The U.S. Supreme Court handed down one of the most anticipated decisions in decades with its ruling on Affordable Care Act (ACA) Thursday.
Justices upheld the law's requirement that most Americans have health insurance however its reasoning is complicated. Read the full opinion here
The 5-4 ruling covers six opinions totaling 187 pages. As a result, the analysis has been slow and, at times, confusing.
Chief Justice John Roberts wrote that the individual mandate cannot be upheld under the commerce clause however Congress can require the purchase of health care insurance under its taxing authority.
Beginning Jan. 1, 2014, Americans must purchase health insurance or pay a penalty - $95 per individual to $285 per family or one percent of their annual income, whatever is greater.
The penalty will be paid to the government in the same way federal income taxes are paid and collected, the opinion read.
But this won't necessarily result in more people buying insurance, said Dr. Robert Seidman, associate professor in San Diego State University's Graduate School of Public Health and head of its division of health management and policy.
"It begs the question: is the penalty enough to induce people to buy insurance? It’s so low that people might pay the penalty instead of insurance. From a financial perspective, you might actually save money by paying the penalty, just as long as you don't get really sick," Seidman said.
Failing to get enough people to buy insurance, rather than paying the penalty may have adverse effects, he said.
“This decision has shifted the loaded gun from states to taxpayers. When people don’t have insurance but still seek medical care, people who buy insurance will have to reimburse them, perhaps through higher premiums.”
The SoCal Tax Revolt Coalition (SCTRC) , an organization that describes itself as the largest Tea Party group in the San Diego area, issued a statement from its leaders condemning the ruling.
"Today is the day American liberty died. I am in shock that the Supreme Court upheld this huge expansion of government overreach," Dawn Wildman, President of SCTRC said in a prepared statement.
Wildman added that she believes the ruling will "energize the base and makes November far more important than yesterday."
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Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced.
The Associated Press put together this list of provisions still intact:
- Young adults can stay on their parents' insurance up to age 26.
- Insurers can't deny coverage to children with health problems.
- Limits on how much policies will pay out to each person over a lifetime are eliminated.
- Hundreds of people already are saving money through improved Medicare prescription benefits for those over 65.
- And co-payments for preventive care for all ages have been eliminated.
However, the ruling put some limits on the law's plan to expand the Medicaid insurance program for the poor, a joint effort of the federal government and states.
Chief Justice Roberts wrote in his opinion that Congress cannot cut off funds to states if they decide not to extend Medicaid to the increasing number of patients who will qualify for the benefits. This means states may have to foot the bill for a higher number of Medicaid patients.
In an interview with reporters Thursday morning, U.S. Rep. and Minority Leader Nancy Pelosi (D-CA) said she is not concerned about the extra patients the state will take on after the policy is implemented. California has already begun implementing parts of the health care overhaul law already, including the beginnings of health care exchanges.
The state also has banned insurers from refusing coverage for children with pre-existing illnesses and allowed young adults to stay on their parents' plans through age 26.
California passed its own state legislation to ensure those measures are preserved even if the federal law is thrown out.
But that doesn't mean the state is unaffected by Thursday's ruling. As one of the law's biggest financial beneficiaries, it stands to gain as much as $15 billion annually in federal money for health programs.
The decision is good news for medical providers who offer charity care to the uninsured according to California Insurance Commissioner Dave Jones.
Giving the uninsured access to preventative care and keeping them out of emergency rooms will help the system, Jones said.
He also said the charity caregivers will be compensated for the care they provide under the Affordable Care Act.
Locals heard about the ruling Thursday morning and responded with mixed feelings. On one hand, the decision was cut-and-dry, said resident Jim Partridge.
"I'm glad to hear that the Supreme Court made the decision that will help a lot of people have affordable healthcare," he said. “It's a fundamental right that I think every American should have."
But on the other hand, the ruling worries some, who believe the policy is dangerous territory.
"I'm very upset," said resident Camille Pekarek. "I think that this is an incredible precedent for potentially unlimited power for the government. And I don't think that they should for all people to purchase things that we don't want to purchase."
Many who spoke with NBC 7 San Diego said they really could not pinpoint how the historic decision might help or hurt the campaigns of President Barack Obama or Mitt Romney. All but one person said this ruling does not make them want to vote for one candidate over another.
Among the early reaction:
"While the Supreme Court has upheld the Affordable Care Act as constitutional, it does not address the basic the factors that drive up the cost of care, namely, excessive litigation by trial lawyers and protectionist policies that do not promote competition in the insurance industry. These are a few issues we need to tackle if we are going to truly lower the cost of care for all Americans,” U.S. Rep. Brian Bilbray (R-CA)
“As nurses and health care professionals we would never turn away from a sick patient. This act makes that bedrock moral stance the law of the land by preventing insurers from turning away Americans with pre-existing conditions from their coverage,” said Ken Deitz, RN, President of The United Nurses Associations of California/Union of Health Care Professionals. “Nowhere does that mean more than here in California, where more residents are denied coverage for pre-existing conditions than in any other state.”
“This is a critical opportunity to provide local families more purchasing power and affirm that lack of access to health care will no longer be a barrier to success,” San Diego Labor Council Secretary-Treasurer/CEO Lorena Gonzalez said in a written statement. “It's now up to our state legislature to make sure that these programs are implemented in the best way possible.”
"The court’s decision is alarming and deeply wrong. ObamaCare holds your health care hostage and offers no real choice," said Steven H. Aden, counsel for the Arizona- based Alliance Defense Fund.
“The ACA has hospitals and providers looking at ways to deliver better and more affordable health care services. When fully implemented, the ACA will help Americans who can’t afford insurance with credits to cover premium costs," Rep. Susan Davis (D-CA).
The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome. Conservative Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented. View a scorecard on the opinion here.