June 28th, 2012
U.S. Supreme Court Upholds Most of Healthcare Law
The U.S. Supreme Court upheld the majority of the Affordable Care Act in a 5-4 decision on Thursday.
With Chief Justice John Roberts writing the majority opinion, the court upheld the central component of the law — the individual mandate — which requires that most Americans have health insurance or pay a penalty. The court determined that the law was constitutional based on Congress’s power to tax, but not its power to regulate interstate commerce.
The decision should allow most of the law’s more expansive changes to proceed, the bulk of which are scheduled to take effect in 2014.
Part of the law that expanded Medicaid by threatening noncooperating states with cuts to their Medicaid funding was struck down.
Here are the New York Times story and a timeline for the Affordable Care Act’s provisions.
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14 Responses to “U.S. Supreme Court Upholds Most of Healthcare Law”
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I think that the ruling that Medicaid cannot be forced upon a state will lead to Red States refusing to adopt PPACA. Wisconsin has already announced as much today. That is as much of a death blow as the individual mandate would have been. I do not expect the insurance portions of PPACA to go into effect by 2014. The unrelated PCORI, CMMI, etc will continue on.
By the way, I see it as very unlikely the sequestration of the Super Committee, that supposedly forces CMS cuts, will ever happen. Look for more fee for service cost inflation. Look for little in real reform or real expansion of coverage even if President Obama is re-elected.
Our health care system is badly broken — too many patients are left without the timely, effective, safe, and patient-centered care they deserve. This is the sad reality that we are witness to everyday on the hospital wards and in our clinic exam rooms. Though far from perfect, the Patient Protection and Affordable Care Act is a significant victory for patients and brings much needed reform to the insurance market and health care delivery.
While I join patients and colleagues in celebrating the Supreme Court ruling, much work remains to be done. For the hard work of actually implementing the ACA and bringing the kind of health care to all of our patients that they deserve, we can not look to President Obama, the Congress, or the Supreme Court — physicians must lead, we must catalyze the transformation in medicine that today’s decision brings into focus.
I’m sure implementation will be a mess and we’lll all get frustrated, and no one will know what they’re doing for 5 or so years.
It will be far, far, better than the current system, which is winner take all. I get great care in attractive settings, because I have good private insurance. My patients who have lost their jobs get to loose their health in addition.
I have become the queen of the patient assistance programs for a motley patchwork of help. It’s not very good use of physician time, but it’s better than watching RA patients go back to their wheelchairs and treating asthma with intubation.
The Supreme Court decision at least now provides some certainty about how to proceed with further health care reform. A bill that provides access to healthcare for about 93% of Americans can’t be all bad, but there are provisions of the bill that clearly need fixing. It would be nice if politicians would stop using healthcare as a political football, and if we could now work together as a country to fix the many remaining problems in our healthcare system.
Will the act survive the republican party attempt to dismantle it?
Yah–senate dems can thwart dismantling
I wholeheartedly agree with Nihar’s assertion that physicians must play a more central role in the transformation in medicine towards more equitable and effective care.
During my medical training, my colleagues have been some of the brilliant, passionate, and decent people I have ever met. They are driven by an intense desire to use their medical knowledge to help those in need.
Why, then, is there such a dearth of physicians on Capitol Hill? Shouldn’t it be physicians and not politicians and lawyers who get to decide the future of the doctor-patient relationship?
Time will tell what is going to happen with this. Hopefully it does not destroy private practice and lead to “too many cooks”. My main issue with the legislation is the individual mandate and the penalty tax. If someone opts to pay the “tax” as now defined by SCOTUS, shouldn’t this now automatically enroll them in medicaid, a taxpayer funded program? To leave them in the street without any insurance at all would be unfair and unjustified. It would also reward people who simply don’t want to work (I’m not including those who can’t work or can’t find it) with medicaid. It will also destroy some small businesses that can’t afford to pay for medical insurance for their employees. We’ll see where the apples land in a few years. My feelings are mixed on the law but generally positive. I was shocked The Supreme Court found it constitutional on a “taxation” basis. However, if you make a penalty a tax, the taxpayer is then entitled to get something back for paying it.
I support the decision, but with considerable ambivalence. Clearly there are positives (e.g., requirements for employer provided insurance, inability to withhold insurance due to pre-existing conditions, coverage of minors and adolescents up to a more “adult” age.
No doubt, insurance companies will find ways to get around some of these provisions. Of more concern, however, is the likelihood that provisions to provide medicaid may not be implemented.
Above all, however, we have to recognize that the program is quite complex, inefficient, and costly. Why not do what most countries have done which is to have universal health insurance funded through a national health program.
Although we are told that the U.S. has the best health care system in the world, the evidence puts us way down on the list of developed countries in relation to patient outcomes, access, and cost-effectiveness. It remains to be seen whether the ACA will have a favorable impact on any of these measures. We should join the developed world and provide a single universal health insurance plan.
I highly recommend every physician read Atul Gawande’s brilliant 6/28 piece in the New Yorker. His analysis is spot on! http://goo.gl/qgicc
Despite what Walker has said eventually the people of Wisconsin will be pretty annoyed that their tax dollars are flowing out of the state to support Medicaid in other states while we get nothing more back. Either Walker will change his tune or he will be working for a right wing think tank somewhere.
Overall we will see less money spent on unneeded tests and fewer patients “crashing” in the ER with CHF or DKA. If every person has a private physician, then his/her chronic problems will be addressed in a more efficient fashion and will be less likely to spiral out of control. Also, not using a family doctor rather than the ER for a headache, dizziness, etc means that expensive workups will be the exception rather than the rule. Wasn’t there an article in Archives of Internal Medicine last year to the effect that the average cost of working up dizziness in the ER$ was $20,000?
The whole house of cards of “health care” is to force primary care physicians to do even more for even less. When will we stand on our hind legs and say “no mas”.
Wnile some states, republican led, suggest they will not opt in,I believe this is temporary and their constituents will make the decision for them.