Constitution Daily

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Updated: Understanding the health care decision in three minutes

June 28, 2012 by Scott Bomboy


The Supreme Court’s historic decision on President Barack Obama’s health-care reform program seems complicated, but much of it can be broken down to a few concepts we can all understand.


UPDATE: Supreme Court Approves Most Of The ACA


Here is an update to our story from June 21, where we broke down the case before the court.


Now that we have a 5-4 verdict upholding health care, we’ve updated our very brief analysis.


We will have other detailed updates in the next few days, but the bottom line is most of the Affordable Care Act was approved by the Supreme Court on June 28, 2012.

Why Was Health Reform In Front Of The Court?

In March 2010, President Obama and Democratic leaders were able to pass the Affordable Care Act.  Every Republican in Congress voted against the act.


The Democrats’ general theory was that broad health coverage would allow health care providers to stabilize prices because costs for uninsured patients wouldn’t be pushed onto other consumers. To do this, most Americans would need health insurance, even if it were government subsidized.


The GOP, libertarians and others believed the ACA wasn’t in the best interests of individuals, states and the economy; Congress had overstepped its powers; and parts of the law were illegal. Most of all, the ACA was seen as a program that allowed the federal government to run the nation’s health care system.


The ACA’s opponents mounted an effort to have the Supreme Court decide if the law was constitutional.


Background: Health care’s big constitutional test is at hand


In November 2011, the Supreme Court decided to hear the case. Arguments were presented in late March 2012. A decision was expected in late June.


Parts of the law already have been enacted. But other key parts don’t start until 2014, when consumers must buy health insurance, or pay a penalty on their annual tax returns.

What Were The Two Big Issues?

It’s a complicated case with many issues, but the Supreme Court dealt with two key ones that decided the rest of the case.


A key part of the ACA was the individual mandate, which requires consumers to carry health insurance starting in 2014 or pay a federal tax penalty.


Background: The clause that could kill the Health Care Act


The mandate’s funds will help insurers pay for expanding coverage to anyone with pre-existing medical problems.


Conservatives and libertarians argue the mandate violates the Commerce Clause, a power in the Constitution that lets Congress regulate trade.


They say Congress has abused this power by forcing consumers to buy a product– health insurance. The ACA’s supporters say the mandate is a tax penalty, and not a product. They also say consumers can decline to buy insurance, and just pay the fine.


Background: Here’s a basic explanation of the Commerce Clause


A second big issue is the expansion of Medicaid, which uses federal and state funds to supply health services to lower-income consumers, at a state level.


Federal funds pay for most of the Medicaid expansion, but states are already trying to cut current costs.


If a state doesn’t agree to the expansion, the federal government can cut off all federal Medicaid funds to it, even for existing programs.


A group of governors claims Congress is coercing the states by threatening to withhold all Medicaid funding as part of the ACA.

What happens next?

The Supreme Court issued its decision at 10: 07 a.m. EST, on June 28.


The Supreme Court upheld most of the entire law, which puts the ACA on course for its 2014 deadline. GOP lawmakers will try to repeal the law if they have enough power after the 2012 general election.


The Supreme Court ruled that the individual mandate was constitutional as a tax. Chief Justice John Roberts also said the mandate was unconstitutional per the Commerce Clause, but the Chief was the tie-breaker, and the individual mandate stays in the law on tax grounds.


Survey: 16 predictions on the health care decision


The court partially rejected the expanded Medicaid program.  States will not be required to take part, or be “coerced” into Medicaid expansion that will take place through 2017. States will also receive their current federal payments to fund Medicaid.


Bottom line: the Obama health care plan is not universal health care, since states can opt out of adding 17 million more people to Medicaid. But up to 12.5 million people might have to buy health insurance, or pay a tax penalty.


What the government, insurers and health providers don’t agree on is how much all this will cost consumers.


Recent Stories On Health Care Reform


Supreme Court upholds most of Obama health care plan
CNN’s ‘Dewey Defeats Truman’ moment–getting the court ruling wrong
Understanding the health care decision in three minutes


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