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High court upholds Obama health law by 5-4 vote

The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's health care overhaul.
WASHINGTON (AP) - The Supreme Court on Thursday upheld virtually all of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that nearly every American have health insurance.

The 5-4 decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.

The ruling hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call "Obamacare," arguing that the ruling characterized the penalty against people who refuse to get insurance as a tax.

Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if elected in November.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. Roberts explained at length the court's view of the mandate as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.

Even though Congress called it a penalty, not a tax, Roberts said, "The payment is collected solely by the IRS through the normal means of taxation."

Roberts also made plain the court's rejection of the administration's claim that Congress had the power under the Constitution's commerce clause to put the mandate in place. The power to regulate interstate commerce power, he said, "does not authorize the mandate. "

Stocks of hospital companies rose after the decision was announced, while shares of insurers fell sharply. Shares of drugmakers and device makers fell slightly.

The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.

The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

Kennedy summarized the dissent in court. "In our view, the act before us is invalid in its entirety," he said.

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."

In all, the justices spelled out their views in six opinions totaling 187 pages. Roberts, Kennedy and Ginsburg spent 51 minutes summarizing their views in the packed courtroom.

The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Majority Leader Eric Cantor, R-Va., said Thursday the House will vote the week of July 9 on whether to repeal the law, though such efforts have virtually no chance in the Democratic-controlled Senate.

House Speaker John Boehner, R-Ohio, said the health care law makes it harder for small businesses to hire workers. "Today's ruling underscores the urgency of repealing this harmful law in its entirety," he said.

But Senate Majority Leader Harry Reid, D-Nev., heaped praise on the court's decision, and the 2010 law, in a Senate speech. "Passing the Affordable Care Act was the greatest single step in generations toward ensuring access to affordable, quality health care for every American, regardless of where they live or how much money they make," he said.

After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Democrats said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.

"Mitt Romney is the intellectual godfather of Obamacare," said Democratic consultant Jim Manley. "The bigger issue is the rising cost of health care, and this bill is designed to deal with it."

More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.

There's also an added safety net for all Americans, insured and uninsured. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections, now standard in most big employer plans, will be available to all, including people who get laid off, or leave a corporate job to launch their own small business.

Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no copayments for preventive care. But hospitals, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.

Illegal immigrants are not entitled to the new insurance coverage under the law, and will remain one of the biggest groups uninsured.

Obama's law is by no means the last word on health care. Experts expect costs to keep rising, meaning that lawmakers will have to revisit the issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-income people.

The health care overhaul focus will now quickly shift from Washington to state capitals. Only 14 states, plus Washington, D.C., have adopted plans to set up the new health insurance markets called for under the law. Called exchanges, the new markets are supposed to be up and running on Jan. 1, 2014. People buying coverage individually, as well as small businesses, will be able to shop for private coverage from a range of competing insurers.

Most Republican-led states, including large ones such as Texas and Florida, have been counting on the law to be overturned and have failed to do the considerable spade work needed to set up exchanges. There's a real question about whether they can meet the deadline, and if they don't, Washington will step in and run their exchanges for them.

In contrast to the states, health insurance companies, major employers, and big hospital systems are among the best prepared. Many of the changes called for in the law were already being demanded by employers trying to get better value for their private health insurance dollars.

"The main driver here is financial," said Dr. Toby Cosgrove, CEO of the Cleveland Clinic, which has pioneered some of the changes. "The factors driving health care reform are not new, and they are not going to go away."

The Medicaid expansion would cover an estimated 17 million people who earn too much to qualify for assistance but not enough to afford insurance. The federal and state governments share the cost, and Washington regularly imposes conditions on the states in exchange for money.

Roberts said Congress' ability to impose those conditions has its limits. "In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement' - it is a gun to the head," he said.

The law says the Health and Human Services Department can withhold a state's entire Medicaid allotment if the state doesn't comply with the health care law's Medicaid provisions.

Even while ruling out that level of coercion, however, Roberts said nothing prevents the federal government from offering money to accomplish the expansion and withholding that money from states that don't meet certain conditions.

"What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding," he said.

Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision. She said Congress' constitutional authority to regulate interstate commerce supports the individual mandate. She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.

"So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions," Ginsburg said in a statement she, too, read from the bench.

In the courtroom Thursday were retired Justice John Paul Stevens and the wives of Roberts, Alito, Breyer, Kennedy and Thomas.
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Associated Press writers Ricardo Alonso-Zaldivar, Charles Babington, Jessica Gresko, Jesse J. Holland and David Espo contributed to this report

Remarks by the President on Supreme Court Ruling

President Barack Obama
President Barack Obama
Earlier today, the Supreme Court upheld the constitutionality of the Affordable Care Act -- the name of the health care reform we passed two years ago. In doing so, they've reaffirmed a fundamental principle that here in America -- in the wealthiest nation on Earth – no illness or accident should lead to any family’s financial ruin.

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.

And because this law has a direct impact on so many Americans, I want to take this opportunity to talk about exactly what it means for you.

First, if you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance -- this law will only make it more secure and more affordable. Insurance companies can no longer impose lifetime limits on the amount of care you receive. They can no longer discriminate against children with preexisting conditions. They can no longer drop your coverage if you get sick. They can no longer jack up your premiums without reason. They are required to provide free preventive care like check-ups and mammograms -- a provision that's already helped 54 million Americans with private insurance. And by this August, nearly 13 million of you will receive a rebate from your insurance company because it spent too much on things like administrative costs and CEO bonuses, and not enough on your health care.

There’s more. Because of the Affordable Care Act, young adults under the age of 26 are able to stay on their parent's health care plans -- a provision that's already helped 6 million young Americans. And because of the Affordable Care Act, seniors receive a discount on their prescription drugs -- a discount that's already saved more than 5 million seniors on Medicare about $600 each.

All of this is happening because of the Affordable Care Act. These provisions provide common-sense protections for middle class families, and they enjoy broad popular support. And thanks to today’s decision, all of these benefits and protections will continue for Americans who already have health insurance.

Now, if you’re one of the 30 million Americans who don’t yet have health insurance, starting in 2014 this law will offer you an array of quality, affordable, private health insurance plans to choose from. Each state will take the lead in designing their own menu of options, and if states can come up with even better ways of covering more people at the same quality and cost, this law allows them to do that, too. And I’ve asked Congress to help speed up that process, and give states this flexibility in year one.

Once states set up these health insurance marketplaces, known as exchanges, insurance companies will no longer be able to discriminate against any American with a preexisting health condition. They won’t be able to charge you more just because you’re a woman. They won’t be able to bill you into bankruptcy. If you’re sick, you’ll finally have the same chance to get quality, affordable health care as everyone else. And if you can’t afford the premiums, you'll receive a credit that helps pay for it.

Today, the Supreme Court also upheld the principle that people who can afford health insurance should take the responsibility to buy health insurance. This is important for two reasons.

First, when uninsured people who can afford coverage get sick, and show up at the emergency room for care, the rest of us end up paying for their care in the form of higher premiums.

And second, if you ask insurance companies to cover people with preexisting conditions, but don’t require people who can afford it to buy their own insurance, some folks might wait until they’re sick to buy the care they need -- which would also drive up everybody else’s premiums.

That’s why, even though I knew it wouldn’t be politically popular, and resisted the idea when I ran for this office, we ultimately included a provision in the Affordable Care Act that people who can afford to buy health insurance should take the responsibility to do so. In fact, this idea has enjoyed support from members of both parties, including the current Republican nominee for President.

Still, I know the debate over this law has been divisive. I respect the very real concerns that millions of Americans have shared. And I know a lot of coverage through this health care debate has focused on what it means politically.

Well, it should be pretty clear by now that I didn’t do this because it was good politics. I did it because I believed it was good for the country. I did it because I believed it was good for the American people.

There’s a framed letter that hangs in my office right now. It was sent to me during the health care debate by a woman named Natoma Canfield. For years and years, Natoma did everything right. She bought health insurance. She paid her premiums on time. But 18 years ago, Natoma was diagnosed with cancer. And even though she’d been cancer-free for more than a decade, her insurance company kept jacking up her rates, year after year. And despite her desire to keep her coverage -- despite her fears that she would get sick again -- she had to surrender her health insurance, and was forced to hang her fortunes on chance.

I carried Natoma’s story with me every day of the fight to pass this law. It reminded me of all the Americans, all across the country, who have had to worry not only about getting sick, but about the cost of getting well.

Natoma is well today. And because of this law, there are other Americans -- other sons and daughters, brothers and sisters, fathers and mothers -- who will not have to hang their fortunes on chance. These are the Americans for whom we passed this law.

The highest Court in the land has now spoken. We will continue to implement this law. And we'll work together to improve on it where we can. But what we won’t do -- what the country can’t afford to do -- is refight the political battles of two years ago, or go back to the way things were.

With today’s announcement, it’s time for us to move forward -- to implement and, where necessary, improve on this law. And now is the time to keep our focus on the most urgent challenge of our time: putting people back to work, paying down our debt, and building an economy where people can have confidence that if they work hard, they can get ahead.

But today, I’m as confident as ever that when we look back five years from now, or 10 years from now, or 20 years from now, we’ll be better off because we had the courage to pass this law and keep moving forward.

Thank you. God bless you, and God bless America.

Statement by Senator Mark Pryor on Health Care Ruling

Mark Pryor
Mark Pryor
"The cost of health care is having a major impact on Arkansas families and it is taking an enormous toll on our nation’s budget and well-being. This reason is why Presidents and lawmakers of both parties have promised to fix this broken system for more than 40 years. It is also the reason I have worked to make health care more affordable, accessible and reliable for Arkansans. The law we passed, while not perfect, is already making health care more affordable, accessible and reliable. It is benefiting children, adults and seniors throughout our state.

Before health care reform, I heard from an individual in Greenwood who couldn’t afford life-saving medicine for his heart condition. He is now one of the 36,000 Arkansas seniors who are saving a collective $30 million on prescription drugs through Medicare. I received a letter from a mom in Fayetteville who can now insure her 5-year-old with Down Syndrome, and an email from Brian in Rogers who was able to purchase health care coverage despite having multiple sclerosis. In fact, in Arkansas more than 35,000 young adults have gained health insurance, 574 individuals with pre-existing conditions were able to buy coverage after being denied in the past and 819,000 individuals received preventive services with no deductible or co-pay. The protections upheld today by the Supreme Court will continue to benefit these families, and thousands of other Arkansans who have struggled with the cost of health care in our country.

I am still analyzing today’s ruling. While it provides more certainty, it still allows us to work in a bipartisan way to improve our health care system."

Boozman Statement on Supreme Court Healthcare Ruling

John Boozman
John Boozman
“I am disappointed in the outcome but respect the decision reached by the Supreme Court. However, just because the Court found the law to be constitutional, does not mean it is good policy. The President rammed this law through Congress claiming it was not a tax increase but the Court ruled it Constitutional as a tax. This is all the more reason to step up our efforts to repeal the law and its accompanying tax increase, and put in place free market solutions that lower costs and allows a patient centered approach to making health care decisions.”
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