Supreme Court health care decision: Heart of law upheld (document, poll)

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The Supreme Court on Thursday upheld the heart of President Barack Obama's health care overhaul.

The 5-4 decision means the historic law known as the Affordable Care Act will stay in effect, and the federal and local governments can continue to implement its provisions over the next few years. That will affect the way that millions of Americans receive and pay for their personal medical care, and could add more than 30 million people to the ranks of those with health insurance.

The justices rejected the argument that the individual mandate violates the Constitution's commerce clause, ruling that the mandate is a tax that Congress can impose on Americans. The court did find problems with the law's expansion of Medicaid, though it said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they do not take part in the law's extension.

An audible exhalation rippled through the courtroom when Chief Justice John Roberts joined the court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, in upholding the law.

Even though she was in the majority, Ginsburg took issue with the court's reasoning. She said the mandate should have been supported under the commerce clause. Ginsburg also said the entire law should have been upheld as written, without forcing any changes in the Medicaid provision. The majority found problems with the expansion of Medicaid, but said it could proceed as long as the government doesn't threaten to withhold a state's entire Medicaid allotment if it doesn't take part in the extension.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented. The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."

Kennedy summarized the dissent in court. "In our view, the act before us is invalid in its entirety," he said. Kennedy predicted that more people might end up with higher health care costs, without an expanded Medicaid program to cover the costs of the uninsured poor who will not have to pay a penalty tax for not having insurance.

The ruling handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty. The president called the ruling "a victory for people all over this country whose lives will be more secure because of this law."

GOP presidential candidate Mitt Romney slammed the decision, calling the Affordable Care Act "bad law" and promising to work to repeal it if elected in November. Opponents of the law see the so-called individual mandate as coercive and an illegal intrusion by the federal government into the lives of Americans. Some supporters of the law liken the mandate to the requirement that drivers carry car insurance.

House Speaker John Boehner said the ruling shows the need to repeal the law. The Ohio Republican said in a statement that the law is hurting the economy by increasing health care costs and making it difficult for small businesses to hire. He says the court's ruling demands repeal of the entire law. House Majority leader Rep. Eric Cantor says a vote to repeal the law is scheduled for July 11, though such efforts have virtually no chance in the Democratic-controlled Senate. Its ultimate fate will be determined by which party controls the White House and Congress after the November elections.

House Minority Leader Rep. Nancy Pelosi (D-SF) declared "a victory for the American people."

Democratic San Gabriel Valley Rep. Adam Schiff, who supported the law, said Roberts made the right decision in siding with the more liberal wing of the court.

“The Court was at risk of becoming yet another partisan institution if it threw out decades of precedent. The Chief Justice chose a different legacy, and this was not only the correct legal decision, it was also enormously important to maintaining the independence and reputation of the Court," Schiff said in a statement.

The decision to uphold the individual mandate has major implications for California, where an estimated 7 million people — about 20 percent of the population — are not currently covered by health insurance.

Republican Rep. Ken Calvert, who represents parts of Riverside and Orange counties, echoed Romney in saying that while the court ruled that the law is unconstitutional, “the American people understand that it is a bad idea.” Calvert committed himself to working to elect Romney and a conservative majority in the Senate “so we may repeal Obamacare and replace it with common-sense reforms that protect Americans’ access to the care they need, and the doctor they choose, and at a lower cost."

The decision is expected to be a boon to much of the health care industry by making coverage affordable for millions of uninsured Americans. But not every company will benefit. Drugmakers, biotech companies, hospitals and insurers likely will get additional customers because the law requires nearly everyone to have health insurance or pay a fine. Medical device makers, meanwhile, will be hit with a sizable sales tax under the law, without knowing whether ACA will lead to more sales.

Outside the Supreme Court, there was the usual chaos that follows important arguments and decisions at the high court: bellydancers in red-and-blue shimmying to a drummer's beat, a man posing in colonial American garb with a tri-cornered hat, and dueling protesters, some chanting "hey, hey, ho, ho, Obamacare has got to go," and others saying, "We love Obamacare." When the decision was announced, there was confusion, with the law's opponents first cheering because of reports that the mandate had been struck down, and then turning angry when they discovered it had survived.

Supreme Court Decision on Health Care

With contributions by NPR

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