WBUR’s Martha Bebinger reports that the U.S. Supreme Court’s 5-4 decision to uphold the Affordable Care Act won’t have much impact in Massachusetts, where many of its provisions are already under way as part of the state’s own health law, signed by then-Gov. Mitt Romney. Still, the political and long-term implications of today’s court ruling are huge. Here are some early reactions:
Prof. Kevin Outterson, co-director of the health law program at Boston University, offers a powerful metaphor to sum up what the court did legally. He says that Obamacare was dancing on a tightrope by arguing that Congress had the power to impose insurance under the “Commerce clause,” and it fell off. But to everyone’s surprise, Chief Justice John Roberts ended up holding a net.
Prof. Outterson says:
“Obamacare was dancing on a high wire, which was the commerce clause, and they fell off — losing that vote 5 to 4 — but we were surprised to find a taxing power net manned by Chief Justice Roberts that saved the entire ACA. The other four conservative justices made it clear as a bell that if they had prevailed on the individual mandate, they would have struck down every word of the ACA.
On the Medicaid issue, a strong majority of 7 Justices said the Medicaid expansion was unconstitutional if HHS threatened states with the loss of existing Medicaid funds for non-compliance. But Roberts, Breyer and Kagan saved Title II by interpreting the statute narrowly to give states a choice: whether they accept the Medicaid expansion or not, all existing funds are safe. I call this the “Red State Veto.”
Here’s Mitt Romney on CSPAN setting the stage for the election: “Our mission is clear. If we want to get rid of Obamacare, we’re going to have to replace President Obama. My mission is to make sure we do exactly that.” And once again, calling for repeal of the ACA: “Perhaps most troubling of all,” Romney said. “Obamacare puts the government between you and your doctor…”
Here’s a statement from Massachusetts Medical Society President Richard Aghababian, M.D.:
“Physicians in Massachusetts have been strong supporters of our state health reform movement from the beginning. Universal coverage has been better for our patients, and it’s been better for the practice of medicine. When people have insurance, they are more likely to get the care they need, when they need it.
They are also more likely to discuss preventive care measures with their doctor … and that may le`d to longer and healthier lives. And when the public’s health is good, society is more productive, the economy is vibrant, and the social fabric of the community is as strong as it can be.
That’s why is we are so pleased that the ACA was upheld. Universal coverage is a state-federal partnership – no state can do this on its own. We’ve accomplished a great deal since 2006 – and there’s still a lot of work to do. Affordability is still a big challenge. We promise to work with the Governor, legislators, and the leaders of the health care community to ensure that the noble vision of our health reform law is fulfilled for many years to come.”
Here’s an emailed quote from Steve Ryan, partner and head of the Government Strategies practice at McDermott Will & Emery:
“It is now clear that the long rows of anonymous Democratic congressional dead (63 in the house and 6 in the Senate) who laid down their seats in the 2010 election for the President’s health care bill did not lose their careers in vain.”
And this, from the Greater Boston Interfaith Organization:
Today the Greater Boston Interfaith Organization issued the following statement in response to the United States Supreme Court’s decision to uphold the Affordable Care Act. A key consumer advocacy group behind the passage of healthcare reform in Massachusetts, GBIO is part of a coalition of multi-faith consumer advocacy organizations fighting for reform on behalf of low- and moderate-income people in states nationwide, including Wisconsin and Illinois.
“We’re elated. The court’s ruling is a milestone victory for people across the United States. Some 30 million low– to moderate-income people will now get their health insurance. Young adults will be able to stay on their parents’ insurance. Individuals with pre-existing conditions cannot be denied coverage. Small businesses will get their tax credit to provide insurance to their workers.
This ruling ends the constitutional debate around healthcare reform, and it should end the rancorous political debate as well. It’s time to move forward with reform and put people before politics. The health of our nation is more important than the health of political parties and political careers.
Healthcare is about people. Now that the court has ruled, it’s time to put the focus back where it belongs – on the people who need healthcare in this country. There are millions of real people and real small businesses who can tell you what healthcare means to them on the ground, where it counts, in their everyday lives.
This ruling has been treated like a sporting event, but healthcare reform is no game to Americans whose health is at risk. The President, Congress, and the states should work swiftly and decisively to implement this decision on behalf of the people they represent. Healthcare is and should always be an issue that transcends partisanship.”
Here’s the statement from Andrew Dreyfus, President and CEO of Blue Cross Blue Shield of Massachusetts:
“Today’s ruling is a validation of decades of work here in Massachusetts to expand health care coverage to all of our citizens. All Americans will now have the same health care benefits and protections that Massachusetts residents have known for years. In addition, this decision will preserve hundreds of millions of dollars per year in federal funding for Massachusetts health reform.
We also know that expanding health care coverage alone is not enough. As we’ve learned in the six years since our reform law passed, the coverage must also be affordable. Now is the time to roll up our sleeves and recommit ourselves to the community’s shared goal of making quality health care both accessible and affordable for the people and employers of Massachusetts.”
When WBUR’s Kathleen Mcnerney asked Dreyfus how the decision felt on a personal level, he responded:
“It’s really an extraordinary moment, having spent a lot of time with a lot of very good people in massachusetts years ago trying to get the public and our political leaders to understand this is something we could achieve, that it was doable here in massachusetts. it’s just an extraordinary moment and a moment of validation to see the supreme court uphold a law that was passed by congress and to know that we played a small part, here in massachusetts, in creating a model that is now going to be applied nationally.”
This comes from Paula Johnson, MD, MPH, Executive Director, Connors Center for Women’s Health and Gender Biology
Chief, Division of Women’s Health at Brigham and Women’s Hospital:
I am overjoyed with the Supreme Court’s historic decision to uphold the Affordable Care Act (ACA) as it is a major victory for the health and equality of our nation’s women. Now, women throughout the country will have access to secure, comprehensive healthcare across their lifetimes, a benefit women in Massachusetts have enjoyed under state reform.
This decision means that women cannot be denied coverage due to a pre-existing condition such as pregnancy, women will no longer be charged more than men for the same insurance or lose coverage when they get sick. As a member of the Institute of Medicine’s Committee on Preventive Services for Women, I am particularly pleased that women will maintain access to the essential no-cost preventive services, including mammograms and screenings for cervical cancer that keep them healthy and improve the quality of their lives and the lives of their families.
Today as we pause to celebrate this monumental win for women’s health, we also call on the states to recognize the integral role they play as health reform moves forward. Women’s health is a major determinant of the health of future generations and communities, and women are 51% of the nation’s population. States must recognize issues affecting women’s coverage, affordability and access to health care in order to implement robust systems of care that work for all women and the nation.
Here’s Sen. Scott Brown:
“The federal health care law may be constitutional, but it is wrong for jobs and the economy. In Massachusetts, we had already dealt responsibly with the problem of our uninsured without raising taxes or cutting care to our seniors. All we got out of this massive new federal entitlement is higher taxes, cuts in Medicare and additional debt at a time when we can least afford it. The bottom line for me is this law makes it harder for our economy to add jobs and for that reason I continue to oppose it.”
And from House Speaker Robert DeLeo:
“I welcome today’s United States Supreme Court decision upholding the Patient Protection and Affordable Care Act. This historic opinion memorializes on a federal level what we are already doing here in Massachusetts – providing access to healthcare to all of our citizens. Accordingly, we will continue our work on health care reform, leading the nation as we collectively curb health care costs and deliver coverage to our residents. As all of the implications of today’s ruling become clear, I am hopeful that the federal government will maintain its fiscal partnership with our efforts.”
And here, for the truly hardcore, are even more:
Rep. Richard Neal:
“As a senior member of the House Ways and Means Committee, I worked closely with President Obama as he drafted the landmark Affordable Care Act, and I can tell you we are on the right path toward universal care for all Americans. I applaud the Supreme Court for agreeing with Democratic leaders that children should not be denied health care because they were born with Diabetes; working families should not face bankruptcy because of medical bills; young adults should not be denied a safety net; women’s preventative health measures should not be sacrificed; seniors should not decide between buying medicine or putting food on the table.
“I am committed to providing health care to tens of millions of hard working families, small businesses, young adults, senior citizens, people with disabilities, and preventative care for women.
“The Supreme Court correctly understood in order to achieve universal health care everyone needs to buy-in; this is why my fellow Democratic leaders and I, along with President Obama, included the individual mandate in the Affordable Care Act. In fact, we must all remember the individual mandate was a Republican idea that was supported by the Heritage Foundation.
“As Democrats, we fought for the historic Affordable Care Act and I am proud to say I spoke on the floor of the House of Representatives in favor of expanding health care coverage.”
Rep. John Tierney:
Today, the Supreme Court upheld the Patient Protection and Affordable Care Act (PPACA). They ruled that the health care reform law passed in 2010 was constitutional.
“Middle-class Americans from across both the 6th District and the country have already seen some of the benefits of Healthcare reform. The Supreme Court has protected the numerous rules that help middle class families get the affordable coverage they deserve, and has put them in charge of their health care, not insurance companies. The law is now helping small businesses afford health insurance for their employees. Millions of middle-class families will continue to be helped by the court’s ruling.”
Statement of Lora Pellegrini, President and CEO, Massachusetts Association of Health Plans:
“We are pleased that the Supreme Court has upheld the constitutionality of the Affordable Care Act.
“Massachusetts is home to the country’s top-rated health plans for clinical quality and member satisfaction. Many of the consumer protections included in the Affordable Care Act were already in place in Massachusetts, including guaranteeing access to coverage regardless of health status, access to external review of coverage decisions, and dnsuring that consumers can renew their coverage regardless of medical history.
“MAHP and our member health plans will continue our efforts with state and federal policymakers on implementing the Affordable Care Act in Massachusetts and we remain committed to working with the Governor and members of his Administration, the Attorney General, and the Legislature on payment reform legislation that creates a more effective health care system and provides meaningful cost savings for Massachusetts employers and working families.”
Rep. Ed Markey:
“Today’s decision is an historic victory for Americans across the country who will finally have the health care security they need.
“Because of today’s ruling, Americans will be able to purchase insurance regardless of whether they’ve been sick in the past. While insurance companies routinely rejected cancer survivors, pregnant women and anyone with a pre-existing medical condition, the law upheld today prevents insurers from turning people away and makes them play by rules that ensure that health care is a right, not a privilege.
“Seniors can still get discounts on their prescription drugs to make them more affordable. And young adults can remain on their parents’ health insurance until they turn 26. Millions of Americans have already benefitted from the law, and thanks to the Court’s decision today, they will continue to do so. No one should go bankrupt just because they get sick. This law will help give Americans the peace of mind they deserve.”
“Republicans will continue to make repeal of this law their number one priority during the election season. When Republicans say ‘Repeal and Replace’ what they really mean is ‘Repeal and Retreat’, pulling our country back to the days when insurance companies could deny coverage to sick children, refuse pregnant women coverage, and make Grandma and Grandpa pay more for their prescriptions. I will continue to fight against these misguided Republican efforts and work to ensure that families have control over their health care choices.
AG MARTHA COAKLEY:
“We applaud the Court’s decision today. Massachusetts served as a model for national health care reform and we have already experienced the many benefits of increasing access to quality, affordable health care. Today’s decision is a victory for millions of Americans who will see increased access to care, coverage that cannot be denied based on pre-existing medical conditions, and the ability to keep their children covered until they turn 26.
“Massachusetts has already begun tackling the next great health care challenge – controlling costs for our families and businesses. With today’s decision, I hope our nation will continue to move forward and do the same.”
In January 2012, AG Coakley filed a brief in the U.S. Supreme Court supporting the federal Patient Protection and Affordable Care Act (PPACA). &&& In that brief, the AG argued that Massachusetts’ own experience supports the federal government’s basis for passing national health care reform.
The federal minimum essential coverage provision at issue in this case was modeled on a similar provision in Massachusetts law, which requires most Massachusetts residents to obtain health insurance. Based on Massachusetts’ experience, AG Coakley argued that preventing healthy people from foregoing health insurance until they are sick or injured (a practice referred to as “free-riding”), generates substantial economic benefits.
Among the tangible benefits of health care reform in Massachusetts cited in the Attorney General’s brief included:
·An increase in the number of insured residents to more than 97% of the state’s population in 2009, up from 87.5% in 2006, giving Massachusetts the lowest rate of uninsured residents in the country;
·The gains in Massachusetts residents with health insurance spurred a corresponding sharp decline in the amount of state spending on “free care” for the uninsured and underinsured. The costs of free care dropped from $709.5 million in fiscal year 2006 to $414 million in fiscal year 2009.
Moreover, the Attorney General argued that despite Massachusetts’s intrastate success in improving access to quality health care and reducing spending on “free care,” national health care reform, such as that embodied in the PPACA, is required to grapple with interstate (and international) health care trends that individual states – acting alone – have little power to influence.
Assistant Attorneys General Daniel Hammond, Emiliano Mazlen, Thomas O’Brien, and Sarah Ragland, and Policy Analyst Merritt Dattel McGowan, assisted in the drafting of the AG’s Brief.
PROF LARRY TRIBE
Although it’s surprising how few people seem to have noticed, Chief Justice Roberts signaled on the very first day of oral argument this March that he saw this mandate as merely a tax, a view I had also expressed in my Boston Globe editorial on April 3, 2011, when I argued “this law doesn’t literally force anybody to do anything; it just increases the tax liability of those who refuse to buy insurance.” It’s enormously gratifying that the Chief Justice, whose views count while of course mine don’t, saved the day – and perhaps the Court. But most gratifying of all is the way millions of otherwise uninsured and uninsurable Americans will now learn in real time how much this landmark piece of legislation will do to protect us all.
Rep Michael Capuana:
“I am very pleased today that the Supreme Court has upheld the Affordable Care Act. With this ruling, Americans will continue to benefit from vital protections such as coverage for pre-existing conditions . It took far too long to achieve comprehensive health care reform and today’s ruling means that we won’t be going back to the days when too many Americans couldn’t afford health care or were denied access to coverage”.
Rep. Bill Keating:
“Today is a great day for American families – for the men and women with pre-existing conditions who previously couldn’t get quality, affordable healthcare coverage; for the young adults who wouldn’t have coverage without being able to stay on their parents’ plans; and for the seniors that are facing rising prescription drug prices.
To put the magnitude of this decision in perspective – Massachusetts has a population of 6.6 million people. That is same number of young adults across the country, up to age 26, who have already taken advantage of the law to obtain health insurance through their parents’ plan. Without that option, an estimated 3.1 million of them would be uninsured.
I applaud the Supreme Court’s decision and commitment to upholding the principles of the Constitution. Today’s discussions, however, as to the Court’s rationale and the political ramifications of this decision are of little consequence to me so long as coverage is expanded, costs are lowered and our citizens receive the best possible care.”
Boston Mayor Thomas Menino:
“Like many others who believe that access to healthcare is fundamental, I strongly support the Supreme Court’s decision today to uphold the major provisions of the Affordable Care Act. This legislation, like the law we passed in Massachusetts, will extend coverage to millions of uninsured Americans, level the playing field between consumers and insurance companies and help us to contain runaway healthcare spending. I am pleased that the benefits we have enjoyed since the law passed remain on firm legal footing and that the Obama Administration is able to continue with implementation of this groundbreaking legislation.”
National Federation of Independent Business:
The Supreme Court’s decision today upholding the bontroversial Affordable Care Act and its heavy-handed individual mandate is a deep disappointment to small businesses everywhere, said the National Federation of Independent Business (NFIB) today.
“While we are certainly disappointed, NFIB respects the decision to uphold the individual mandate by the Supreme Court. Clearly this mandate has now become a tax on all Americans and a broken campaign promise from President Obama not to raise taxes,” said Dan Danner, President and CEO of the National Federation of Independent Business. “We are concerned about the precedent that this will set in Congress’ ability to mandate other aspects of our lives, but we will move forward from today to continue to fight, harder than ever, for real health-care reform for our membership.
“Under PPACA, small-business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses. We will continue to fight for the repeal of PPACA in the halls of Congress; only with PPACA’s full repeal will Congress have the ability to go back to the drawing board to craft real reform that makes reducing costs a number one priority. The power and control of health-care decisions should be in the hands of the consumer, not the government.”
“This day will go down in history as the day when Americans lost a part of their freedom – the freedom to choose what to buy with their own money.” said Karen Harned, Executive Director of NFIB’s Small Business Legal Center.
NFIB State Director Bill Vernon said the ruling guarantees that Massachusetts residents will have their lost personal health care decisions made by politicians and bureaucrats in Washington and in other states whom they’ve never met and whom they’ll have a hard time influencing in the future.
“The tragedy in this ruling is that Massachusetts residents are now at the mercy of politicians from other states and bureaucrats in Washington whose decisions won’t be based on what is best for Massachusetts,” said Vernon. “Small businesses here will be overwhelmed by mandates, taxes and burdens imposed on them by people whom we cannot as easily hold accountable.”