Chief Justice John Roberts joined with the left members of the court to rule that the individual mandate at the heart of the historic Affordable Care Act is constitutional. The complicated opinion is being parsed by analysts at SCOTUS blog, but it seems clear the entire controversial Affordable Care Act has been upheld, granting an enormous victory for President Obama and for the already millions of Americans benefiting from the law.
The vote cast by the conservative Chief Justice saved the Affordable Care Act, the other four right-leaning justices apparently voting against the individual mandate.
In reading the dissent, Justice Anthony Kennedy revealed that the conservative justices meant to strike down the whole of the law. He repeated versions of the word “entire” twice in one short sentence.
“In our view, the entire Act before us is invalid in its entirety,” he reportedly said.
Amy Howe at SCOTUS blog summarizes the as-yet-unavailable ruling (now available here):
In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
Already, in the two years since the law passed, millions of Coloradans have benefited from early provisions.
The website Healthcare.gov has rounded up data suggesting the broad impact the law has already had state to state. The numbers come from the Center for Consumer Information and Insurance Oversight within the Department of Health and Human Services.
In a relatively low population state like Colorado, home to roughly 5 million residents, the numbers are impressive, as far as the percent of the population affected, the money saved and the bang for the buck the law is providing for patients.
So far, 50,000 people under 26 now have insurance as a direct result of the law. Coloradans on Medicare have saved $40 million on prescription drugs.
More than 500,000 people on Medicare have received free preventive care services and 700,000 Coloradans with private insurance received preventive care without cost sharing.
Coloradans will receive $27 million in rebates from insurance companies that spent too much on overhead and not enough on patient care.
Nearly 2 million Coloradans no longer need to worry about being thrown off insurance because the law has ended lifetime limits on coverage. That includes 700,000 women and 500,000 children.
More than 1,200 Coloradans unable to secure coverage due to preexisting conditions are now covered.
Colorado pulled down $17 million in grants from the Prevention and Public Health Fund created by the law.
Colorado Health centers have received $79 million to expand services.
Colorado has received more than $106 million to expand the ranks of health care workers in the state.
The problems the Affordable Care Act aims to solve are well known, although they have been buried in many circles during the debate over the constitutionality of the law– a debate politicized in part by detractors that include hard-lobbying health insurance corporations.
As Jeff Madrick summarized recently in the New York Review of Books, more than 50 million Americans, 16 percent of the population, have no health insurance. That population is made up overwhelmingly of people who are young and poor. The uninsured die younger, work less due to illness and struggle with medical bills. According to Harvard Medical School, 45,000 Americans per year die due to lack of insurance. Those who finally go to hospitals for help mostly arrive too late and drain resources with their advanced illnesses and untreated injuries.
Even though one in six Americans don’t have health insurance, Americans pay more than 17 percent of GDP for health care, more by far than any other of the world’s wealthy nations. Not enough emphasis is placed on early relatively inexpensive basic and preventive care. Overall effectiveness has been spiraling downward as a result for decades. The U.S. now ranks 48th in infant mortality. It ranked 12th in 1960.
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