Thursday the Supreme Court by its rulings upheld two of three provisions of the ACA that had been the subject of legal challenges.
What that will mean in the future of Health Care is yet to be determine. In the mean time there are several aspects to this action; the first is the legal implications of the Courts rulings; the second is the future of the nature of health care which I hope to opine about next week.
One must first realize that Thursday was not a vindication of “Obama Care”. The one act that was rejected will impact on the scope of care to those who live within the level of income limits eligible for Medicaid. That can vary in various states.
The court turned down the Government’s provision for States receiving increased funding they must expand to certain levels their Medicaid programs. The present law which allocates to each state fund that the state must supplement to provide services; permits States to have the ability to determine within definite parameters what services and who will be covered by Medicaid
The Court found the new law to be coercive since it had universal mandates that had to be followed or the state would lose its present funding. Therefore it was unconstitutional.
The problem with that ruling is that there are several programs they give states funds and include a prescribed usage of those dollars. Many are in the educational field a May now become open to legal challenge.
In upholding the mandatory insurance act, Roberts’ majority opinion in essence rewrote the law by declaring it constitutional under Congress’s tax powers. But not under its Commerce powers.
Roherts said that the law does not truly impose such a mandate on Americans. It simply requires those who do not have health insurance to pay a tax penalty. That tax requirement, he said, passes constitutional muster.
"The federal government does not have the power to order people to buy health insurance," he wrote. "The federal government does have the power to impose a tax on those without health insurance."
Justice Ginsburg while voting to uphold the mandatory provision disagreed that it was covered under the Taxation powers but was constitutional under the Commerce provisions. She was alone in that position.
The Court has entered a dangerous area of the Nine Justices usurping Congress’s Constitutional prerogative of writing laws through use of novel interpretations instead of just judging their constitutionality.
The example here was stating that the Mandatory Insurance act would be unconstitutional if held to the Congressional powers relating to Commerce which was the rational under which the act was conceived. Instead the Court declared its Constitutionality was valid under the Federal Taxation powers.
What has been gained is the ability of all to have affordable health insurance. I am sure that present premiums will rise because the insurance carriers will spread increased risks over the entire buyers base.
Perhaps the end may justify the means. However this may prove to be a truly Pyrrhic Victory in which the Republicans will have ammunition to prove that the Democrats are committed to raise taxes; always a bad idea in an election year.