it certainly does nothing to make this mandate or government takeover of our health care right."

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Rahm Emanuel, President Barack Obama's former chief of staff, famously warned Obama over and over again the political costs of pursuing health care reform in his first term.

On Thursday, Emanuel praised the Supreme Court decision and expressed relief that Obama did not heed his advice.

"I told him many times (about) the political cost of doing this,” Emanuel said, according to the Chicago Tribune. “And thank God for the country, he didn’t listen to me.”

-- Sabrina Siddiqui

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The effects of today's Supreme Court decision on efforts to create single-payer health care, which would provide something like Medicare for all Americans, are difficult to judge at this early point.

But one state is already moving ahead: Vermont, where Governor Pete Shumlin (D) signed into law a "framework" for single-payer on May 26. The Green Mountain State's progressive politics make "Medicare For All" an easier sell there than probably anywhere else in the country, as does the fact that its biggest insurer is a nonprofit.

Turning an idea into a health care system, however, will take time. Not until 2017 will some form of single-payer be in place. If Justice Anthony Kennedy's dissent had swung the court on Thursday, the state would have lost around 0 million in annual Medicaid funds provided under the Affordable Care Act. Now it will get to use that money once single-payer is in place and pass on the savings to taxpayers.

"We were certainly pleased with the results of the U.S. Supreme Court decision," said Robin Lunge, the state's director of health care reform. "For us it's full steam ahead."

--Matt Sledge

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Former presidential candidate Herman Cain released a statement, calling the ruling a 'temporary setback.'

The Obama Administration sold the individual mandate again and again with the argument that it was not a tax. Then they argued before the Supreme Court that it was a tax, because that was the only way to defend it constitutionally.

Justices Scalia, Thomas, Kennedy and Alito clearly saw through this exercise in semantics, and they deserve our thanks for their commitment to the Constitution and the law in their dissent. The best that can be said for Chief Justice Roberts, in voting to uphold the law, is that he rejected the administration’s argument that the mandate was permitted by the commerce clause.

That said, it should never have been the job of the Supreme Court to clean up a terrible piece of legislation perpetrated by Congress and the White House. ObamaCare may have been declared constitutional by five justices – although not in the manner the White House sold it, which is telling – but that doesn’t change the fact that it is a horrible law that will bankrupt this country, explode health care costs and diminish the quality of care throughout this nation.

Government tyranny has been slowed, but not stopped. What today’s ruling means is that anything government can call a tax, it has the power to do. Regardless of the semantics, we are subjected to government tyranny.

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@ JackKingston : With #Obamacare ruling, I feel like I just lost two great friends: America and Justice Roberts.

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A small business group representing over 150,000 firms and more than 300,000 entrepreneurs and investors applauded today's Supreme Court ruling that upheld most of President Barack Obama's health care reform law.

"The Court’s ruling means that businesses will continue to enjoy important provisions which have already reduced their health insurance costs, and enabled them to cover more of their employees. This will help businesses to expand and step up their hiring," said David Levine, CEO of the American Sustainable Business Council, in a written statement.

Although congressional Republicans have spent years portraying Obama's Affordable Care Act as a job-killing disaster for small businesses, many entrepreneurs and mom-and-pop shops have long supported the bill for reducing their health care costs.

"Today marks an extraordinary day for American businesses, which will continue to benefit from health care tax credits and reduced insurance costs," said Frank Knapp Jr., vice chair of ASBC and head of the South Carolina Small Business Chamber of Commerce. "Not only does the ACA help small businesses to be more profitable, but it can level the playing field with big businesses that pay lower rates simply because of their size."

The National Federation of Independent Business, a Republican coalition of the nation's small business owners, has opposed the reform legislation and spearheaded the lawsuit against the bill. NFIB has dominated talking points about small business in Washington, but several other groups, including the Main Street Alliance and the ASBC, have significantly expanded their once-minor influence in recent years.

Tax credits provided by the health care law have already cut costs for many small firms. Once the full bill takes effect, major provisions like the individual mandate and the new system of health insurance exchanges are expected to enhance competition for insurance, drive down prices for all healthcare and thus result in lower costs for businesses.

Moreover, big companies with hundreds of thousands or millions of employees, have long been able to secure cheaper, better health care plans from insurance companies, simply by offering insurers a bigger pot of business. Small firms that employ a few dozen people or fewer must pay more for the same quality care or offer weaker plans to their workers. The new insurance regulations under the Affordable Care Act will require all insurance plans to offer a stronger slate of options for employees of any company, making it easier for small companies to attract talent.

-- Zach Carter

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