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U.S. Supreme Court upholds Affordable Care Act


The U.S. Supreme Court, in a landmark ruling, has upheld the individual mandate in the Affordable Care Act, the chief domestic measure of President Barack Obama’s first term.

The complex decision on June 28, announced by Chief Justice John Roberts, was seen as the most significant of the High Court’s 2012 term, with far-reaching impact on health care reform.

With the ruling expected sometime after 10 a.m., hundreds of activists, reporters and photographers assembled outside the court building.

The Court kept them – and audiences monitoring the morning’s events on the Web, radio, television and smart phone apps – waiting, releasing a ruling in a free-speech case first.

The decision on the Affordable Care Act was released at about 10:15 a.m., with some early confusion about the verdict as reporters read through the first pages of the lengthy opinion.

A number of LGBT groups had participated in a friend-of-the court brief to the Court that defended the challenged elements of the ACA as constitutional and noted the law would help to close the health care gap for LGBT Americans.

Supreme Court arguments on the ACA took place March 26-28, nearly two years to the day after Obama signed the legislation into law. Almost immediately after the White House signing, the series of constitutional challenges were filed.

The central component of the law examined by the Court was the individual mandate requiring that uninsured people purchase health coverage – with government help for those who can’t afford the premiums. The question before the Court was whether the U.S. Constitution allows the government to require Americans to obtain insurance or pay a penalty?

The Court, in the 5-4 opinion, ruled that the individual mandate is allowed for – not under the commerce clause but as a tax. Roberts wrote, "The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."

Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor joined Roberts in the majority. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

The Court also explored whether, with an expansion of Medicaid, the federal government would be unconstitutionally forcing states to spend more on health care for the poor. The medicaid provision also was upheld.

The president, in a statement at the White House, said, “The highest court in the land has now spoken. We will continue to implement this law and we’ll work together to improve on it where we can.

“What we won’t do – what the country can’t afford to do – is re-fight the political battles of two years ago or go back to the way things were. With today’s announcement, it’s time for us to move forward.”

Republican presidential candidate Mitt Romney vowed to repeal the law on his first day in office, if elected. "If we want to get rid of Obamacare, we're going to have to replace President Obama," the candidate said.

In a news release earlier this week, Romney's campaign spokesperson said the law – similar to one Romney signed as a governor – had hurt the economy and stalled jobs creation.

Meanwhile, many LGBT leaders this week, with the observation of National HIV Testing Day, were stressing the importance of the Affordable Care Act in expanding access to HIV testing as they anticipated the Court decision.

When the president signed the ACA, LGBT leaders celebrated its provisions, including:

• A National Prevention Strategy that says, “All Americans should have the opportunity to live long, healthy, independent, and productive lives, regardless of their … sexual orientation or gender identity; geographic location; or other characteristics.”

• Data collection, beginning in 2013, to better understand LGBT health disparities.

• A Patient’s Bill of Rights to end insurance company abuses. The law ended lifetime limits on coverage in 2010 and by 2014 will phase out annual limits on coverage, which is seen as critical to quality care for people living with HIV and cancer.

• Expanded Medicaid eligibility so that adults under age 65 and earning less than $15,000 a year become eligible. Studies show that LGBT people, with discrimination in employment and relationship laws, are disproportionately more likely to make less than $15,000 a year and be uninsured.

• A health insurance exchange in 2014 that offers subsidies to small employers and individuals earning $15,000 to $43,000 a year to purchase coverage.

• A prohibition in the exchange on discrimination on the basis of sexual orientation and gender identity in coverage and requires that benefits include drugs, hospital stays, mental and behavioral health services.

• Web-based resources that help same-sex couples find plans that include domestic partner coverage.

• A tripling in the size of the health service corps in underserved areas of the country, expanding community health centers and increasing support for LGBT sensitivity training from Health and Human Services.

• A prohibition, beginning in 2014, against insurance companies denying or canceling coverage on the basis of a pre-existing conditions, including HIV or gender dysphoria.

• A system for making HIV/AIDS drugs more affordable and eliminating the requirement that people with HIV wait for an AIDS diagnosis before qualifying for Medicaid.

• A prohibition against insurance companies charging co-pays or other fees for preventive services recommended by a U.S. task force, including testing for HIV and STDs, depression screening, vaccinations, cholesterol and blood-pressure screening.

Reacting to the Court decision, Rea Carey of the National Gay and Lesbian Task Force, said, "This ruling is a victory for millions of people and families across the country who have suffered significant health and financial turmoil because of a lack of access to adequate, affordable health care."

Carey, encouraging people to vote in November, said the ruling is a reminder that votes for the president and the Senate can shape the Supreme Court, which next year is likely to decide two marriage equality cases.

At the Human Rights Campaign, president Chad Griffin said, "The Supreme Court's decision means millions of Americans – including many lesbian, gay, bisexual and transgender people and their families – will be better served by our nation’s health care system.  The Affordable Care Act addresses a number of the barriers LGBT people face in obtaining health insurance, from financial barriers to obtaining affordable coverage to discrimination by insurance carriers and healthcare providers. While there is a great deal more that must be done to ensure that the health needs of all LGBT people are fully met throughout the healthcare system, today’s decision is an important victory in the fight for healthcare equality."

Scott Schoettes, the HIV Project director for Lambda Legal, called the decision a victory – but not a complete one, because the "decision allows states to opt out of the Medicaid expansion that would provide insurance coverage for many low-income people who cannot otherwise afford it."

He added, "Our continuing challenge will be to make sure that states opt to expand Medicaid so that more low-income people, and particularly those with HIV, can get the health care they urgently need."

Victor Barnes of AIDS United, though also with concern about the opt-out Medicaid allowance for states, said, “The end to HIV in the United States is in our sight. The Supreme Court’s ruling upholds the ACA’S pivotal provisions that keep us on the course that has been outlined by the first-ever National HIV/AIDS Strategy and by the significant treatment and prevention advances that we’ve seen over the last year.”

Log Cabin Republicans, a gay GOP group, did not cheer the health care ruling. A news release said, "Today’s ruling by the U.S. Supreme Court upholding Obamacare is a license for Washington to continue its expansion into the lives of American citizens and businesses. Writing for the majority, Chief Justice Roberts wrote, 'Simply put, Congress may tax and spend.'"

"The court has enabled Washington’s addiction to big government and coercive taxes,” said LCR deputy director Christian Berle.

A number of conservative groups and leaders also expressed disappointment – and a lot of outrage – at the Supreme Court decision.

Former vice presidential candidate Sarah Palin said the ruling proved Obama lied when he said the individual mandate was not a tax.

Americans for Prosperty, the Koch brothers' group, said, "The Court got it wrong, and now Congress must step in. President Obama’s big-government legislation will result in higher costs, fewer choices, and centralizes health care decisions in Washington instead of with patients and families."

The ruling means that the Obama administration, unless Congress intervenes, will proceed with the full implementation of the law.

In Wisconsin, about 9 percent of residents – 526,000 people – are uninsured. The state has not begun setting up its health insurance exchange. Gov. Scott Walker put that work on hold in January and vowed not to implement any measures of the federal law until after November.

State Rep. Brett Hulsey, D-Madison, in a statement hours after the decision’s release, said the Court’s finding “underscores the importance of our efforts to stop Gov. Walker from taking BadgerCare from 65,000 Wisconsinites, including 29,000 children, and affordable medicine from thousands of our parents and seniors by doing away with SeniorCare.

“Gov. Walker should move forward to provide affordable health care and medicine for all instead of taking health care away from kids and workers and playing politics with people’s lives.”

The Obama administration says the ACA has many benefits for Wisconsin.

Click to read the Court's opinion.

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