Supreme Court Backs Much of Controversial Health Reform Law

THURSDAY June 28, 2012 -- Surprising many legal scholars, the U.S. Supreme Court upheld on Thursday the constitutionality of most of the controversial health reform law that requires almost all Americans to have health insurance or pay a penalty in the form of a tax.

The Patient Protection and Affordable Care Act, the signature legislative achievement of President Barack Obama's administration, has been fiercely debated since its inception in March 2010. On one side of the argument have been many Democrats, who view the law as the first substantive legal attempt to greatly expand the number of insured Americans while improving health care and attempting to contain medical costs. On the other side have been many Republicans, who view the measure as an unprecedented intrusion into the private lives of citizens by telling them they have to buy a certain product -- in this case, health insurance.

Chief Justice John Roberts announced the court's complicated 5-to-4 decision that allows the law to proceed with its goal of covering more than 30 million uninsured Americans.

The Associated Press reported that the court did have some concerns with the law's expansion of Medicaid, the government-funded insurance program for low-income Americans. But the court said the expansion could go forward as long as the federal government doesn't threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension, the news service said.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the decision. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented, the AP reported.

The law set in motion a series of reforms designed to extend health coverage to more than 30 million uninsured Americans. It seeks to accomplish these goals in several ways. More lower-income people will be allowed to enroll in Medicaid, while other uninsured individuals can buy coverage through new state health insurance exchanges. Some people who buy coverage may qualify for tax credits.

The 2010 law's most controversial component -- and one of the key targets of the Supreme Court's scrutiny -- requires almost all Americans to maintain health insurance coverage or pay a penalty in the form of a tax.

The law also aims to improve the quality and efficiency of health care. For example, there are programs to improve care coordination and reduce fraud and abuse in Medicare, the government-run insurance program for older and disabled Americans.

A number of the law's most popular provisions are already in effect. For instance, parents in private insurance plans that offer dependent coverage can keep their adult children on the plan up to age 26. And most plans must now cover preventive health screenings, such as mammograms and colonoscopies, at no out-of-pocket cost to the patient.

Core elements of the law -- such as expanding Medicaid, establishing the state health insurance exchanges and requiring people to have coverage or pay a penalty, known as the "individual mandate" -- aren't scheduled to take effect until 2014.

Polls have shown that Americans remain sharply divided over the health care law. But a Harris Interactive/HealthDay poll in January found that an increasing number of Americans were slowly starting to embrace some key components of the legislation.

To be sure, Americans remain divided over the legislation, with slightly more than one-third (36 percent) of adults saying they wanted the law repealed and 21 percent saying they wanted it to remain as is. Another 25 percent said they'd like to see only certain elements of the law modified, the poll found.

"The public is still divided, mainly on partisan lines, as to whether to implement or repeal all, parts, or none of the health care reform bill," said Harris Poll Chairman Humphrey Taylor.

The poll found that support for the legislation broke down along party lines. Almost two-thirds of Republicans (63 percent) said they wanted the Patient Protection and Affordable Care Act repealed, compared to 9 percent of Democrats.

But while respondents were split about the law as a whole, many strongly supported key elements of the bill, with 71 percent of those polled now backing the provision that prevents insurance companies from denying coverage to those already sick, for example.

The notable exception remains the individual mandate [the requirement that all adults purchase health insurance], "which remains deeply unpopular," Taylor said.

In February 2011, the Congressional Budget Office estimated that savings from the Affordable Care Act would cut the federal deficit by $210 billion during the next decade.

The law's supporters argue that without the requirement that people have insurance coverage while they're healthy, there won't be enough money in the risk pool to pay to take care of them when the need for health care eventually -- and inevitably -- arises.

"If people don't feel like paying, then get sick and go to the emergency room or the hospital, those people's costs will be added on to our insurance bills as they are today, which makes it much more expensive," said John Rother, president of the National Coalition on Health Care, which works to achieve reform of the U.S. health-care system.

But opponents say that the cost-cutting provisions probably won't work.

Devon Herrick, a health economist at the free-market National Center for Policy Analysis, said the law set up a "slippery slope" that will increase costs, not lower them.

"If Congress and company have the legal authority to decide the minimum coverage you must have, all manner of lobbyists and special interests and providers for specific diseases will descend on Washington and state capitals, as they always have, to make sure that their respective services are covered by that mandate," Herrick said.

In the two years since its passage, the Affordable Care Act has been the target of multiple lawsuits, with a handful of cases working their way through the federal appellate court system before the Supreme Court heard oral arguments in March.

More information

The Kaiser Family Foundation has a primer on the Supreme Court's review of the health-care reform law.

Posted: June 2012


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