Opinion

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The much-anticipated Supreme Court decision to uphold the entirety of the individual mandate and most of the Medicaid expansion central to the Patient Protection and Affordable Care Act, moves our country closer to solving one of our most pressing social and economic problems — health care — and is a significant public health victory. 
 Today's historic decision maintains the momentum already under way across the country to reform our health care system by changing the way we deliver and finance health care services so that we can improve the health of our population. With this decision, the&nbsp;United States falls in line with the rest of the industrialized world — and many developing countries — in recognizing the importance of increasing access to health care for all citizens. 
 Some specifics: The individual mandate has been upheld as a tax rather than a legal mandate to purchase something. Those who do not purchase health insurance will have to pay more in taxes starting in 2014. The goal of this tax is to encourage people who do not have insurance (but still use the health system inefficiently, for example by going to the emergency room for nonemergent issues) to purchase insurance, pay regular premiums and use more appropriate levels of care. 
 More affordable insurance plans will be available, fewer restrictions on eligibility will be&nbsp;allowed, and subsidies will be provided for those who cannot afford health insurance.&nbsp; 
 This strategy — with both economic and social underpinnings — will reduce the numbers of uninsured, bring people into care sooner, improve health outcomes and use resources more efficiently. 
 It's true that concerns remain regarding how effective the tax for not purchasing health insurance will be on bringing people into the system. However, while there may be some within the coveted "young and healthy" (i.e., less costly) group that will opt to pay the tax instead of purchasing health insurance, we shouldn't minimize the power of the law to encourage people to do the right thing. Furthermore, we can look with hope at the experience of Massachusetts, where the rate of uninsurance fell dramatically following the passage of their individual mandate. 
 Allowing the federal government to move forward with the Medicaid expansion will increase access to care to millions of vulnerable people with incomes above the poverty line; however, the Supreme Court also ruled that states choosing not to participate in the expansion cannot be penalized. While states certainly need autonomy to make budgetary decisions that are reflective of their individual situations, this decision will exacerbate already wide state-by-state variations in Medicaid coverage. 
 Overall, today's ruling by the Supreme Court keeps health care reform on solid ground, and moves us closer to a more rationale, viable, efficient and effective health care system. 
 Corinne Kyriacou, PhD, is an associate professor and director of the master of public health program at Hofstra University in Hempstead. &nbsp;

Kyriacou: Big victory for public health

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It is impossible to tell what impact today's Supreme Court decision on the Affordable Care Act will have on the presidential election. But it is not too early to say what the ruling means for patients and providers. This decision affirms the constitutionality of single most important piece of social legislation since the passage of Medicaid and Medicare nearly half a century ago. 
 As commentator Jonathan Alter tweeted, "We have ended discrimination against sick people in our time." 
 Today's ruling, while potentially limiting the expansion of the Medicaid program, does clear the way for the creation of state-level health insurance exchanges. These exchanges will expand partially subsidized insurance coverage and fix the individual and small group insurance markets, the markets that -- until now -- were fatally compromised by adverse selection and uncontrolled insurance costs. 
 But in many respects, the court's decision simply amplifies the momentum that has already gathered behind the fundamental reform of the American health care-delivery system. Reform efforts all across the country are transforming hospitals like the Nassau University Medical Center, the hospital which I run. 
 Such efforts are essential if we, as Americans, are going to obtain the best possible outcomes at costs that we, and future generations, can afford. So in the coming years, I expect that my hospital will get smaller, it will emphasize community-based primary care instead of inpatient services, it will partner with other providers to manage the care of vulnerable populations, it will be integrated clinically with the North Shore-Long Island Jewish Health System, and it will be committed to "bending the cost curve" by improving, each and every day, the quality of care it delivers to its patients. 
 Today's ruling means these reforms can continue at their already staggering pace, assured of needed federal financial support and, now, with the welcomed imprimatur of the Supreme Court. 
 Arthur A. Gianelli is president and chief executive officer, NuHealth, operator of the Nassau University Medical Center in East Meadow.

Gianelli: Health care ruling is progress for patients, providers

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The Affordable Care Act has lots of good things in it — and three really good things: It allows young people to be covered on parents’ policies until the age of 26, it prevents insurers from denying coverage to people with pre-exisiting conditions, and it would have allowed expansion of Medicaid coverage for state-based coverage of the poor. 
 Today’s Supreme Court ruling means the first two of those provisions will stand, but before the rejoicing starts, I see a few potential downsides: 
 Chief Justice Roberts’ opinion questions whether the federal government can require states to expand Medicaid coverage. This presents a question mark about whether the health care law will really give coverage to the poor. And Roberts' opinion is based not on what everyone expected -- the Commerce Clause -- but instead on Congress's power to levy taxes. 
 So, another question mark for me is this: Is it OK for the federal government — instead of providing insurance itself — to say that you, citizen Jane Doe, must pay a private company for insurance? 
 My fellow public health professionals will share my relief about the two plusses above, but some will continue to be disappointed that we don’t have some kind of federally organized single-payer coverage. I would like to see what my colleagues in the public health profession say about the late, lamented "public option." And what’s going to happen with Medicaid. 
 Philip Alcabes, PhD, is an epidemiologist, professor in the School of Nursing, and director of public health program at Adelphi University, Garden City.

Alcabes: Medicaid limit could jeopardize coverage of the poor

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Bringing this issue to the Supreme Court has never really been about health care, but rather about politics. Hopefully, the debate and focus can now shift to what the Affordable Care Act will actually mean to employers, health care providers, insurers and consumers. Although I suspect much of this will be held in abeyance until after the November elections, I can't think of a more pressing issue and one that needs to be a lot less politicized. 
 Amy J. Allen is managing director for advocacy and international business of the Westchester County Association, a not-for-profit member group&nbsp;that focuses on&nbsp;economic development, public policy issues&nbsp;and reforms

Allen: Move health care focus to employers, providers, consumers

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At a point at which the majority of the American people had come to view the Supreme Court as just another partisan battleground, Chief Justice Roberts' decision to cross party lines and uphold the constitutionality of the Affordable Care Act is an important step to restoring the court's credibility as an institution. 
 In addition, Roberts' opinion decides the issue before the court on the narrowest ground possible, thus adhering to the important legal principle of judicial restraint and deference to the elected branches of government. 
 Chief Justice Roberts’ decision to show judicial restraint is eerily similar to the decision made by another Justice Roberts during President Franklin D. Roosevelt’s administration. Before 1937, the Supreme Court’s conservative majority had struck down numerous parts of the New Deal, 5 to 4. In 1937, exactly 75 years ago, in a case called West Coast Hotel v. Parrish, one of those five conservatives, Justice Owen Roberts, began to vote with the four more liberal members of the Court and upheld challenged New Deal programs from that point on. 
 Justice Owen Roberts' seeming shift was called the “Switch in Time that Saved Nine.” Chief Justice John Roberts, in 2012, has saved The Nine again. Thomas Lilly Jr. is assistant professor of the Department of Politics, Economics and Law at SUNY Old Westbury. Carolyn Cocca is the department's chair. &nbsp;

Lilly, Cocca: Chief Justice Roberts follows another Justice Roberts

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I am pleased to see the Supreme Court ruling as the key part of this act was insurance reform to protect patients. That this will be preserved is good. Real health care reform will come from the innovators in the provider community, not government mandates. This will move forward based on creative health systems, not regulations. Dr. Lawrence Smith is dean of the&nbsp;Hofstra North Shore-LIJ School of Medicine and executive vice president and physician-in-chief of the&nbsp;North Shore-LIJ Health System.

Smith: Provider innovation, not government, will reform health care

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In a surprising and complicated decision, the U.S. Supreme Court upheld the individual mandate that was the central part of the Obama administration’s health care overhaul as within Congress's taxing authority. In passing the bill, the administration had labeled the monetary punishment a penalty, not a tax. 
 As the scope of the taxing power is significantly greater than the substantial but not limitless scope of the Commerce Clause, the Supreme Court majority gave the administration the benefit of the doubt. Conservatives around the country will be very upset that Chief Justice John Roberts joined the court’s liberals on this point. 
 The court's complicated opinion did find that the Affordable Care Act is beyond the court's commerce clause authority, but because it is within Congress's taxing authority, the commerce problem does not matter. 
 The act is not only invalid in terms of the commerce clause, it is not even valid as a "necessary and proper" means of regulating commerce. 
 The act is likely to persevere even if Mitt Romney wins in November. The Republicans will remain in control of the House, but even if they take the Senate, they won't have the 60 votes needed to break a Democratic filibuster. Once people start getting the benefits of the Affordable Care Act, it will become nearly impossible to revoke. 
 Jeffrey Segal is chairman of the Department of Political Science and professor at Stony Brook University and a recent Guggenheim fellow.

Segal: Court gives Obama benefit of the doubt

Segal: Supreme Court gives Obama benefit of the doubt

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