U.S. Supreme Court


What The Supreme Court Ruling On Obamacare Means: A Student’s Perspective

By Marina Renton
CommonHealth Intern

As a public health major at Brown University, I’ll admit I’m biased: When the King v. Burwell decision was handed down this week, I was absolutely elated. The decision felt exactly right to me; people were not going to lose their health care coverage, and more might even have the chance to gain it.

But the case is complicated, so to really understand the take-home messages, I consulted a couple of health care policy experts.

One is Ira Wilson, professor of Health Services, Policy and Practice at Brown University, who taught my “Health Care in the United States” class last semester.

The other is Michael Doonan, assistant professor at the Heller School for Social Policy and Management at Brandeis and executive director of the Massachusetts Health Policy Forum

Their responses are lightly edited:

MR: What background do we need to understand the Supreme Court decision?

IW: One of the core tenets of health care reform is that people who can’t afford insurance get subsidies so that they can buy it.

The ACA:

• Reforms insurance by doing things like preventing denials due to pre-existing conditions. So it requires that insurance do certain things that it hasn’t always done in the past.

• Requires that everybody get insurance. That’s the individual mandate, and that was covered in the 2012 challenge and then upheld in the 2012 case.

• Requires that affordable insurance be available to everyone. And this King case threw into question that third leg of the stool, as it were. Or at least it brought it into question for the states that, rather than deciding to develop their own exchange, used a federal one. So without this, the entire framework for health care reform in those states that have a federal exchange begins to fall apart. And as we know because we’ve seen lots of articles about estimating how many people would lose insurance if those subsidies were taken away (estimates were in the six million range), it would have a devastating impact on people who are now insured who would lose it.

What does the ruling say about Obamacare?

MD: If the Supreme Court had ruled against the government and said that the subsidies could not be available in the 34 states that have federally run exchanges, it might not have been the death of Obamacare, but it certainly would have put it on life support. So this decision is really critical in helping root and solidify the Affordable Care Act. And the more it gets rooted in each of the states, the harder it’s going to be to repeal.

IW: So this actually was a 6-3 decision, not a 5-4 decision. And it does seem to me the fact that both Justice Roberts and Justice Kennedy — who were the two that one might have imagined might have been on the other side of this issue — came down on the side of upholding these subsidies is a bit of a statement.

What if the ruling had gone the other way?

MD: Think about Texas. Now, in Texas, there are about 1.1 million people who are enrolled in that exchange, that marketplace. Well, 90% of them — over 900,000 people — are receiving those subsidies, and they could have lost their insurance.

And it’s not only important that people lose their insurance, which is the most critical thing, but hospitals would see many, many more uninsured patients. So even people adamantly opposed — I think that even Republican governors who are opposed to this are secretly saying, “Oh my gosh; thank goodness.” This would have caused them a tremendous, tremendous burden, because they would have seen more uninsured.

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No Health Law Ruling Today, But Scotus-Watchers Remain On Edge


From about 10 am until 10:26 today, I though I might have some kind of bad cardiac event, or maybe even a stroke.

My heart raced, I felt dizzy and slightly nauseous. I couldn’t move. I emailed a colleague citing my rising anxiety level.

I hadn’t just eaten a vat of fried dough, nor was I experiencing a post-strenuous-exercise collapse.

Along with tens of thousands of others (70,000 according to CoverItLive), I was glued to the Scotusblog, the Bloomberg Law-sponsored live blog of the U.S. Supreme Court. Snapping to attention with each new audio type-writer click, we wanted to be right there (or as close to there as possible sitting at home in front of a screen) if the high court ruled on the health law this morning. Of course, they didn’t. Continue reading

Post-Supremes: Deconstructing The Health Law Arguments

Webcast Replay: Health Reform And The Court (Kaiser Health News)

Screenshot of the Kaiser Health News' webcast "Health Reform And The Court." Click the above image to link to the full webcast replay.

If, for some reason, you haven’t had enough parsing of this week’s judicial thrashing of the national health care law, listen to this thoughtful Kaiser Health News analysis by a panel of smart reporters and observers who covered the past three days of oral arguments on the health law before the U.S. Supreme Court.

Asked what happens to the provisions of the law that are already in effect if the entire law is invalidated, Tom Goldstein, publisher of the Scotusblog said he’s not sure of the legal term but, basically “God only knows.”

Massachusetts Keeps A Close Eye On Supreme Court


The Supreme Court Justices (DonkeyHotey/Flickr)

The Supreme Court Justices (DonkeyHotey/Flickr)

Martha Bebinger reports that “the unprecedented combination of health care policy, legal theory and broccoli before the U.S. Supreme Court this week has kept many Boston area residents glued to their computers, radios, TVs and phones for updates.”

This barrage of coverage has an air of inevitability to it: there’s an overall sense that the individual mandate will be invalidated and much, if not all, of the health law may go down with it. (The government’s case is being called, alternatively, “a train wreck” and a “plane wreck,” the U.S. solicitor general’s performance has been panned as he came off as nervous and awkward even while the Obama administration says it remains confident that the law will be upheld.)

So, Martha writes: “Many Massachusetts residents are surprised at how the individual mandate was described this week in and outside the Supreme Court.”

“One thing we’re hearing a lot in Washington, particularly from people who are opposed and would like to see it overturned, is how draconian the mandate is and what an extreme overreach of government it is, and it’s the death of freedom and all of that,” says David Kravitz, co-founder of the left leaning blog Blue Mass Group. Continue reading

Health Law Deja Vu: Bush v. Gore And Politics On The High Court

Lady Justice (Scott*/Flickr)

Lady Justice (Scott*/Flickr)

In the fall of 2000, my reporter buddies and I would gather every evening at various bars or people’s apartments, fixated and anguished by the political theatre of Bush v. Gore before the U.S. Supreme Court. Yesterday’s partisan grilling by the justices on the health law’s individual mandate slammed me right back to that time. Once again, politics seemed to dominate the high court in so many ways.

As I followed all the analysis yesterday — CNN’s Jeffrey Toobin says the mandate is dead, the government’s case is deemed a “train wreck,” the anti-health-law faction’s broccoli-obsession, etc. — I wondered if the justices truly came at the case with open minds or if political orientation is the main driver here. We may never know. But if you want comprehensive coverage of the drama that continues today with arguments on Medicaid and “severability,” here’s Kaiser Health News’ Health Law March Madness, which examines pretty much every angle of the case and its broad implications.

Here’s one piece looking at ways to salvage the health law should the individual mandate be found unconstitutional:

There are ways that Obama—if he’s re-elected — might be able to salvage the law even if the court strikes down the individual mandate but leaves the rest intact, health policy experts say.

These fixes would create financial incentives for people to not delay enrolling in insurance. Continue reading

Berwick Says He Thinks Health Law Will Stand

Wishful thinking? Maybe.

But Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services tells Kaiser Health News that despite “messaging problems,” he believes the national health law will stand. “I expect the law will be upheld,” he says.

(Next week, the U.S. Supreme Court hears arguments on the law’s constitutionality; a decision is expected in June.)


Politico: Obama Targeting Supreme Court Conservatives On Health Law

The U.S. Supreme Court considers the health law this month. (OZinOH/flickr)

This month, the U.S. Supreme Court is scheduled to hear arguments on the constitutionality of the Affordable Care Act, the national health law signed by President Obama in 2010.

Politico reports on the administration’s strategy targeting conservative justices on the high court, hoping that at least one of them will rule in favor of the law. Here’s a run-down of the government’s approach, including a play for Scalia:

Administration lawyers have peppered their briefs with citations to opinions written by Anthony Kennedy and Antonin Scalia, they’ve seized on the arguments made by one of Scalia’s most beloved former clerks and their allies in legal circles have talked up how a decision upholding the Affordable Care Act would play into John Roberts’s legacy as chief justice.

A long shot? Maybe, but it’s the only shot the administration has on a court dominated 5-4 by conservatives… Continue reading