Supreme Court upholds affordable care act

The Supreme Court’s approval of President Obama’s favored “Patient Protection and Affordable Health Care Act” will extend health care coverage to more in America. Yet, some believe the ruling may have set a dangerous precedent by upholding the controversial “individual mandate.” Opponents of the mandate fear it sets a precedent allowing the government to “tax” or fine citizens into buying anything.

The high court also struck down an essential piece of the legislation requiring states to comply with the law’s extension of Medicaid.

The law, passed in 2010 and set to take full effect by 2014, will extend Medicaid eligibility to 133 percent of the poverty line. A wide-reaching act, the law included the following measures, among others: insurance companies must offer coverage to those with preexisting conditions and remove lifetime and annual coverage caps; parent insurance plans will cover children up to age 26; insurance companies must cover some preventive services without co-pays or deductibles.

The law also called for an insurance exchange with which citizens can leverage the buying power of a national group plan. Congress members will have to purchase their health care insurance on this exchange, a measure meant to ensure the quality of the exchange.

The law’s individual mandate will require all citizens to purchase health insurance or face a fine. The law allows an exception to this requirement: those whose premiums exceed eight percent of their income; those under the income threshold for filing taxes; and, those with religious objections to receiving health care. Opponents, such as Republican Senator from Kentucky Mitch McConnell, said this violates the constitution by requiring citizens to enter into a business transaction.

The Supreme Court upheld most of the law, including the individual mandate. Conservative Justice John Roberts gave the tie-breaking vote and wrote the ruling, saying the fine penalizing those without insurance is the same as a tax, which Congress has the right to levy.

But, the high court struck down the piece of the law that tied state funding to whether states extend Medicaid coverage the full amount the law called for.

Roberts called this requirement a “coercive” move by the federal government. States will continue to receive Medicaid funding even if they do not comply with the law and extend Medicaid coverage according to the federal law. They will only receive Medicaid funding according to how much Medicaid coverage they offer. According to Lawrence Jacobs, a University of Minnesota political scientist, once the health care system is fully in place, six percent of the population will not have health care coverage. Many of those will not be fined, Jacobs said.

It is unclear how the repeal of the requirement state Medicaid extension requirement affects Jacobs’ estimation.

With a narrow five-to-four majority, the varied reasons justices gave for supporting the ruling show a court divided over the implied precedent set by the individual mandate. Of the five justices who voted in favor of the law, only Roberts supported the mandate because he said it is equivalent to a tax and is therefore protected under the Congressional right to tax. The other four said the mandate is permissible under Congress’ right to regulate commerce, but Roberts disagreed, as did the four dissenters. Though the majority favored the mandate, there was no majority opinion as to why the mandate is permissible. The official court ruling only reflects one justice’s opinion on this particular matter. So, while the precedent for the mandate is technically set, ambiguity for the exact implication of that precedent may remain.

Though not directly in question in this case, the challenge jeopardized the law’s measures ensuring more equitable health care for women. The law makes it illegal for insurance companies to charge women more simply for being women, a common practice. It also includes women’s basic screenings and birth control as preventive care that needs no copay, the birth control piece falling under some public scrutiny for religious reasons. Also, insurance companies may no longer deny coverage for maternity care and care related to sexual abuse and assault as “preexisting conditions.” And, companies with 50 or more employees must provide private areas and breaks for lactating mothers to express breast milk.

The Supreme Court posted the full text of its opinions on its website,

Readers can find the full text of the law posted at

Those seeking health insurance or state assistance may also visit the health care site to find out what they qualify for in state assistance and what kind of insurance they can afford.