US Supreme Court upholds healthcare reform law


Obama: "A victory for people all over this country"

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The US Supreme Court has said President Barack Obama's landmark healthcare reform act is constitutional.

The court upheld a core requirement known as the "individual mandate" that Americans buy insurance or pay a fine.

Of the nine justices on the bench, Chief Justice John Roberts' vote was decisive in the Supreme Court's 5-4 ruling in favour of the law.

The ruling comes months before the US election, with Republicans vowing to push for a repeal of the bill.

Healthcare is a deeply polarising issue in the US and Republicans strongly opposed Mr Obama's legislation.

Start Quote

In our view, the entire Act before us is invalid in its entirety”

End Quote Justice Anthony Kennedy Dissenting opinion

The state of Florida, along with 12 other states, filed a legal challenge to the bill minutes after Mr Obama signed The Patient Protection and Affordable Care Act (ACA) into law in March 2010.

They were later joined by 13 more states, the National Federation of Independent Businesses and several individuals.

'Implement and improve'

Speaking afterwards, President Obama called the court's decision a victory for the country, saying people would not need to "hang their fortunes on chance" or fear financial ruin if they became sick.

"The highest court in the land has now spoken. We will continue to implement this law and we'll work together to improve on it where we can," Mr Obama said, speaking at the White House.

"What we won't do - what the country can't afford to do - is re-fight the political battles of two years ago or go back to the way things were. With today's announcement, it's time for us to move forward.

This ruling means President Obama avoids a humiliating shellacking and does not have to make a near impossible decision about how to replace an eviscerated law. He can wipe his brow and breath a huge sigh of relief. But that does not mean it is bad news for Mitt Romney. The only way to get rid of the law is to elect him. He now has a cause that not only fires up his supporters but may also appeal to all important swing voters. It is, as he has said, a choice.

"We will be better off because we had the courage to pass this law," Mr Obama added.

Republican presidential candidate Mitt Romney said the healthcare bill was "bad law yesterday, it's bad law today".

"This is a time of choice for the American people. If we're going to get rid of Obamacare we're going to have to replace President Obama. My mission is to make sure we do exactly that."

He called "Obamacare" a tax rise that would add to the national debt, a "job-killer", and said it would put the federal government "between you and your doctor".

Congressional leaders also responded quickly to the verdict. Senate Minority Leader Mitch McConnell, a Republican, said: "We've passed plenty of terrible laws around here that were constitutional."

On the Senate floor, he said the only way to fix the law was "full repeal".

Meanwhile, the Senate's Democratic majority leader, Harry Reid, disagreed: "Now that this matter is settled, let's move on to other things. Like jobs."

'Triggering a tax'

The mandate was eventually upheld by the justices, citing the taxation powers granted to Congress by the US constitution.

Who's uninsured?
  • Who's uninsured?
  • Nearly 50 million, or 16.3% of Americans are uninsured
  • By ethnicity, the rate of those who lack insurance is
  • 15.4% White
  • 20.8% Black
  • 18.1% Asian
  • 30.7% Hispanic
  • Source: US Census Bureau

Chief Justice Roberts said: "We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation's elected leaders.

"We ask only whether Congress has the power under the Constitution to enact the challenged provisions."

A majority of justices agreed that the penalty individuals must pay if they refuse to buy health insurance falls within Congress' power to levy taxes, upholding the "individual mandate".

"The mandate can be regarded as establishing a condition - not owning health insurance - that triggers a tax - the required payment to IRS," Justice Roberts wrote.

The government's main argument was that the law was legal under Congress' ability to regulate "interstate commerce" - but a majority of justices did not agree with this view.

Four dissenting justices said that limits on the power of Congress to regulate commerce and raise taxes "cannot be such as will enable the Federal Government to regulate all private conduct and to compel the States to function as administrators of federal programs."

"That clear principle carries the day here," they added.

In an opinion written by Justice Anthony Kennedy, the dissenting justices went further, to say: "In our view, the entire Act before us is invalid in its entirety."

Medicare clause limited

While the court described the penalty as a tax, it did not invoke a law that could have prevented the justices from ruling on the case.

Healthcare verdict

  • Individual mandate upheld
  • Expansion of Medicaid limited but not struck down
  • Five justices voted to uphold the law: John Roberts (chief justice), Ruth Bader Ginsburg, Elena Kagan, Sonia Sotomayor, Stephen Breyer
  • Four justices dissented: Antonin Scalia, Anthony Kennedy, Clarence Thomas, Samuel Alito

Under a law called the Anti-Injunction Act, taxes cannot be legally challenged until after they have been levied. This could have delayed a verdict till 2015 - after the "individual mandate" comes into effect and the first round of penalties have been paid.

They were also not required to rule on the issue of "severability", which would determine whether other parts of the healthcare law could stand even if the mandate was struck down.

In addition to the individual mandate, the Supreme Court was asked to consider another part of the law that deals with the expansion of Medicaid, a government healthcare programme for low-income citizens.

The court ruled to limit that provision but did not strike it down altogether, saying Congress could place conditions on the use of federal funds.

"What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding," the Supreme Court's opinion said.

Some hospital and health insurance stocks were trading higher in the wake of the Supreme Court's ruling.

The rising cost of healthcare over 50 years, 1960-2010
  • By 1960, in GDP terms, American spending on health was
  • 5%
  • By 2010 it was
  • 18%
  • Medicare was
  • 4%
  • and Medicaid was
  • 3%

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  • rate this

    Comment number 515.

    505. scirop

    Why are there thousands of starving poor living in makeshift housing with no medical care what so ever.

    The poor are covered by Medicaid, complete medical coverage. They also get Welfare and housing assistance. You should really educate yourself.

  • rate this

    Comment number 514.

    You don't have to be a bigot to be Tea Party
    but if you check their pictures the bigots are a tea party pimpers paradise
    so many old racists
    @ Eddy from Waring 434 and others might learn from this insightful and brilliant analysis of US politics and reponse to Obamacare. See how the race slur replaces rational thought. All opponents must be TP racists. Stands to reason innit?

  • rate this

    Comment number 513.


    P.S. Why do think your PM wants to reform NHS?"

    because he is a sociopath.

  • rate this

    Comment number 512.

    1/3 of all Charitable donations in America go towards building new facilities for Worship/Health/Education. The top 10% of the rich give vasts amounts to make sure their name is granted to the new Wing of a Hospital or a new Library at a University that only caters to the top 10%.
    Per capita, America is the best at charity. But the actual charities themselves do not help the poor.

  • rate this

    Comment number 511.

    @505 - Those people in the slums of the US get better medical care than I do - and I have insurance. Insurance does not equal care. Insurance is just a deadweight loss on the system. Forcing people to buy it does not improve care or service availability.

    Charity to be truly charitable must be a wholly voluntary act, otherwise it breeds resentment towards the recipients by those forced to give.

  • rate this

    Comment number 510.

    506.powermeerkat - ".....Do you consider UK an affluent nation these days?......"

    You really ought to do your reserach before gobbing off - the poorest person alive in Britain today is one of the world's richest 20% of people.

    Is Britain an afflunet nation? YES, it most definately is.....

  • rate this

    Comment number 509.

    ..most americans Dont want this.
    ..oh! and the drug Company will make a LOT of money out of this.

    Let me re-phrase this:
    Most Reublican Americans don't want this, the rest of the population does.
    Both Drug and Insurance Companies have in the past and already do now, make a lot of money out healthcare.

  • rate this

    Comment number 508.

    506 "P.S. Why do think your PM wants to reform NHS?"
    Did Rupert and Neo Con Health Lobbies ask him to
    Did Fox News tell you about it
    Did you have Lunch with Fat Dave at 10 for £25,000 US Style Politics

  • rate this

    Comment number 507.

    491. Adam

    Merlin from London

    A civilised society doesn't necessarily need the state to provide healthcare, but rather to make sure that citizens have access to healthcare.

    And I dare you to find any quote in which Mitt Romney says he disagrees with that.
    Romney has quite reasonable views if one looks more deeply than the soundbites used in a political battle. I hope he wins.

  • rate this

    Comment number 506.

    487.Merlin from London

    "USA welcome to the civilised world in which affluent nations provide healthcare for all citizens, rich or poor."

    Do you consider UK an affluent nation these days?

    Or perhaps Spain or Italy?

    Even the richest EU country, Germany, has increased retirement age and is gradually limiting its social benefits.

    P.S. Why do think your PM wants to reform NHS?

  • rate this

    Comment number 505.

    If Americas are so good at given charity, why is it everytime I visit my American relatives, we have to drive through areas that can only be called Shanty Towns to get to their gated rich community.
    Charity begins at home, America being your home. Why are there thousands of starving poor living in makeshift housing with no medical care what so ever.

  • rate this

    Comment number 504.

    I saw figures last year, that suggested that if the US adopted a national health service like approach, it would actually cost less per capita than a system that leaves 50m uncovered. You would think that Republicans would approve of that on savings grounds if its true. As it is, their reliance on wholly private healthcare actually drives the costs up.

  • rate this

    Comment number 503.

    Those blasting this court opinion often talk about how "people may lose the health insurance currently provided by their employer".... like the insurance provided by employers is FREE! Employess PURCHASE health insurance through their employers. Businesses should be THRILLED to not have to provide insurance... they don't belong in that business anyway!

  • rate this

    Comment number 502.

    Remember that it's easy to say that poor people get a free ride. But then so does a rich landlord.

    Capitalism is great but some core things in life should be nationalised like energy, railways, and especially the health service.

    Obama means well. He's better than anyone we have here in the UK. It must be hard for him having to fight off the banking mafia and turkey shooters at every corner.

  • rate this

    Comment number 501.

    434.Eddy from Waring
    "...The US need socialism..."
    I think that's about as silly a caricature, of one side of the discussion, as any I've seen.
    @ Yes a caricature which exposes much background thinking about this complex issue. But do you really expect anything other than silly in our moderated HYS? See my full comment, step out of the limits here, and discuss.

  • rate this

    Comment number 500.

    You don't have to be a bigot to be Tea Party
    but if you check their pictures the bigots are a tea party pimpers paradise
    so many old racists

  • rate this

    Comment number 499.

    The law doesn't cover illegal aliens, so the taxpayers will still be paying for all of their medical costs, and states will still be heading towards insolvency due to this extreme cost, and the federal government refuses to enforce its own immigration laws, but no doubt will go after, with zeal, any citizen or someone who is legally present in the country for not purchasing health insurance.

  • rate this

    Comment number 498.

    130. MidwesternSue "You don't have to be a bigot to dislike Obama".
    No you don't, and I'm tired of lazy liberals pulling out the race card and beating those who disagree with his POLICIES with it.

    12.TokyoMoscowSeoul "the US need an American NHS"
    The NHS is fine unless you're fat, in which case it doesn't matter how much you've paid in over the years: you'll get treated like dirt, if at all.

  • rate this

    Comment number 497.

    Fortunately we do not face health care rationing as in the capitalist USA. It is all fair and civilised here, no death panels, no discrimination. Just cost benefit assessment which is fair and replaces ethical discussion.

  • rate this

    Comment number 496.

    This is nothing but paying back a huge lobby for political endorsement. I have heard nothing about cost regulation, improved care, or better service. The only thing I hear is more taxes, fat insurance companies that fill the pockets of politicans. We will all lose as long as the lobby controls the Country.


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