The Patient Protection and Affordable Care Act – VICTORIOUS!

Drum roll, please…..

I have the supreme pleasure of presenting to you a constitutionally protected Affordable Care Act AND a vindicated Obama Administration. Haters may now exit the building. Thank you for playing, now please go play in traffic.

As everyone and their momma should know by now, yesterday the Supreme Court of the United States of America (SCOTUS) handed down their ruling on the Obama Administration’s “Patient Protection and Affordable Care Act,” a.k.a. “ObamaCare” and victory is on the side of those Americans who believe ALL Americans should have access to affordable healthcare. YAAAAAAAAAAAAAAAAAY!

The two key provisions to note are (1) the Individual Mandate and (2) the Medicaid Expansion.

The Individual Mandate is the provision that requires “almost all Americans [to] buy health insurance by 2014 or pay a penalty”. The federal government argued that the mandate was constitutional under Congress’ power to regulate interstate commerce. Chief Justice Roberts was like “umm no you can’t use the commerce clause” (which regulates interstate commerce) because in this instance the mandate doesn’t so much regulate commerce as it “creates commerce” to be regulated and that isn’t what the founders had in mind. (Grossly paraphrasing but that’s basically what he said.) (scotusblog)

“To an economist, perhaps, there is no difference between activity and inactivity; both have measurable economic effects on commerce,” Chief Justice Roberts wrote. “But the distinction between doing something and doing nothing would not have been lost on the framers, who were practical statesmen, not metaphysical philosophers.” (NYT)

INSTEAD, a majority of the court determined that the “must pay a penalty if you do not comply” component could be viewed as a tax and thus is constitutional under Congress’ constitutional taxing power.

“The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice Roberts wrote in the majority opinion. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” (NYT)

He acknowledged that the mandate (and its accompanying penalty) is primarily intended to get people to buy insurance, rather than to raise money, but it is, he explained, still a tax.  If someone who does not want to buy health insurance is willing to pay the tax, that’s the end of the matter; the government cannot do anything else. (scotusblog)

The second key provision – the Medicaid Expansion – did not receive similar favorable treatment.

Currently, Medicaid is a joint state and federally funded program that provides health coverage or nursing home coverage to certain “low-asset” people. However simply being considered a “low asset” person (i.e., poor) is not enough to qualify for Medicaid. You have to be poor AND fall within one of the defined eligibility categories – children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care.

Under the Affordable Care Act, states would be required to expand Medicaid to include ALL income eligible persons under the age of 65. Specifically, “people with income up to 133% of the poverty line would qualify for coverage, including adults without dependent children.” (Wiki) If a state did not comply it would lose all of its Medicaid funding.

A majority of the court ruled that although the federal government is allowed to “encourage” states to do its bidding – one example occurred in 1987 with the threat to withhold 5% of federal highway funds from states that did not raise their drinking age to 21 – however in this instance the court ruled that the Medicaid Expansion provision “goes too far” and is more like “holding a gun to the head” in order to get the states to comply and thus Congress had exceeded its constitutional authority with such a threat.

However, perhaps all is not lost on this issue as the federal government still has other means of “encouraging” states to fall in line:

“the Court made clear that Congress could still attach some strings to the Medicaid funds.  Specifically, even if it can’t take away all of the funding for states that don’t comply with the new eligibility requirements, it can still withhold the new Medicaid funds if states don’t comply.  So although the Obama Administration lost on this issue, it’s probably a loss that it is willing to live with for now, as few states (if any) are ultimately expected to turn down the new Medicaid money, even with the strings.” (scotusblog)

And now let’s hear from President Obama!

“I know there will be a lot of discussion today about the politics of all this, about who won and who lost.  That’s how these things tend to be viewed here in Washington.  But that discussion completely misses the point.  Whatever the politics, today’s decision was a 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.”

I could take a moment to take a dig at Romney and the Haters (new singing group?) but nah, I’ll get back to them next week – I’m still basking in the glow of Obama’s victory. #HappyDance

Actually I do have one response to the Hater section – actually that “hopey changey stuff” is working out just fine for me, thanks for asking.  🙂


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