Health act upheld
BY WAYNE GREENE World Senior Writer
Friday, June 29, 2012
6/29/12 at 6:59 AM
Read the Tulsa World continuing coverage of the health care law.
The U.S. Supreme Court upheld the constitutionality of almost all of the Affordable Care Act - "Obama care" to its opponents - setting up a November presidential referendum on the issue.
The keystone of the law - the so-called individual mandate, which requires Americans to have health insurance or pay a penalty - is a constitutional use of the federal government's authority to levy taxes, the court found in a 5-4 decision.
"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 John Roberts wrote. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."
The high court found that Congress couldn't withhold existing Medicaid funding if they refuse to go along with the law's expansion of Medicaid eligibility - the day's only victory for opponents of Obama care.
In a nationally televised speech, President Barack Obama, who has tied much of his political future to the law, said the decision 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."
Obama said the law could be improved, but in the long run it will mark a watershed in U.S. history.
"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," Obama said.
Legal vs. political
While the decision resolved legal questions about the law, political ones - especially whether the United State can afford a major expansion of health care - remain.
A March Congressional Budget Office estimate of the federal budget impact of expanding insurance coverage would be $1.76 trillion for 2012 through 2022.
Oklahoma reaction to the high court ruling was swift and, in a word, "disappointed."
Gov. Mary Fallin said the ruling points to the importance of November's election to determine the nation's future.
"President Obama's health-care policies will limit patients' health care choices, reduce the quality of health care in the United States and will cost the state of Oklahoma more than a half-billion dollars in the process.
"Today's decision highlights the importance of electing leaders who will work to repeal the federal health care law and replace it with meaningful reform focused on commonsense, market-based changes," she said.
The high court's decision leaves Fallin and the Oklahoma Legislature in a difficult position.
Legislative leaders had put off a decision on complying with the law's mandate to create a state health-care exchange until after the high court ruled.
With the ruling, which leaves the requirement in place, lawmakers have to decide whether to comply with the law or allow the federal government to impose a health-care exchange on the state.
Under the law, the state faces an end-of-the-year deadline to have a plan in place, but Fallin said she has no plans to call a special legislative session to deal with the issue.
The Supreme Court decision makes the law's increase in eligibility essentially voluntary - suggesting one way lawmakers could resist the law.
The court said Congress can't take away Medicaid funding if states refuse to go along with the eligibility increase, which is one of the keys to the law's attempt to reduce the number of uninsured Americans.
Expanding Oklahoma's Medicaid program would make health-care benefits available to an estimated 200,000 newly qualified adults, ages 19 to 64, with household incomes at or below 133 percent of the federal poverty level. For example, a single adult could make up to $15,414 a year, or a family of three would qualify with a household income at or below $26,344.
If the state chooses to expand Medicaid in 2014, the first three years of benefits for the new population would be paid completely by the federal government. Beginning in 2017, the federal government's share would be 95 percent and would taper to 90 percent in 2020.
Alex Weintz, spokesman for Fallin, said she is studying the ruling's effect on Medicaid but isn't ready to address the issue yet.
Foes' fight continues
Oklahoma Attorney General Scott Pruitt was in Washington on Thursday to testify to a congressional committee and was present for the high court's announcement. In March, he attended part of the oral arguments on the case.
While the decision didn't come out in Pruitt's favor, he promised to fight on.
"The battle isn't over," Pruitt said. "It is now up to the political process to repeal the act and replace it with measures that address the health-care crisis within the confines of the Constitution.
"We must continue to oppose this act and multiple overreaching regulations proposed by the Obama administration that cross the line of federal power."
U.S. Sen. Jim Inhofe, R-Okla., said Roberts' ruling proves that the law is a tax increase, despite President Obama's past claims that it is not.
"It turns out that Obama and the Democrats have levied an enormous tax increase on the middle and lower classes," Inhofe said. "The individual mandate will cost Americans the greater of a per-person flat fee or percentage of the household's income. The flat fee is up to $695, and the income percentage is up to 2.5 percent. That is just not workable for most families."
U.S. Sen. Tom Coburn plans to renew efforts to repeal the law in Congress, spokesman John Hart said.
"Dr. Coburn will be reviewing the ruling and will respond with an updated plan to repeal and replace this unworkable law," Hart said. "The Court affirmed Congress' power to tax people if they don't eat their broccoli. Now it's up to the American people to decide whether they will tolerate this obscene abuse of individual liberty."
U.S. Rep. John Sullivan, R-Oklahoma, took strong exception to the court's decision.
"I strongly disagree with the court's decision to uphold the individual mandate - I fear this ruling will forever change the relationship between the federal government and the people in this country," Sullivan said.
"Nowhere in the U.S. Constitution is Congress given the power to force Americans to purchase a good or a service or to enter into a contract," Sullivan said. "By signing Obamacare into law, the president and Democrat leaders told the American people they don't have a right to choose what health insurance plan best meets their needs. I strongly disagree.
Sullivan, who lost a bid for re-election on Tuesday, said he will continue his effort to fight the law while he remains in office.
Bipartisan solutions
The only Oklahoma Democrat in Congress - U.S. Rep. Dan Boren - said the nation needs to find a way to deal with its health-care problems.
"It has always been my belief that health-care reform should be done incrementally," Boren said. "There are pieces of the health-care law, like covering patients with pre-existing conditions, on which most Oklahomans and many Americans agree. As we move forward, I hope we can find bipartisan solutions to addressing our nation's health care challenges."
U.S. Rep. Frank Lucas, R-Okla., expressed his disappointment with the ruling.
"Americans have spoken loudly in opposition to this unworkable law, and it is discouraging the court has found it constitutional," Lucas said. "Families should have the freedom to make their own health-care decisions, and Obamacare takes that freedom away, while in turn costing our nation trillions of dollars without addressing our health-care problems."
Lucas said he will work with members of the U.S. House to repeal the law and replace it with health-care reforms.
"We need to refocus our efforts to make efficient and cost-effective changes to the system, while also ensuring health-care treatments are never rationed by government officials," Lucas said.
Health insurance highlights
Oklahoma population: 3,667,824
Total uninsured: 624,480 (17 percent)
Oklahomans who get health insurance from employers: 43 percent
Oklahomans who purchase their own insurance: 4 percent
Oklahomans on Medicaid: 20 percent
Oklahomans on Medicare: 15 percent
What the ruling means
The Supreme Court decision upholding President Barack Obama's health care law affects nearly every American. The law tells almost everyone they must have health coverage and guarantees it will be available to them even if they are already ill or need hugely expensive care. It helps the poor and many middle-class people afford coverage.
What the justices said
- The high court upheld almost all of the law, including the most disputed part: the mandate that virtually all Americans have health insurance or pay a fine. The court said that fine is essentially a tax, and that's why the government has the power to impose it.
- The ruling limited the law's plan to expand the Medicaid insurance program for the poor, a joint effort of the federal government and states. It says the U.S. government cannot withhold a state's entire Medicaid allotment if it doesn't participate in the expansion.
Chief Justice John Roberts sided with the court's four liberal justices - Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor - to form the 5-4 majority.
Oklahoma health insurance facts
Information is from 2010, unless noted.
Oklahoma population: 3,667,824
Total uninsured: 624,480 (17 percent)
Uninsured children: 119,747 (12 percent)
Uninsured women: 247,000 (21.9 percent)
Uninsured adults under age 65: 503,644 (23 percent)
Employees of businesses of less than 50 workers: 348,668
Number whose employers do not offer health insurance: 168,407
Employees of businesses of 50+ workers: 840,470
Number whose employers do not offer health insurance: 15,128
Oklahomans to age 26 who were able to stay on parents' health insurance because of Affordable Care Act: 37,262
Oklahoma children with pre-existing conditions aided by Affordable Care Act: 66,900
Estimated number of Oklahomans who become eligible for Medicaid under Affordable Care Act in 2014: 200,000
Number of previously eligible Oklahomans expected to sign up for Medicaid: 50,000
Number of children enrolled in Medicaid (May 2012): 498,477
Oklahomans who get health insurance from employers: 43 percent
Oklahomans who purchase their own insurance: 4 percent
Oklahomans on Medicaid: 20 percent
Oklahomans on Medicare: 15 percent
Three insurance companies write 78 percent of the individual health insurance in Oklahoma, and three companies write 70 percent of the small group market in Oklahoma.
Sources: Oklahoma Health Care Authority; reports to and final report, Joint Committee on Federal Health Care Law, National Women's Law Center
Wayne Greene 918-581-8308
wayne.greene@tulsaworld.com
Associated Images:
Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington. DAVID GOLDMAN/Associated Press
Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington, Thursday, after the court's ruling. DAVID GOLDMAN/Associated Press
An opponent of President Barack Obama's health-care law demonstrates outside the Supreme Court in Washington, on Thursday before the court's ruling on the law. The Supreme Court's decision to uphold the historic overhaul is expected to be a boon to most of the health-care industry by making coverage more affordable for millions of uninsured Americans. DAVID GOLDMAN/Associated Press
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