UPHELD!

[Guinevere]

Supreme Court, in a decision authored by the Chief Justice, upholds all of the health care law. Apparently the key was the taxing power of Congress, rather than the commerce clause power.

Will post a link to the decision, and more thoughts, once it is up on the Court's website.

Listen, can you hear millions of tea-bagger's heads exploding now . . ..

[Jarlaxle]

Well...that was my tipping point. Time to figure a way to leech off the public tit for the rest of my life. And now I need a new doctor...as he informed me last year, Obamacare being upheld means hes retiring.

[BoSoxGal]

[Guinevere]

Well...that was my tipping point. Time to figure a way to leech off the public tit for the rest of my life. And now I need a new doctor...as he informed me last year, Obamacare being upheld means hes retiring.

Of course it has nothing to do with leeching off the "public tit" but you go right ahead and remain uninformed.

[Guinevere]

193 pages of Opinion here:

http://www.supremecourt.gov/opinions/11 ... 93c3a2.pdf

Scalia, Kennedy, Thomas, and Alito dissented and found the entire Act invalid -- surprising no one.

[Sue U]

ROBERTS, C. J., announced the judgment of the Court and delivered the opinion of the Court with respect to Parts I, II, and III–C, in which GINSBURG, BREYER, SOTOMAYOR, and KAGAN, JJ., joined; an opinion withrespect to Part IV, in which BREYER and KAGAN, JJ., joined; and an opinion with respect to Parts III–A, III–B, and III–D. GINSBURG, J., filed an opinion concurring in part, concurring in the judgment in part,and dissenting in part, in which SOTOMAYOR, J., joined, and in which BREYER and KAGAN, JJ., joined as to Parts I, II, III, and IV. SCALIA, KENNEDY, THOMAS, and ALITO, JJ., filed a dissenting opinion. THOMAS, J., filed a dissenting opinion.

Boy, just figuring out which parts of the opinion are actually usable law is a project in itself.

[Crackpot]

Can someone give the broad strokes for us untrained in legalese?

While I wouldn't say it was a surprise Kennedy (and Roberts for that matter) were far from known quantities.

[Guinevere]

From one of my municipal law attorney list-servs (I make no representations regarding the accuracy of the summary, I won't get to read the beast until tonight):

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.

[Crackpot]

So they punted?

[Econoline]

[Sue U]

So they punted?

Not a punt at all. The "individual mandate" is constitutional as the associated penalty is considered a tax. That was the heart of the issue.

[Scooter]

The piece that I don't get is how it is unconstitutional for Congress to impose new conditions on an existing federal program (Medicaid) and to withhold funding from states that don't choose to comply. How does Congress overhaul any federally funded program if they don't retain the power to turn off the tap in order to force compliance?

[Crackpot]

It was my understanding that the tax issue mainly fell under a ruling that a tax could not be challenged until it went into effect. Therefore, it could be retried after implementaion.

[Sue U]

The piece that I don't get is how it is unconstitutional for Congress to impose new conditions on an existing federal program (Medicaid) and to withhold funding from states that don't choose to comply. How does Congress overhaul any federally funded program if they don't retain the power to turn off the tap in order to force compliance?

It's a matter of degree, apparently:

Here, the Government claims that the Medicaid expansion is properly viewed merely as a modification of the existing program because the States agreed that Congresscould change the terms of Medicaid when they signed on in the first place. The Government observes that the Social Security Act, which includes the original Medicaidprovisions, contains a clause expressly reserving “[t]he right to alter, amend, or repeal any provision” of that statute. 42 U. S. C. §1304. So it does. But “if Congress intends to impose a condition on the grant of federal moneys, it must do so unambiguously.” Pennhurst, 451 U. S., at 17. A State confronted with statutory language reserving the right to “alter” or “amend” the pertinent provisionsof the Social Security Act might reasonably assume that Congress was entitled to make adjustments to the Medicaid program as it developed. Congress has in fact done so, sometimes conditioning only the new funding, other times both old and new. See, e.g., Social Security Amendments of 1972, 86 Stat. 1381–1382, 1465 (extending Medicaid eligibility, but partly conditioning only the new funding); Omnibus Budget Reconciliation Act of 1990, §4601, 104 Stat. 1388–166 (extending eligibility, and conditioning old and new funds).

The Medicaid expansion, however, accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for four particular categories of the needy: the disabled, the blind, the elderly, and needy families with dependent children. See 42 U. S. C. §1396a(a)(10). Previous amendments to Medicaid eligibility merely altered and expanded the boundaries of these categories. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage.14

Indeed, the manner in which the expansion is structured indicates that while Congress may have styled the expansion a mere alteration of existing Medicaid, it recognized it was enlisting the States in a new health care program. Congress created a separate funding provision to cover the costs of providing services to any person made newly eligible by the expansion. While Congress pays 50 to 83 percent of the costs of covering individuals currently enrolled in Medicaid, §1396d(b), once the expansion is fully implemented Congress will pay 90 percent of the costs for newly eligible persons, §1396d(y)(1). The conditions on use of the different funds are also distinct. Congress mandated that newly eligible persons receive a level of coverage that is less comprehensive than the traditional Medicaid benefit package. §1396a(k)(1); see Brief for United States 9. As we have explained, “[t]hough Congress’ power to legislate under the spending power is broad, it does not include surprising participating States with postacceptance or ‘retroactive’ conditions.” Pennhurst, supra, at 25. A State could hardly anticipate that Congress’s reservation of the right to “alter” or “amend” the Medicaid program included the power to transform it so dramatically.

It was my understanding that the tax issue mainly fell under a ruling that a tax could not be challenged until it went into effect. Therefore, it could be retried after implementaion.

The Act was challenged on the basis that requiring individuals to purchase health insurance overstepped the powers granted to Congress by the Commerce Clause. Roberts and the four dissenters agreed that was the case; however, if the "mandate" is viewed as imposing a tax for failure to have healthcare coverage, then that is permissible as part of Congress's taxing power, according to the majority.

ETA:

Although I can appreciate the dstinction, it seems to me a matter of semantics, really. The way to have avoided the issue from the outset would have been to impose a tax on everyone and then grant an exemption with proof of health insurance. Although the real way to avoid the problem altogether would have been to enact my healthcare reform plan.

[dgs49]

The fact that the Chief Justice wrote this opinion, and that he employed such bizarre reasoning to support Congress' unconstitutional assault on individual liberty was, shall we say, surprising.

So a measure that we were assured, over and over, by Congressional Democrats and the President himself (the audio clips are all over the airwaves as I type this) was NOT A TAX, has been ratified under Congress' taxing powers. Think about that: A premium for insurance that is paid, not to the Government, but to some private corporation, is deemed by the USSC to be a "tax." So Congress could require all middle income taxpayers to purchase a new Chevy Volt. Same reasoning. Congress wants to fight CO2 "pollution," and chooses this way of doing it. Just a tax. Nice.

Ironically, the mandate itself is rather harmless in the Big Picture. People who "can afford" health insurance will be compelled to purchase it whether they feel they need it or not. The influx of money from people who don't actually need insurance (young, healthy people) will partly offset the costs that the insurance companies will be compelled to pay under their pre-existing condition exclusions, and for healthcare for the economically retarded young adults who will be covered under their parents' policies. One of the many stupid things about the law is that MANDATORY insurance should be truly insurance in the traditional sense: employed to protect the policy holder against catastrophic losses, but this mandate is for insurance that covers routine expenses, thus making it hugely expensive. BC pills covered by insurance? Ridicluous.

The pity is that the USSC has finally seated the last nail in the coffin of the Tenth Amendment. It is difficult to imagine much that Congress could do that would be outside its theoretical powers, if this is the way the Court will view the Constitution going forward.

Yet another reason why Barry MUST be defeated, and the Senate must be "righted."

[Scooter]

A premium for insurance that is paid, not to the Government, but to some private corporation, is deemed by the USSC to be a "tax."

No. The penalty that is assessed by and paid to the government of the United States, as a consequence of not procuring private insurance for oneself, was deemed to be a tax. A completely different thing.

[Scooter]

One of the many stupid things about the law is that MANDATORY insurance should be truly insurance in the traditional sense: employed to protect the policy holder against catastrophic losses, but this mandate is for insurance that covers routine expenses, thus making it hugely expensive. BC pills covered by insurance? Ridicluous.

The stupid thing is not recognizing that paying for birth control via insurance will save huge amounts in prevented costs for the birth and eventual health care costs of children that will not be born as a result.

ETA - since it apparently bears repeating:

Rhode Island was the first state to obtain approval to expand the availability of family planning services provided under Medicaid. In the first three years it cost them an additional $5.7 million to pay for family planning, and saved $14.3 million in costs for delivery and post-natal care. That's a return on investment of 150%. What insurance company isn't going to love that? Research has also been done on the costs/savings associated with employer-paid oral contraceptive coverage. Taking into account only direct medical expenses of pregnancy/childbirth/abortion, the savings generated by the use of oral contraceptives were $2,500 per patient per year. Mercer did a study incorporating all of the indirect expenses of pregnancy (absences, maternity leave, reduced productivity, turnover when pregnant employees decide to leave), and found that it would cost employers 15-17% more if they chose not to provide contraceptive coverage.

[Rick]

The piece that I don't get is how it is unconstitutional for Congress to impose new conditions on an existing federal program (Medicaid) and to withhold funding from states that don't choose to comply. How does Congress overhaul any federally funded program if they don't retain the power to turn off the tap in order to force compliance?

I'm stepping on a limb here.

I think it's cause laws are implemented forward not retro.

Meaning those funds already allocated cannot be changed (I would guess applicable to all CURRENT recipients), however from the point of implementation all new applicants will fall into the "must comply" catagory...

[Sue U]

One of the many stupid things about the law is that MANDATORY insurance should be truly insurance in the traditional sense: employed to protect the policy holder against catastrophic losses, but this mandate is for insurance that covers routine expenses, thus making it hugely expensive.

This is exactly wrong. Routine care is very cheap and avoids the much greater costs of treating serious illness that could have been nipped in the bud, or illnesses that are being treated at great expense in hospital emergency rooms rather than a physician's office.

But the economic facts of healthcare are that half the population spends virtually nothing on healthcare each year, while 5 percent of the population accounts for 50% of all costs. And the greatest share of those costs are for treating long-term chronic illnesses: emphysema, heart disease, diabetes, cancer. The more non-consuming people are brought into the system, the greater the pool of premiums/tax penalties -- and the lower the individual cost -- to offset the costs of the 5%. (And some day we are all likely to be part of that 5%.) That's exactly how insurance works.

[dgs49]

Good talking point. I've heard it before.

And just where are the doctors going to come from to treat tens of millions more people who will start going to their PCP's for "routine care" when it's "free"?

Oops.

Oh yeah, this new law is going to save a BUNDLE!