The Supreme ‘Obamacare’ surprise will test mental health limits


By Al Norman

On June 28, Chief Justice John Roberts surprised a lot of people — myself included. I had been writing that the U.S. Supreme Court would eviscerate the Affordable Care Act (ACA) on a 5-4 party line vote. The number count was right — but Roberts shifted to the other side. Yet his opinion came to bury the ACA, not to praise it.

Robert’s vote does not mean he supports what conservatives like to call “Obamacare.” In his opinion, Roberts says, “the Court does not express any opinion on the wisdom of the Affordable Care Act … that judgment is reserved to the people.”

In fact, the Supreme Court ruled that the ACA “is constitutional in part, and unconstitutional in part.” The controversial provision that Congress can require every American to have health insurance  was declared outside the bounds of Congress’ powers under the Commerce Clause. The court said Congress had the right to “regulate interstate commerce, (but) not to order individuals to engage in it.” Instead, the Supremes said Congress was within its rights to increase taxes on those who have a certain amount of income, but choose to go without health insurance.”

In practical terms, this ruling means that starting in 2014,  individuals who refuse to buy a “minimum essential” health policy, will have to make a “shared responsibility payment” in the form of a penalty tax paid on their IRS tax return. Millions of Americans will pay this penalty rather than have to buy health insurance, undermining the concept of a broad risk insurance pool.

The other major issue besides the individual mandate was whether or not Congress had the power to force states to accept an expanded Medicaid program. Here again, the Court said it was unconstitutional for Congress to order states to regulate according to its instructions. “Congress may offer the State grants and require the States to comply with accompanying conditions,” the court said, “but the States must have a genuine choice whether to accept the offer.”

Under the ACA law, if a state did not comply with the Act’s new expanded eligibility coverage, it could lose all of its federal Medicaid funds. The Roberts Court called this “a gun to the head,” and a form of “economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.”

The court said, “What Congress is not free to do is to penalize States that choose not to participate in that new program.” As result, the Court wrote, “that means States “may now choose to reject the expansion; that is the whole point.” Given the fact that 26 states brought this lawsuit, it’s reasonable to assume that many of these same states will boycott the Medicaid expansion part of the ACA, and not accept enhanced federal funding for their low-income residents — thereby frustrating the law’s intent.

On both the individual mandate and the Medicaid expansion provision, individuals and states can refuse to play. In this way, the Supreme Court decision undermines two of the key objections of the ACA law. This can only be described as a mixed victory for health care reform.

On a political level, the folks who don’t like “Obamacare” were ignited by the Supremes’ decision. Senate Republican Leader Mitch McConnell, R-Ky., said, “Congress must act to repeal this misguided law.” House Speaker John Boehner, R-Ohio, said, “Today’s ruling underscores the urgency of repealing this harmful law in its entirety.” McConnell said Republicans need to enact “step-by-step solutions” to prevent further damage from this “terrible law.” Boehner claimed Americans wanted a “step-by-step approach to health care reform.” Clearly they were reading from the same step-by-step talking points.

The Supreme Court ruling means five more months of lockstep political punditry that will test the limits of our collective mental health.

Al Norman is the executive director of Mass Home Care. He can be reached at 978-502-3794, or at