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High court upholds Affordable Care Act

Individual mandate survives as a tax; but ruling puts some apparent limits on Medicaid expansion

By Mike Shields | June 28, 2012

U.S. Supreme Court justices today upheld the controversial federal health reform law passed in 2010.

They said the Affordable Care Act's requirement that all people who can afford it purchase health insurance or pay a penalty, could remain intact as a tax. Many court observers had expected that provision to be struck down.

Kansas was among the 26 states that challenged the law's constitutionality, saying the individual mandate was overreaching and that the law's provisions expanding Medicaid coverage were coercive to states.


ACA Opinion

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State options for Medicaid

The court ruling, according to early analysis, limited the Medicaid expansion provisions but did not invalidate them.

According to an analysis of the decision released by the National Association of Medicaid Directors, the Medicaid expansions called for in the law are now optional for states.

"States will now have to make a series of decisions moving forward," said Matt Salo, the association's executive director. "Those include the political, fiscal, and policy calculations of whether or not this particular expansion makes sense. They will also have to factor in what may happen in the wake of the November elections, and (the U.S. Department of Health and Human Services) will assuredly have to promulgate guidance on the issue."

The projections are that 130,000 additional Kansans would become eligible for Medicaid under the law. The state currently has about 350,000 people directly benefiting from Medicaid services.

A member of Gov. Sam Brownback's administraton, speaking on background, said officials were still analyzing the decision but that it appeared it would make it difficult for states to not participate in the Medicaid expansion.

On the record, Brownback officials said they still wanted no part of "Obamacare" and "will take no action to implement it."


"This is now a political issue that will be decided by the American people in the November elections," said Sherriene Jones-Sontag, the governor's chief spokesperson.

Politics also was directly referenced in the opinion.

Chief Justice John Roberts was part of the 5-4 majority.

"It is not our job to protect the people from the consequences of their political choices," he wrote in the opinion.

Brownback, like many of his Republican counterparts in other states, insisted early on that his administration would take no steps to implement the law.

Last year, he returned a $31.5 million federal grant that would have helped the state develop a health insurance exchange. The exchanges, which the law calls for having in place nationwide by Jan. 1, 2014, are a major component of the law.

Brownback then said he would not implement any of the law until the court ruled. Now, it seems, that moratorium will continue in Kansas at least until the elections.

“I’m deeply disappointed in the Court’s decision. The era of big government lives on," said Kansas Attorney General Derek Schmidt, a Republican who also campaigned against the law.

But Schmidt said the ruling regarding the Medicaid expansion showed that the states' arguments against the law did not go completely ignored.

“The Supreme Court today flatly rejected the federal government’s unprecedented power grab under the Commerce Clause," he said in a prepared statement. "It also rejected the federal government’s effort to transform the Medicaid program from a federal-state partnership into a centralized program run by Washington, from Washington and solely for Washington. These legal rulings will benefit the long-term vigor of our federal system.”

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'Proud of our country'

Insurance Commissioner Sandy Praeger, a Republican who helped draft portions of the law on behalf of the National Association of Insurance Commissioners, praised the court's ruling.

“I’m proud of our country today, that we’ve made that kind of a statement about what our country ought to be doing for everyone,” she said. “I’ve said all along, it’s too bad it’s become so caught up in politics."

Praeger said leaving the law on the books will mean more Americans have access to affordable medical care.

“For the first time now, public policy in this country says everyone should have access to health care services and a means to pay for them," she said. "Don’t we think it’s right that people in this country have access to health care? Don’t we think there is a moral responsibility that you not be denied health care because you can’t pay for it?”

'Stopping Obamacare'

But other ranking Kansas Republicans said they would continue working to undo the law.

U.S. Sen. Pat Roberts said it will be the job of Congress to eliminate the Affordable Care Act.

“It’s now up to the Congress to repeal and replace this law with step by step, common-sense, cost-cutting solutions that work for Kansans and all Americans, and that’s what I will work to do in the Senate," he said in a prepared statement.

Brownback also issued a terse prepared statement: "Stopping ObamaCare is now in the hands of the American people," he said. "It begins with electing a new president this fall.”

Interest in the decision was so high that the U.S. Supreme Court blog (SCOTUSblog) doubled its staffing and added Internet servers to deal with the explosion of traffic to the website. At 10 a.m. Eastern time the site had 344,000 simultaneous readers, more than double the normal traffic. That swelled to 866,000 readers by 10:22 a.m. Eastern time, shortly after justices began describing the majority opinion.

Staff writer Jim McLean contributed to this story.

Previous coverage of health reform and the Supreme Court

Anticipating the Supreme Court's ruling

Supreme Court to rule Thursday on health care reform
New consumer protections depend on high court's ruling
Court challenge could result in Medicaid cutbacks instead of expansion
GOP promises smaller-scale health care agenda if court strikes down law
Some health system changes will stay, no matter how Supreme Court rules
Obama administration finds 3.1M young adults gained coverage under law
What's at stake for Medicare beneficiaries in health reform ruling
What's at stake for women if health law overturned
Washburn law professor holding to prediction that health reform law will be upheld
Even without the individual mandate, health law would still affect millions

The Great Health Reform Debate: Kansas experts weigh in
"The system we have in this country is a failure because people do not have equal access to care," said retired Stormont-Vail HealthCare CEO Maynard Oliverius. He is one of six Kansas experts who weigh in on the health reform debate ahead of the Supreme Court's ruling on the law.
Watch the six video shorts here.

Oral arguments before the Supreme Court

Day 1 — Anti-Injunction Act
Guide to what happened at the Supreme Court
Day 2 — Individual Mandate
Kansas AG Schmidt encouraged by justices' skepticism of health reform law
Justices grill Obama administration on health law
National media round-up
Day 3 — Medicaid Expansion and Severability
Vigorous severability, Medicaid questions

Preview to the Supreme Court oral arguments

Schmidt’s pledge to join ACA challenge bolstered candidacy
Full interview: Derek Schmidt on the legal challenge of the health reform law
The Health Law and the Supreme Court: A primer for the upcoming oral arguments
Video explainer: The health care reform challenge before the Supreme Court

Related coverage

Kansas rejects $31.5 million for insurance exchange

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