Kristin Murphy, Deseret News
SALT LAKE CITY — Judi Hilman got up at 4 a.m. Thursday to figure out her response to the then-pending health care reform decision from The U.S. Supreme Court. The director of Utah's Health Policy Project planned for two possibilities: that the mandate requiring most Americans to purchase insurance would be stricken or that the entire Patient Protection and Affordable Care Act would fall.
Instead, in a 5-4 ruling, the court largely affirmed the controversial health care reform act, with Chief Justice John Roberts writing the majority opinion.
"This is historic — and frankly unexpected," said Hilman during a press conference that the bipartisan UHPP hastily renamed a "celebration" three hours after the ruling. The organization has supported health reform efforts.
Responses were varied, but uniformly volatile. Whether the Supreme Court decision is to be approached with the gravity and fear of the unknown that was seen in planning for Y2K with its expectation of a horrifying computer glitch or with the festivity of a Superbowl party depends entirely on who was responding, one observer noted.
The court upheld the requirement that most people purchase insurance or face penalties, called the individual mandate, on the grounds that is the equivalent of a tax, which Congress has a right to levy. The court struck down part of the expansion of the Medicaid program, ruling only expansion money could be withheld from states that choose not to participate with the measure, which expands Medicaid coverage to parents and childless adults up to 133 percent of poverty. The federal government will not be allowed to force compliance by withholding other Medicaid money.
"It takes away the stick with which to beat the states" if they don't comply, said Robert Bennett, former U.S. Senator from Utah and now a fellow at George Washington University's School of Media and Public Affairs. "It leaves the carrot."
The ruling surprised some watchers, who'd predicted that the chief justice and Associate Justice Anthony Kennedy would side together on ACA. Instead, Roberts sided with the more liberal wing of the court. In voting that way, he said, Roberts countered critics of the court who have said the justices are too political and would not set aside personal beliefs to decide cases on the basis of the law. The ruling "drove a major stake in that argument," Bennett told the Deseret News.
But he believes the decision, while upholding the individual mandate, also weakens it. People may choose to ignore the mandate and pay the tax penalty instead, he noted. That would change the depth of the risk pool, which has to be big enough to afford the costs associated with all the coverage that the ACA provides.
The ruling changes the act from a legal question — it's now officially constitutional — to a political one, said Rich McKeown, CEO of Leavitt Partners, which he founded with former Secretary of Health and Human Services Mike Leavitt.
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