Supreme Court Rules Health Care Act Constitutional; Ruling
Does Not End Healthcare Crisis; Head's Up on Future Court
Rulings (initial wrap-up of today's big story)
1. Supreme Court Rules, Obamacare Can Go Forward (Jonathan
Cohn in the New Republic)
2. `Court Ruling Does Not End Healthcare Crisis Or the Need to
Continue the Campaign for Reform' (National Nurses United)
3. Supreme Court Upholds the Health Care Reform Law (AFL-CIO
President Richard Trumka)
4. `Health Law Upheld, But Health Needs Still Unmet': National
Doctors Group (Physicians for a National Health Program)
5. The Roberts Court is Born (Adam Winkler in SCOTUSBlog)
Supreme Court Rules, Obamacare Can Go Forward
by Jonathan Cohn
The New Republic Blog
June 28, 2012 - 10:26 am - Updated at 12:34 pm EST
The Supreme Court has ruled. Health care reform lives.
The decision was actually three separate rulings, with the
justices taking different positions on different parts of the
law. But it means that the Affordable Care Act can take
effect, unless lawmakers decide to repeal it, as Mitt Romney
and congressional Republicans have vowed to do.
If fully implemented, thirty million people who might
otherwise be uninsured will get coverage. Tens of millions
more will get better insurance than they might have had,
whether it's seniors getting additional drug coverage or
purchasers of private insurance getting the right to appeal
insurer treatment decisions. Nearly all Americans will gain
new peace of mind - the knowledge that comprehensive coverage
will always be there, no matter what their medical or
Speaking at the White House moment ago, President Obama hailed
the ruling and what it means for average Americans:
Whatever the politics, today's decision was victory for
people all over this country whose lives will be more
secure because of this law and the Supreme Court's
decision to uphold it.
Here's how the opinions broke down:
The four liberals effectively embraced the government's
arguments in defense of the mandate.
Four conservative dissenters rejected the government's
arguments. Justice Anthony Kennedy wrote the dissent, saying
that he would have invalidated the entire law.
The third opinion, somewhat surprisingly, came from Chief
Justice John Roberts alone, although other justices signed
onto parts. He joined the conservatives in rejecting arguments
that the mandate was a permissible use of federal authority to
regulate interstate commerce. But he said that the mandate was
effectively the same as a tax and, as a result, passed
Roberts' opinion gave the Affordable Care Act the critical
fifth vote it needed. In the key passage, he wrote
The Affordable Care Act's requirement that certain
individuals pay a financial penalty for not obtaining
health insurance may be reasonably characterized as a tax.
Because the constitutional permits such a tax, it is not
our role to forbid it, or to pass upon its wisdom or
Part of Roberts' decision, joined by the dissenters and two of
the liberal justices, limited the federal government's ability
to dictate how states use Medicaid funds. This makes the
expansion of Medicaid essentially voluntary. And while that
may not have much practical effect, given that generous
federal matching funds make the expansion a sweetheart deal
for states, that part of the ruling could limit the federal
government's leverage over states in the future.
Samuel Bagenstos, a constitutional law professor at the
University of Michigan, explained why via e-mail:
The Medicaid holding -- adding up Chief Justice Roberts's
lead opinion (joined on this point, perhaps surprisingly
by Justices Breyer and Kagan) and the
Scalia/Kennedy/Thomas/Alito opinion -- does make the
expansion entirely voluntary. The expansion is still a
really good financial deal for states, though, so the
question "for the ACA" is whether and which states will
decide to forego the expansion. The holding has
potentially serious implications for cooperative federal
spending programs generally, though. I would expect lots
of new Spending Clause challenges to those programs to be
brought after this opinion.
Conservatives can (and should) take heart in that development.
They can also celebrate vindication of a key constitutional
argument: That neither the Commerce Clause nor the "Necessary
and Proper" Clause justify the mandate. Roberts and the four
conservative justices endorsed that view and, again, that
could have long-term effects on the extent of federal
regulatory authority, depending on how broadly future justices
read the provision.
But the immediate result is a win - a huge win - for those who
support health care reform. Via SCOTUSblog, which was (I
think) the first to report the result accurately:
Bottom line: The entire ACA upheld, with the exception
that the federal government's power to terminate states'
Medicaid funds in narrowly limited.
In issuing this ruling, the Court has not only validated the
Affordable Care Act. It has also validated its own reputation.
The vast majority of legal experts have said, all along, that
the law is constitutional under any reasonable reading of past
decisions. The only way for the justices to overturn the law
would have been to rewrite decades of constitutional law, if
not more, and to substitute their own judgment about
legislation in a way the Court has not done in nearly a
Instead, five justices demonstrated that judges should act
with caution and humility, overturning major federal
legislation only in cases where such legislation represents
clear violations of the Constitution.
Roberts and the four Republican appointees put down markers
that could, over the long term, seriously limit federal power.
But they did so in a way that interferes minimally with laws
that today's lawmakers have enacted.
[Jonathan Cohn covers domestic policy and politics, with a
particular emphasis on social welfare, labor, and health care.
He is also the author of Sick: The Untold Story of America's
Health Care Crisis - and the People Who Pay the Price.
Jonathan has been recognized in the pages of the Washington
Post as "one of the nation's leading experts on health care
policy" and in the New York Times as "one of the best health
care writers out there."]
Nurses: `Court Ruling Does Not End Healthcare Crisis
Or the Need to Continue the Campaign for Reform'
National Nurses United
June 28, 2012
Contact: Charles Idelson, 510-273-2246, 415-559-8991 or Carl
Ginsburg, (917) 405-1060
The Supreme Court decision should not be seen as the end of
the efforts by health care activists for a permanent fix of
our broken healthcare system, said the nation's largest union
and professional association of registered nurses today.
To achieve that end, 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,
but "on a universal program based on patient need, not on
profits or ability to pay. That's Medicare for all," said NNU
Co-President Jean Ross, RN. "It is not time to stop, but a
reminder to begin that effort anew."
"Nurses experience the crisis our patients continue to endure
every day. That's the reason we will continue to work for
reform that is universal, that doesn't bankrupt families or
leave patients in the often cruel hands of merciless insurance
companies," said NNU Co-president Karen Higgins, RN.
Stepping up the fight for Medicare for all is even more
critical in the midst of the still persistent economic
crisis," added NNU Co-president Deborah Burger, RN, noting
that nurses have seen broad declines in health status among
patients related to loss of jobs, homes, and health coverage.
NNU has been holding free health screenings and hosting town
halls on the ongoing healthcare crisis over the past two weeks
- and hearing daily reminders of the ongoing plight of many
patients. In addition, NNU will be joining with Michael Moore
to host a national town hall later this summer.
"The continuing fiscal crisis at all levels of government and
the anemic economic recovery remind us that rising healthcare
costs and shifting costs to workers burden our society, cause
much of these fiscal problems, and limit the opportunities for
working people. Only real cost control through a national
health program can solve this crisis. Improved Medicare meets
that challenge," said Ross.
"Medicare is far more effective than the broken private system
in controlling costs and the waste that goes to insurance
paperwork and profits, and it is universally popular, even
among those who bitterly opposed the Obama law," said Higgins.
"Let's open it up to everyone, no one should have to wait to
be 65 to be guaranteed healthcare."
The Affordable Care Act still leaves some 27 million people
without health coverage, does little to constrain rising out
of pocket health care costs, or to stop the all too routine
denials of needed medical care by insurance companies because
they don't want to pay for it.
"Some opponents of expanding Medicare to cover everyone
dismiss the idea as out of reach. If political opposition is
the criteria for social progress, we would never have outlawed
Jim Crow segregation, or won enactment of voting rights for
women, Social Security, and the original Medicare," said
"Nurses know how to fight for our patients. We fight every day
to make sure our patients will get the care we need, and we
are not about to stop," Burger said.
The healthcare crisis is greater than ever, say nurses who see
patients in distress every day. After all the attention on the
court ruling fades, the problems will remain, said Higgins.
"We will continue to see a steady stream of employers dropping
health coverage or shift more and more costs to their
Even after this decision, said Higgins, who was at the Supreme
Court when the ruling was announced,
"We will continue to see patients who postpone filling
prescription medications, or delay doctor-recommended
diagnostic procedures or even life saving medical treatment
because of the high out of pocket costs, or families faced
with the terrible choice of paying for medical care or food or
clothing, or who delay payment on medical bills at the risk of
bankruptcy or a destroyed credit rating."
"We will continue to see hospitals, insurance companies and
drug companies engage in price gouging and insurance
companies refusing to authorize treatment recommended by a
doctor under the pretext it was "experimental" or "not
medically necessary," euphemisms for care that doesn't meet
the real test of a profit driven bottom line. "
"And we will continue to see the U.S. from falling farther
behind other countries in a wide range of health barometers,
including life expectancy, deaths of women of child bearing
age, and long waits for care, even though we spend twice as
much per capita or more than those other nations," Higgins
The U.S. outspends all other nations per capita on care, yet
trails dozens of other nations, which have a national system,
such as our Medicare program, in a wide array of vital
barometers, including life expectancy. While some of those
countries are also mired in economic troubles due to the
global banking crash, the presence of a national health system
has softened the blow on peoples' health.
NNU is joining one of the first post-decision public events
Saturday, a fifth anniversary of Michael Moore's film "SiCKO"
chronicling the healthcare crisis. The event, featuring Moore
and several of the real life stars of the film who continue to
struggle with multiple problems in the health care system,
will be held in Philadelphia at 7 p.m. at the Plays and
Players Theater, 1714 Delancey St.
For more on the nurses campaign, see
Supreme Court Upholds the Health Care Reform Law
AFL-CIO President Richard Trumka released the following
statement on the U.S. Supreme Court's decision this morning
upholding the Affordable Care Act.
June 28, 2012
We are pleased and relieved that the Supreme Court has upheld
the constitutionality of the Affordable Care Act. Today's
decision means that we can continue moving full speed ahead to
implement and build upon the Affordable Care Act. We have no
illusion that the destination has been reached, and we are
more committed than ever to the hard work necessary to achieve
our dream of quality health care for all.
With this decision, more than 105 million Americans will
continue to benefit from the elimination of lifetime limits
and the coverage of preventive services without cost-sharing,
and more than 6 million young adults will remain covered by
their parents' health care plans. Seniors will continue to
save money on prescription drugs as the Part D donut hole
closes over the next eight years; already over 5 million
seniors have saved $3.7 billion on prescriptions in 2010 and
2011. And insurance companies will not be able to deny
coverage due to pre-existing conditions, charge women more or
drop coverage for those who get sick.
To assure that 33 million Americans will be able to obtain
health care coverage through the exchanges and Medicaid
beginning in 2014, all states, including those that waited for
this decision to be issued, must now do their job and act
without delay. We are troubled by the Court's decision
limiting the ability of the federal government to encourage
states to extend Medicaid coverage to certain lower income
individuals, and it would be unconscionable for states to
refuse to extend that coverage, using today's decision as a
The Affordable Care Act is our first step in expanding health
care coverage, improving care and beginning to get control of
health care costs. We will need to build on the achievements
of the Act, Medicare and Medicaid in order to fix our broken
health care system and advance along the path to a more
equitable and cost-effective system.
We believe the way forward is to build on the Affordable Care
Act reforms that strengthen Medicare's historic leadership in
containing health care costs, without cutting benefits. A
simple indisputably constitutional solution is to allow
Americans of all ages to buy into an improved Medicare
program. We believe every baby in America-whether rich or
poor-deserves the same standard of quality care, and we will
keep moving forward until we make this a reality.
We cannot afford to go backward, but that is what Mitt Romney
and the Republican leadership in Congress would do. Their
prescriptions would not expand coverage or control health care
costs. Instead, they would shift costs to working families,
retirees and the states.
The election this November provides a clear choice between the
President, who has stood for fairness and for working men and
women, and Romney, who urges repealing health insurance
protection for working families. We stand with the President.
`Health Law Upheld, But Health Needs Still Unmet': National
Although the Supreme Court has upheld the Affordable
Care Act, the law will not remedy the U.S. health
crisis, physicians group says
Physicians for a National Health Program (PNHP)
June 28, 2012
The following statement was released today by leaders of
Physicians for a National Health Program (www.pnhp.org). Their
signatures appear below.
Although the Supreme Court has upheld the Affordable Care Act
(ACA), the unfortunate reality is that the law, despite its
modest benefits, is not a remedy to our health care crisis:
(1) it will not achieve universal coverage, as it leaves at
least 26 million uninsured, (2) it will not make health care
affordable to Americans with insurance, because of high co-
pays and gaps in coverage that leave patients vulnerable to
financial ruin in the event of serious illness, and (3) it
will not control costs.
Why is this so? Because the ACA perpetuates a dominant role
for the private insurance industry. Each year, that industry
siphons off hundreds of billions of health care dollars for
overhead, profit and the paperwork it demands from doctors and
hospitals; it denies care in order to increase insurers'
bottom line; and it obstructs any serious effort to control
In contrast, a single-payer, improved-Medicare-for-all system
would provide truly universal, comprehensive coverage; health
security for our patients and their families; and cost
control. It would do so by replacing private insurers with a
single, nonprofit agency like Medicare that pays all medical
bills, streamlines administration, and reins in costs for
medications and other supplies through its bargaining clout.
Research shows the savings in administrative costs alone under
a single-payer plan would amount to $400 billion annually,
enough to provide quality coverage to everyone with no overall
increase in U.S. health spending.
The major provisions of the ACA do not go into effect until
2014. Although we will be counseled to "wait and see" how this
reform plays out, we've seen how comparable plans have worked
in Massachusetts and other states. Those "reforms" have
invariably failed our patients, foundering on the shoals of
skyrocketing costs, even as the private insurers have
continued to amass vast fortunes.
Our patients, our people and our national economy cannot wait
any longer for an effective remedy to our health care woes.
The stakes are too high.
Contrary to the claims of those who say we are "unrealistic,"
a single-payer system is within practical reach. The most
rapid way to achieve universal coverage would be to improve
upon the existing Medicare program and expand it to cover
people of all ages. There is legislation before Congress,
notably H.R. 676, the "Expanded and Improved Medicare for All
Act," which would do precisely that.
What is truly unrealistic is believing that we can provide
universal and affordable health care in a system dominated by
private insurers and Big Pharma.
The American people desperately need a universal health system
that delivers comprehensive, equitable, compassionate and
high-quality care, with free choice of provider and no
financial barriers to access. Polls have repeatedly shown an
improved Medicare for all, which meets these criteria, is the
remedy preferred by two-thirds of the population. A solid
majority of the medical profession now favors such an
approach, as well.
We pledge to step up our work for the only equitable,
financially responsible and humane cure for our health care
ills: single-payer national health insurance, an expanded and
improved Medicare for all.
Garrett Adams, M.D.
Andrew Coates, M.D.
Oliver Fein, M.D.
Claudia Fegan, M.D.
David Himmelstein, M.D.
Steffie Woolhandler, M.D.
Quentin Young, M.D.
Don McCanne, M.D.
Senior Health Policy Fellow
For a fact sheet on health care access, costs, safety-net and
women's health issues, and the evidence-based case for single-
payer national health insurance, click here.
For bios and video clips of selected PNHP spokespersons, click
Physicians for a National Health Program (www.pnhp.org) is an
organization of more than 18,000 doctors who advocate for
single-payer national health insurance. To speak with a
physician/spokesperson in your area, visit
www.pnhp.org/stateactions or call (312) 782-6006.
[See Electronic Press Kit with selected spokesperson bios
here. For contacts in nearly every state and major city,
contact Mark Almberg, PNHP, (312) 782-6006, cell: (312)
622-0996, [log in to unmask], or see www.pnhp.org/stateactions.]
The Roberts Court is Born
by Adam Winkler
Posted June 28th, 2012 12:01 pm
Today's Supreme Court is often referred to as Anthony
Kennedy's Court. Although Kennedy is the swing justice who
usually casts the deciding vote in close cases, the landmark
ruling this week in the healthcare cases clearly mark the
maturation of the "Roberts Court."
Chief Justice John Roberts was the surprising swing vote in
today's Obamacare decision. Although he agreed with the four
conservative justices, including Kennedy, that the individual
mandate was not a regulation of interstate commerce, he voted
with the Court's moderates to hold that it was justified as a
tax. Because people who don't obtain insurance pay a tax to
the IRS, the mandate was within Congress's power to raise
taxes for the general welfare. As a result, the Affordable
Care Act was upheld.
With this deft ruling, Roberts avoided what was certain to be
a cascade of criticism of the high court. No Supreme Court has
struck down a president's signature piece of legislation in
over 75 years. Had Obamacare been voided, it would have
inevitably led to charges of aggressive judicial activism.
Roberts peered over the abyss and decided he didn't want to go
Roberts' decision was consistent with his confirmation
hearings pledge to respect the co-equal branches of
government, push for consensus, and reach narrow rulings
designed to build broad coalitions on the Court. He promised
to respect precedent. His jurisprudence, he said, would be
marked by "modesty and humility" and protection of the
precious institutional legitimacy of the Court.
Today, the institutional legitimacy of the Court was
buttressed. President Obama wasn't the only winner at the
Supreme Court today. So was the Supreme Court itself.
Roberts' humble move was a surprise only because his oft-
stated concern for protecting the Court by avoiding bold
rulings doesn't always hold. Despite today's decision, the
Roberts Court is hardly conservative in the sense of cautious
or avoiding bold rulings. In contrast to an older conservatism
that emphasized judicial restraint, the Roberts Court is not
hesitant to forcefully asserts its power.
Since John Roberts became Chief Justice in 2005, the Court has
issued one landmark ruling after another. The Roberts Court
gave us Citizens United, which struck down longstanding limits
on corporate political spending. This Court also allowed new
restrictions on women's right to choose; became the first
Supreme Court in American history to strike down a gun control
law as a violation of the Second Amendment; effectively
outlawed voluntary efforts by public schools to racially
integrate; and curtailed the reach of environmental
In many of these decisions, the Roberts Court overturned or
ignored precedent, including Rehnquist Court decisions less
than a decade old. Prior to Citizens United, the Supreme Court
had explicitly held in two cases that corporate political
expenditures could be limited - the most recent of which was
handed down in 2003. Six years before the Roberts Court upheld
the federal ban on "partial birth" abortion, the Rehnquist
Court, which wasn't known for its liberal leanings, had
overturned a nearly identical law.
Of course, the Roberts Court isn't the first to overturn
precedents and issue major rulings. Yet this Court has been
uniquely willing to do so by sharply divided 5-4 majorities.
The Warren Court's Brown decision was famously 9-0. New York
Times v. Sullivan, which freed up the media to discuss public
figures, was decided by the same margin. Gideon v. Wainwright,
on the constitutional right to counsel, and Loving v.
Virginia, invaliding bans on interracial marriage, were also
unanimous. Even Roe v. Wade was decided by an overwhelming 7-2
Perhaps as a result of the Roberts' Court's controversial 5-4
rulings, public opinion of the Court is at an historic low.
Even after controversial rulings like Roe and Bush v. Gore,
the Court still maintained high levels of public respect. But
unlike the Warren Court, whose landmark rulings, though
classified as "liberal," didn't match up with the platform of
the Democratic Party - southern Democrats were the biggest
opponents of Brown - its hard to ignore the consistent fit
between the Roberts Court's rulings and the Republican agenda.
Maybe that's why recent polls show the Court's public approval
rating has dropped from over 80% in the 1990s to only 44%
today. Three in four Americans now believe the justices' votes
are based on politics. Nothing could be worse for the Court's
Roberts may have voted to save healthcare because he wants to
preserve the Court's capital to take on other big issues
heading toward the Court. Legal experts predict the Roberts
Court will invalidate a key provision of one of the most
important laws in American history, the Voting Rights Act,
next term. And the Court is set to end affirmative action in
public education. Both policies have been centerpieces of
America's commitment to civil rights for over forty years.
The Roberts Court has only just begun.
[Adam Winkler is a constitutional law professor at UCLA and
the author of Gunfight: The Battle over the Right to Bear Arms
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