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New York Times on Health Care

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Justices, By 5-4, Uphold Health Care Law 11:12am
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WASHINGTON The Supreme Court on Thursday largely let stand President Obama’s health care overhaul, in a mixed ruling that Ccourt observers were rushing to analyze.

The decision was a striking victory for the president and Congressional Democrats, with a majority of the court, including the conservative chief justice, John G. Roberts Jr., affirming the central legislative pillar of Mr. Obamas term.

Many observers called the case the most significant before the court since at least the 2000 Bush v. Gore ruling, which decided a presidential election. In addition to the political reverberations, the case helps set the rules for one of the largest and fastest-growing sectors of the economy, one that affects nearly everyone from cradle to grave.

The decision did significantly restrict one major portion of the law: the expansion of Medicaid, the government health-insurance program for low-income and sick people. The ruling gives states some flexibility not to expand their Medicaid programs, without paying the same financial penalties that the law called for.

The debate over health care remains far from over, with Republicans vowing to carry on their fight against the law, which they see as an unaffordable infringement on the rights of individuals. The presumptive Republican presidential nominee, Mitt Romney, has promised to undo it if elected.

But the court ruling is a crucial victory for the law that will allow its introduction to continue in the coming years. Passed in 2010, the law is intended to end the United States status as the only rich country with large numbers of uninsured people, by expanding both the private market and Medicaid.


The key provision that 26 states opposing the law had challenged – popularly known as the individual mandate – requires virtually all citizens to buy health insurance meeting minimum federal standards, or to pay a penalty if they refuse.

Many conservatives considered the mandate unconstitutional under the commerce clause, arguing that if the federal government could compel people to buy health insurance, it could compel them to buy almost anything – even broccoli, the archetypal example debated during the oral arguments three months ago.

In a complex decision, the court found that Congress’ powers to regulate commerce did not justify the mandate. But it reasoned that the penalty, to be collected by the Internal Revenue Service starting in 2015, is a tax and is not unconstitutional.

Chief Justice Roberts, in the majority, said that the mandate was unconstitutional under the Constitution’s commerce clause. But that did not matter if the penalty that enforces it was constitutional on other grounds.

The court’s four liberals made it clear that they disagreed with the chief justice's view of the commerce clause, but joined him because the effect of his ruling was to let the law stand.

The Obama administration had said in court in 2010 that the mandate could be upheld under the taxation powers, which it called even more sweeping than the federal power to regulate interstate commerce.

It was needed, the government said, because it allowed other provisions to function: those overhauling the way insurance is sold, and those preventing sick people from being denied or charged extra for insurance.

The mandate’s advocates said it was necessary to ensure that not only sick people but also healthy individuals would sign up for coverage, keeping insurance premiums more affordable. The law offers subsidies to poorer and middle-class households, varying with their incomes. It also provides subsidies to some businesses for insuring their workers.

The law requires states to expand Medicaid coverage for people living in or near poverty. In all, tens of millions of people are expected to gain insurance from the law, according to the Congressional Budget Office. But the court's decision limited the use of the federal government's financial leverage over the states, which had challenged the provision as being coercive because it would have withheld money from states that fell short.

By allowing the march toward universal coverage to continue, the court kept within sight a goal that has eluded legislators and presidents – including Franklin Delano Roosevelt, Harry S. Truman, Lyndon B. Johnson, Richard M. Nixon and Bill Clinton – for generations.

The decision came on the last day of the term, which the justices extended by three days to deal with the crush of major issues. On Monday, the courtoverturned several parts of an Arizona law intended to crack down on illegal immigrants, which the Obama administration opposed , while allowing one notable provision to stand.

That Chief Justice Roberts provided the decisive vote the liberals needed was a surprise. He also joined the more liberal justices, and Justice Kennedy, this week in throwing out portions of Arizona's tough immigration law.

Before this week, the Roberts court has delivered a series of major victories to conservatives, including the Citizens United campaign finance decision, which on Monday it declined to reconsider. In next year’s term, it could take up other major issues; it has agreed to hear a case on affirmative action, and may also consider same-sex marriage and the Voting Rights Act.

In an extraordinary series of oral arguments in March, the differences on the bench that the court had to bridge, if not the ultimate outcome, were disclosed in sharp relief.

Until those arguments, many observers – within the White House and beyond – had seen the law as likely to survive a legal challenge that even many Republicans once viewed as a long shot.

But the skeptical questioning by a majority of the justices – and Justice Kennedy in particular – called that view seriously into doubt, as did a somewhat halting presentation by the administration’s advocate. Rulings by appeals courts had split on the main questions, with two courts upholding the law and one striking down the mandate.

A fourth appeals court deferred consideration of the law until 2015, reasoning that the courts lacked jurisdiction until the first penalties enforcing the mandate came due.

Although there were some exceptions, in the lower courts most judges appointed by Democrats voted to uphold the law, while most appointed by Republicans voted to reject at least part of it. With Thursday’s ruling, Chief Justice Roberts joined the roster of Republican appointees who voted to uphold the law

Supreme Court Upholds Health Care Law, 11:35am
Change
WASHINGTON The Supreme Court on Thursday left standing the basic provisions of the health care overhaul, ruling that the government may use its taxation powers to push people to buy health insurance.

The narrowly delineated decision was a victory for President Obama and Congressional Democrats, with a 5-to-4 majority, including the conservative chief justice, John G. Roberts Jr., affirming the central legislative pillar of Mr. Obama's presidency.

Chief Justice Roberts, the author of the majority opinion, surprised observers by joining the court's four more liberal members in the key finding and becoming the swing vote. Justice Anthony M. Kennedy, frequently the swing vote, joined three more conservative members in a dissent and read a statement in court that the minority viewed the law as “invalid in its entirety.”

The decision did significantly restrict one major portion of the law: the expansion of Medicaid, the government health- insurance program for low-income and sick people. The ruling gives states some flexibility not to expand their Medicaid programs, without jeopardizing financing for their current programs, as called for by the law.

The case is seen as the most significant before the court since Bush v. Gore ruling, which decided the 2000 presidential election.

In addition to its political reverberations, the decision allows sweeping policy changes affecting one of the largest and fastest-growing sectors of the economy, touching nearly everyone from the cradle to the grave.

The political fight
over health care remains far from over, with Republicans campaigning on a promise to repeal the law, which they see as an unaffordable infringement on the rights of individuals. The presumptive Republican presidential nominee, Mitt Romney, has promised to undo it if elected.

But the court’s ruling is a crucial milestone for the law, allowing almost all of its far-reaching changes to roll forward. Several of its notable provisions have already taken hold in the past two years, and more are imminent. Ultimately, it is intended to end the United States’' status as the only rich country with large numbers of uninsured people, by expanding both the private market and Medicaid.

The key provision that 26 states opposing the law had challenged – popularly known as the individual mandate – requires virtually all citizens to buy health insurance meeting minimum federal standards, or to pay a penalty if they refuse.

Many conservatives considered the mandate unconstitutional under the commerce clause, arguing that if the federal government could compel people to buy health insurance, it could compel them to buy almost anything – even broccoli, the archetypal example debated during the oral arguments three months ago.

In a complex decision, the court found that Congress’ powers to regulate commerce did not justify the mandate. But it reasoned that the penalty, to be collected by the Internal Revenue Service starting in 2015, is a tax and is not unconstitutional.

Chief Justice Roberts, in the majority, said that the mandate was unconstitutional under the Constitution’s commerce clause. But that did not matter if the penalty that enforces it was constitutional on other grounds.

The court’s four liberals made it clear that they disagreed with the chief justice's view of the commerce clause, but joined him because the effect of his ruling was to let the law stand.

The Obama administration had said in court in 2010 that the mandate could be upheld under the taxation powers, which it called even more sweeping than the federal power to regulate interstate commerce.

It was needed, the government said, because it allowed other provisions to function: those overhauling the way insurance is sold, and those preventing sick people from being denied or charged extra for insurance.

The mandate’s advocates said it was necessary to ensure that not only sick people but also healthy individuals would sign up for coverage, keeping insurance premiums more affordable. The law offers subsidies to poorer and middle-class households, varying with their incomes. It also provides subsidies to some businesses for insuring their workers.

The law requires states to expand Medicaid coverage for people living in or near poverty. In all, tens of millions of people are expected to gain insurance from the law, according to the Congressional Budget Office. But the court's decision limited the use of the federal government's financial leverage over the states, which had challenged the provision as being coercive because it would have withheld money from states that fell short.

By allowing the march toward universal coverage to continue, the court kept within sight a goal that has eluded legislators and presidents – including Franklin Delano Roosevelt, Harry S. Truman, Lyndon B. Johnson, Richard M. Nixon and Bill Clinton – for generations.

The decision came on the last day of the term, which the justices extended by three days to deal with the crush of major issues. On Monday, the courtoverturned several parts of an Arizona law intended to crack down on illegal immigrants, which the Obama administration opposed , while allowing one notable provision to stand.

That Chief Justice Roberts provided the decisive vote the liberals needed was a surprise. He also joined the more liberal justices, and Justice Kennedy, this week in throwing out portions of Arizona's tough immigration law.

Before this week, the Roberts court has delivered a series of major victories to conservatives, including the Citizens United campaign finance decision, which on Monday it declined to reconsider. In next year’s term, it could take up other major issues; it has agreed to hear a case on affirmative action, and may also consider same-sex marriage and the Voting Rights Act.

In an extraordinary series of oral arguments in March, the differences on the bench that the court had to bridge, if not the ultimate outcome, were disclosed in sharp relief.

Until those arguments, many observers – within the White House and beyond – had seen the law as likely to survive a legal challenge that even many Republicans once viewed as a long shot.

But the skeptical questioning by a majority of the justices – and Justice Kennedy in particular – called that view seriously into doubt, as did a somewhat halting presentation by the administration’s advocate. Rulings by appeals courts had split on the main questions, with two courts upholding the law and one striking down the mandate.

A fourth appeals court deferred consideration of the law until 2015, reasoning that the courts lacked jurisdiction until the first penalties enforcing the mandate came due.

Although there were some exceptions, in the lower courts most judges appointed by Democrats voted to uphold the law, while most appointed by Republicans voted to reject at least part of it. With Thursday’s ruling, Chief Justice Roberts joined the roster of Republican appointees who voted to uphold the law
Select Witness

Supreme Court Upholds Health Care Law, 5-4, Nov. 6

Justices, By 5-4, Uphold Health Care Law 11:12am

Supreme Court Upholds Health Care Law, 11:35am

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