Obamacare is now the law of the land

Demonstrators react to the Supreme Court landmark decision

Demonstrators react to the Supreme Court landmark decision on health care outside the court in Washington. (June 28, 2012) Photo Credit: AP

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The Supreme Court's historic decision finding Obamacare constitutional yesterday was a win for the nation -- and the deft way it sorted the explosive issues was a win for the court.

The partisan firefight over the Patient Protection and Affordable Care Act hasn't cooled in the 21/2 years since it became law in a close, party-line vote on Christmas Eve. Neither has the challenge of providing health care coverage for more people and containing medical spending. Obamacare's imperfections are well documented and troubling, but the law has advanced the struggle to solve problems that have vexed the nation for decades.

This work in progress needs improvements, particularly in corralling runaway costs. But if the court had overturned the law, the ambitious attempt to find solutions would have been lost. And any remaining faith that the government can actually solve big problems would have been abandoned.

Setting aside the politics, partisanship and unease about how the act will work, yesterday was a historic day. John Roberts, the Chief Justice -- who was appointed by Republican President George W. Bush -- joined the court's more liberal justices in a 5-4 decision that brilliantly preserved health care reform while limiting the government's power to intrude on individual liberty and to coerce states to act against their economic self-interest.

The court rejected the law's mandate that almost everyone buy health insurance. It was seen as an overreach beyond the power given to Congress over interstate economic activity through the Constitution's commerce clause.

"The framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it," the ruling said. Drawing that clear line may come to mark a significant turn away from the expansive view of congressional authority in this important arena, which the court has maintained for five decades.

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But while limiting Congress on commerce, the court recognized its power to tax. It upheld the penalty underlying the individual mandate by calling it what it is -- a tax triggered by not owning health insurance.

It will be paid by taxpayers without insurance when they file their returns. It doesn't apply to individuals who pay no federal income taxes because they earn less than the filing threshold. And the amount is determined by familiar factors such as income and the number of dependents.


When the bill was constructed, the Obama administration went to great lengths to avoid calling it a tax -- arguably the most toxic word in the English language these days. But the court isn't restrained by such political concerns. And because individuals have a choice -- buy insurance or pay the tax -- the Affordable Care Act won't actually force people to buy a consumer product they don't want.

Four million people a year will pay the IRS rather than an insurance company, according to an estimate from the nonpartisan Congressional Budget Office. That will blunt the law's impact in reducing the ranks of the uninsured. But many will choose to buy insurance instead of paying the IRS. Either way the result will be fewer free-riders who currently contribute nothing toward the cost of their care.

The court's decision to limit Washington's power to nudge states to expand Medicaid eligibility will also reduce the number of uninsured who get coverage. But it was the right call. The law gave the administration too much power in withholding existing federal Medicaid funding from states that opted out of the expansion -- amounting to more than 10 percent of many states' budgets. It crossed the line from encouragement to coercion.

The court's decision presents new challenges for policy-makers, but it appropriately left those challenges for Congress and the White House.

So the bitter political fight over how to reform health care is far from finished. Democrats and Republicans didn't even pause in their jousting yesterday. Republican presidential candidate Mitt Romney and Republican congressional leaders insisted they will still see the law repealed. But the court's ruling takes the question of its constitutionality off the table. Responsible elected officials should recognize that and temper their rhetoric.

By walking a fine line between penalties and taxes, encouragement and coercion, the court masterfully answered the constitutional questions raised by the law while steering clear of the brawling and election-year politics surrounding health care reform.

"Members of the court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation's elected leaders, who can be thrown out of office if the people disagree with them," Roberts wrote.

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Finely parsed, the ruling reveals that Roberts carved new limitations on the reach of the federal government while finding a clever way to give deference to Congress. Roberts struck the delicate balance needed in times of momentus questions to preserve the legitimacy of the judicial branch.


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