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.
06/29/2012 4:36 PM EDT
Gallup Finds A Split Decision On Health Care Ruling
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
06/29/2012 3:17 PM EDT
Obama Health Official: States Won't Refuse Medicaid Expansion
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 $14,856 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
06/29/2012 11:28 AM EDT
HuffPost Readers Sound Off On SCOTUS Ruling
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.
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.
I am on Social Security disability benefits and Medicare. I live on less than $13,000 a year and receive $16 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.
06/29/2012 11:10 AM EDT
Anthony Weiner On The Health Care Debate
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
06/29/2012 10:59 AM EDT
O'Malley Slams Republicans
@ samsteinhp :
O'Malley on McDonnell and R Govs: "The only health care mandate they embrace are trans-vaginal probes for woman"
06/29/2012 10:17 AM EDT
Louisiana Gov. Bobby Jindal Slips Up?
@ aterkel :
Clarification: Jindal said "Obamney--" then said "Obamacare instead.
06/29/2012 9:51 AM EDT
In Battleground States, Editorial Boards Weigh In On SCOTUS
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
06/29/2012 9:28 AM EDT
Romney: SCOTUS Failed Us
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 $500 billion in taxes, it cuts Medicare by $500 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
06/29/2012 9:15 AM EDT
Rick Santorum: Mitt Romney Learned From Health Care 'Mistakes'
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
06/29/2012 9:00 AM EDT
Eric Cantor On Plans To Repeal Health Care Law
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