Obama signs the health care law (White House photo)

A sharply divided U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act, known also as “Obamacare.” 

In a 5-4 decision, Chief Justice John Roberts sided with the majority, including Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor. 

President Obama, speaking early this afternoon, said the ruling upheld the principle that illness and accident should not lead to a family's financial ruin. Obama said that whatever the politics, the decision was a victory for families across America.

"Insurance companies can no longer impose lifetime limits on the care you will receive," Obama said as he listed the benefits the measure provides to individual Americans. He said 26 million Americans under 26 have already benefited from the law by being able to stay on their parents' healthcare policy.

Obama reacts to the ruling from the East Room

He said the benefits "enjoy broad popular support" among middle-class families and said healthcare providers will no longer be able to "bill you into bankruptcy."

Obama said he knew the mandate would not be politically popular but said it was necessary to spread the cost of healthcare fairly among everyone. 

"It should be pretty clear by now I didn't do this because it was good politics. I did it because I thought it was good for the country," Obama said, referring to the vehement opposition the measure has aroused among conservatives.

The mandate

The majority found the individual mandate, considered the heart of the healthcare law, is permissible under Congress’s taxing authority. Writing for the majority Roberts held, “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."  

The mandate requires people to buy health insurance or pay a fine. 

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented. In his dissent, Kennedy said the entire act is “invalid” and should be repealed in its entirety.

In a joint statement, the dissenters said, "The act before us here exceeds federal power both in mandating the purchase of health insurance."

The ruling means implementation of the healthcare law can proceed as scheduled.

What it means

PhotoThe Supremes have spoken. The high court's ruling is the final word on the Affordable Healthcare Act. No further legal appeals challenging the constitutionality of the law are possible except in the most extrordinary circumstances, which means that only Congress can modify or repeal the law.

Mitt Romney has said that if elected President, he will "end Obamacare on Day One," although it is not clear how he would do that, since it is now the law of the land and the President does not have the authority to repeal laws passed by Congress.

The Supreme Court's decision -- whether you agree or disagree with it -- at least removes an air of uncertainty that has stymied healthcare organizations, hospitals, insurance companies, drugmakers, doctors and consumers. It has been difficult to plan intelligently for the future without knowing whether the law would remain in effect.

Effect on consumers

Most elements of the Health Care Act have not yet taken effect and will not do so until 2014, so today's ruling has little immediate effect on most consumers.

However, there are a few early provisions that are already in effect and that will remain so under today's ruling. They include:

  • Parents will still be able to keep their children on their insurance plans up to age 26.
  • Medicare recipients will continue to receive discounts on prescription drugs to close a gap in coverage known as the "doughnut hole."
  • New taxes and fees, including the 10% tax on tanning services, remain in place.

Pediatricians commend the Court

Robert W. Block

The American Academy of Pediatrics (AAP), which represents 60,000 pediatricians, commended the Court's decision. “Today, the Supreme Court upheld a law that invests in children’s health from the ground up,” said AAP President Robert W. Block, MD, FAAP.

“Pediatricians have already seen firsthand that health reform works,” said Dr. Block. “Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents’ plans. These are just a few of the law’s investments in child health, with many more set to take effect over the next few years as affirmed by today’s decision.”

The Academy endorsed the law in 2010 and filed three amici curiae (“friends of the court”) briefs to the Supreme Court in support of the Affordable Care Act’s Medicaid expansion, individual mandate and the mandate’s severability from the rest of the statute.

States react

Ken Cuccinelli
Colorado Attorney General John Suthers was one of the state attorneys general who oversaw the multistate case challenging the individual health insurance mandate. He called the decision "unexpected."

“The Court has approved the stick and not the carrot. Congress can now penalize individuals for refusing to buy a commercial product,” Suthers said.

Virginia Attorney General Ken Cuccinelli went even further and proclaimed it  “a dark day for the American people, the Constitution, and the rule of law.  This is a dark day for American liberty.”

“This decision goes against the very principle that America has a federal government of limited powers; a principle that the Founding Fathers clearly wrote into the Constitution, the supreme law of the land.  The Constitution was meant to restrict the power of government precisely for the purpose of protecting your liberty and mine from the overreaching hand of the federal government,” Cuccinelli said.

California Attorney General Kamala D. Harris, on the other hand, called it "a historic victory."

today issued the following statement regarding the U.S. Supreme Court’s decision on the Affordable Care Act:

“Today’s decision is a historic victory for Californians, for the President, and for the country. The Affordable Care Act repairs a healthcare system badly in need of reform and ensures that every American has access to affordable health care. We never doubted the constitutionality of this law, and it is already making a difference in the lives of millions of Californians,” she said.


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