Daily Health Policy Report

Friday, June 29, 2012

Last updated: Fri, Jun 29

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace

Campaign 2012

Capitol Hill Watch

State Watch

Editorials and Opinions

Weekend Reading

KHN Original Reporting & Guest Opinion

Justices Uphold Individual Mandate, Set Limits On Medicaid Expansion

Kaiser Health News staff writers Julie Appleby and Jordan Rau report: "The U.S. Supreme Court upheld nearly all of the landmark federal health law, affirming its mandate that most everyone carry insurance, but complicating the government's plan to extend coverage to the poorest Americans. Chief Justice John Roberts Jr. joined the court's four liberals in upholding the mandate, the best-known and least popular part of the law. The court also upheld hundreds of other rules embedded in the law designed to help millions more Americans obtain insurance and to refashion the health care industry. But a majority of the justices voted that the government could not compel states to expand Medicaid, the federal state program for the poor, by threatening to withhold federal money to existing Medicaid" programs (Appleby and Rau, 6/28). Read the story.

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Ruling Puts Pressure On States To Act

Kaiser Health News staff writers Phil Galewitz and Marilyn Werber Serafini report: "The Supreme Court has given states a way out of expanding the Medicaid program under the health law, but governors will be under strong pressure to take the federal money that would pay for coverage for millions of low-income people" (Galewitz and Werber Serafini, 6/28). Read the story; the related sidebar What Will States Do On Medicaid?; or the table Estimated New Medicaid Enrollees Under The Health Law.

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Hospitals Celebrate Decision, But Threats Remain

Kaiser Health News staff writer Jay Hancock reports: "Everybody agreed hospitals would be the biggest business losers if the Supreme Court overthrew the health act. But the Thursday ruling that preserved most of the law — along with the promise of billions in extra hospital revenue — raises new problems for the industry. Hospital bosses applauded and hospital stocks soared as investors bet that coverage for as many as 30 million extra Americans would reduce unpaid bills and boost profits" (Hancock, 6/29). Read the story.  



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California Races To Enroll Uninsured

Reporting for Kaiser Health News, Russ Mitchell writes: "At a time when only 14 states and the District of Columbia have even authorized the legal framework for the state-based insurance markets called for in the law, California is sprinting towards the law’s October 2013 deadline to begin enrolling the uninsured. Along the way, state officials are betting they’ll become a national role model" (Mitchell, 6/29). Read the story.

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Video: Making Sense Of The Supreme Court Ruling

This Kaiser Health News video webcast features KHN's Mary Agnes Carey, Stuart Taylor and Julie Appleby as well as SCOTUSblog's Tom Goldstein and Lyle Denniston as they discuss Thursday's landmark Supreme Court decision on the constitutionality of the health law. Watch the video.

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Judging The Health Law: KHN's Resource Page On The Health Law Decision And What Might Happen Next

Kaiser Health News has an array of resources, including excerpts from both the justices' majority and minority opinionsvideo clips featuring political reactions to the decision; transcripts of remarks from President Barack Obama and GOP presidential hopeful Mitt Romney; and an updated version of KHN's consumer guide to the health law.

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Political Cartoon: 'Can You Hear Me Now?'

Kaiser Health News provides a fresh take on health policy developments with "Can You Hear Me Now?"by John Cole.

And here's today's health policy haiku:

LOOKING FOR FRESH CONVERSATION

The Court has spoken
What is there to talk about?
Maybe SOMETHING ELSE?!
-Beau Carter

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Supreme Court Lets Most Of Health Law Stand

In a decision that surprised many observers, the high court allowed the measure's individual mandate to survive as a tax but set limits on the law's Medicaid expansion.  

Kaiser Health News: Justices Uphold Individual Mandate, Set Limits On Medicaid Expansion
The U.S. Supreme Court Thursday upheld nearly all of the landmark federal health law, affirming its mandate that most everyone carry insurance, but complicating the government’s plan to extend coverage to the poorest Americans. ... But a majority of the justices voted that the government could not compel states to expand Medicaid, the federal and state program for the poor, by threatening to withhold federal money to existing Medicaid programs (Rau and Appleby, 6/28). 

The New York Times: Supreme Court Lets Health Law Largely Stand, In Victory For Obama
The Supreme Court on Thursday upheld President Obama’s health care overhaul law, saying its requirement that most Americans obtain insurance or pay a penalty was authorized by Congress’s power to levy taxes. The vote was 5 to 4, with Chief Justice John G. Roberts Jr. joining the court’s four more liberal members (Liptak, 6/28).

The Wall Street Journal: Court Backs Obama On Health Law
The ruling clears the way for the biggest revamp of America's health-care system since the 1960s—and sets the stage for a renewed political fight over its merits. By a 5-4 vote, the court held the law's mandate requiring Americans to carry health insurance or pay a penalty valid under Congress's constitutional authority to levy taxes. The financial penalty for failing to carry insurance possesses "the essential feature of any tax," producing revenue for the government, Chief Justice Roberts wrote (Bravin and Radnofsky, 6/29).

Los Angeles Times: Supreme Court Upholds Obama's Healthcare Law
Led by a chief justice who some conservatives immediately branded a turncoat, the Supreme Court upheld most of President Obama's healthcare law Thursday, resolving a high-stakes constitutional clash not seen in decades and handing Obama a victory that surprised many in Washington (Savage, 6/29).

The Washington Post: Supreme Court Upholds Obama's Health-Care Law
The court’s 5 to 4 ruling was a stunning legal conclusion to a battle that has consumed American politics for two years. Roberts’s compromise offered a dramatic victory for Obama and Democrats' decades-long effort to enact a health-care law and a bitter defeat for Republicans and tea party activists, who had uniformly opposed the Patient Protection and Affordable Care Act (Barnes, 6/28).

Bloomberg: Obama's Health-Care Overhaul Upheld by U.S. Supreme Court
The U.S. Supreme Court affirmed the core of President Barack Obama's health-care overhaul in an opinion that held two surprises: Chief Justice John Roberts was the deciding vote, and his legal reasoning was unanticipated. The 5-4 ruling yesterday gave Obama an election-year triumph by declaring that Congress had the power to make Americans obtain insurance or pay a penalty. That requirement is at the center of the measure and of a political debate over the appropriate role of government in health care that showed no signs of abating with the court’s decision (Stohr, 6/29).

Kaiser Health News: Video: Making Sense Of The Supreme Court Ruling
This Kaiser Health News video webcast features KHN's Mary Agnes Carey, Stuart Taylor and Julie Appleby as well as SCOTUSblog's Tom Goldstein and Lyle Denniston as they discuss Thursday's landmark Supreme Court decision on the constitutionality of the health law. 

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Medicaid Piece Of High Court Decision Creates Questions For States

The element of the ruling that allows states to "opt out" of the health law's Medicaid expansion without losing current program funding immediately changed state-level implementation dynamics.

Kaiser Health News: Ruling Puts Pressure On States To Act
The Supreme Court has given states a way out of expanding the Medicaid program under the health law, but governors will be under strong pressure to take the federal money that would pay for coverage for millions of low-income people (Galewitz and Werber Serafini, 6/28).

The Wall Street Journal: Medicaid Decision Looms For States
The Supreme Court's decision to let states opt out of the health overhaul's Medicaid expansion without losing current funding for the program lifts a budget mandate from states but could mean fewer Americans gain insurance coverage under the law (Burton, Radnofsky and Dooren, 6/28).

NPR: High Court Health Care Ruling Shifts Action To States
The Supreme Court's decision to uphold nearly all of the Affordable Care Act may move the debate to presidential campaign trail. But it shifts much of the burden of implementing the law to the states.
States are actually responsible for the lion's share of getting people without insurance covered under the health law (Rovner, 6/29).

Los Angeles Times: Court's Decision Could Widen Medicaid Gap
The Supreme Court did not dismantle that guarantee Thursday. But while upholding the Affordable Care Act, the court opened the door to something the president and other champions of the law sought to avoid — widening disparities between red and blue states in who gets healthcare. Under the court's ruling, states will be free to elect not to cover all of their poor residents through their Medicaid programs (Levey, 6/29).

The New York Times: Uncertainty Over States And Medicaid Expansion
The Supreme Court said on Thursday that a huge expansion of Medicaid envisioned in the 2010 health care law was an option, not a mandate, for states. Experts disagreed on whether states would take the option, one of the most important questions created by the court’s decision (6/28).

The New York Times: States Face A Challenge To Meet Health Law’s Deadline
The Supreme Court’s decision to uphold the Affordable Care Act shifts the focus from whether sweeping changes to the health insurance market should take place to a scramble to meet the law’s rapidly approaching deadlines (Sack and Abelson, 6/28).

Bloomberg: States Confront Tough Choice on Medicaid Funds After Ruling
The U.S. Supreme Court ruling on President Barack Obama's health-care overhaul forces Republicans in states that opposed the measure to make a difficult choice. ..."There's probably a small group, at least initially, who won't do it," said Ray Scheppach, the former executive director of the National Governors Association who is now a professor of public policy at the University of Virginia in Charlottesville. "It's part political. It's part fiscal. There's pressure on them both ways" (Selway and Wayne, 6/28).

Modern Healthcare: Public Hospitals Wary Of Ruling On Medicaid
If states are not going to be required to expand Medicaid, that would hurt safety net providers, which as part of the ACA are going to see reduced payments from the disproportionate-share hospital program, Siegel said. The expansion of Medicaid would have presumably removed the need for the DSH program, but now that trade-off is put into question, he said. The [National Association of Public Hospitals and Health Systems] wants Congress to avert what it says would be a potentially disastrous outcome for vulnerable populations by immediately re-evaluating safety net funding in light of the decision, according to a news release (Barr, 6/28).

The Fiscal Times:  Will States Opt Out Of Medicaid Expansion?
Now states are facing another crossroads in the evolution of the program, assuming the Affordable Care Act, better known as Obamacare, politically survives beyond the fall elections. The Supreme Court on Thursday reaffirmed the right of states to reject expanding Medicaid to cover poor-but-working adults and prohibited the federal government from withdrawing support for other parts of the program to penalize non-participation.  Some states are already planning to ignore the coverage expansion offer when it goes into effect in 2014 (Goozner, 6/28).

CQ HealthBeat: States With Largest Uninsured Populations May Be More Likely To Opt Out Of Medicaid
Any states that choose to follow the Supreme Court's ruling and opt out of the health care law's Medicaid expansion are likely to be those with a larger population of uninsured and poor people, experts said. But doing so would mean refusing huge sums of federal money, which could be difficult for most states to do (Reichard, 6/28).

Stateline:  Court Lets States Opt Of Medicaid Expansion
But in declaring the health law constitutional, the justices also limited the federal government’s power to compel states to expand their Medicaid programs. That is likely to change the course of the law’s implementation in much of the country…The court ruled that if a state chooses not to participate in the Medicaid expansion, the federal government can withdraw only funds specifically targeted to the expansion. It cannot take away existing Medicaid funds (Vestal, 6/28).

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How The Medicaid Ruling Is Playing In The States

State officials offer views on their newfound options regarding the health law's Medicaid expansion. Also, news outlets report on how many people might become eligible for Medicaid and at what cost. 

Georgia Health News: Weighing Impact On Medicaid Expansion, Exchange
Gov. Nathan Deal  said Thursday that it's too early for the state to make a decision on whether to expand Medicaid or create its own health insurance exchange, if the Affordable Care Act (ACA) survives a renewed Republican effort to repeal it. Deal, expressing dismay over the Supreme Court ruling that largely upheld the health law, called for its repeal by Congress. He said at a press conference that he did welcome the part of the court ruling that left it up to the states whether they would expand their Medicaid programs to cover more low-income residents (Miller, 6/28).

Richmond Times-Dispatch: Virginia Faces Key Decisions On Special Session, Medicaid
Virginia political leaders and lawmakers may not like the U.S. Supreme Court ruling to uphold federal health care reform, but they face big decisions soon on how to carry out the law in a national election year. The most immediate decision is whether to call a special legislative session this year on creating a state exchange for health benefits. The ruling also gives Virginia an unexpected choice on whether to expand its Medicaid program to cover hundreds of thousands of uninsured Virginians. Calling the court's decision "extremely disappointing for Virginia and for America," Gov. Bob McDonnell said the state will evaluate the steps necessary to comply with the Patient Protection and Affordable Care Act. "While we have awaited this decision, planners have been working to identify necessary resources and issues to be addressed to ensure Virginia implements this flawed law in the most effective and least costly and burdensome way possible," he said in a statement immediately after the ruling Thursday (Martz and Meola, 6/29).

Arizona Republic: Health Care Ruling Could Mean Coverage For Hundreds Of Thousands Of Uninsured Arizonans
Arizona Gov. Jan Brewer and state lawmakers face a key decision in the wake of the U.S. Supreme Court upholding the federal health-care law's broad expansion of Medicaid: They can extend health insurance to more than 300,000 low-income Arizonans at a cost of $250 million for the first year or opt out of the largest expansion in Medicaid's nearly 50-year history. Brewer is expected to confer with health-care officials in the coming weeks before deciding (Reinhart, 6/28).

The Houston Chronicle: Health Law Ruling Leaves Uninsured Texans In Limbo
The 6.5 million Texans without health insurance faced a future of hope tempered with uncertainty Thursday, as the U.S. Supreme Court ruled that most of the health care reform law was valid but left a key provision up to the states…..But the ruling left plenty of questions unanswered, including whether Texas will participate in a program to expand Medicaid coverage - if it doesn't, as many as 1.5 million low-income people will remain uncovered - and whether, and how quickly, it will set up the health insurance exchange intended to make it easier to shop for insurance. Texas did little to prepare for the law (Kever and Ackerman, 6/28).

The Dallas Morning News: Health Law Ruling Means Texas Could Reject Medicaid Expansion, But At A Cost
The U.S. Supreme Court’s decision on the health law gives Texas an opportunity to opt out of a massive expansion of Medicaid that would enroll as many as 1.5 million more adults in the program….The opinion is likely to prompt some Texas conservatives to demand that Texas opt out of the Medicaid expansion. That choice is likely to become a major part of the Legislature’s agenda when it meets in January (Michaels, 6/28).

Detroit Free Press: Medicaid Expansion: Up To 500,000 More People Will Be Covered In Michigan
Among the provisions of the law: As many as a half-million more of Michigan's lowest-income residents will get government-funded Medicaid insurance as it expands under health care reform in 2014 -- an expected influx on top of the 1.9 million already in the program. … The better system is one in which consumers purchase an affordable Medicaid plan that works as a health savings account of sorts -- ensuring patients are more thoughtful about accessing care, said Dr. Matt McCord, an Ann Arbor anesthesiologist and member of Docs4PatientCare, a national group of doctors fighting the new law. The Supreme Court ruling is a reminder that the state needs to be careful about how it expands its program, McCord said (Erb and Anstett, 6/29).

CNN Money: Medicaid Expansion: Many Could Be Left Out
The Supreme Court may have upheld health care reform, but the ruling has left many of the poorest Americans at risk of remaining uninsured. The justices' decision Thursday kept in place nearly all of the Affordable Care Act's provisions, including the mandate that all consumers buy health insurance by 2014 or pay a tax. Also upheld was a provision that expands Medicaid coverage to include all adults with annual incomes at or below 133% of the federal poverty level, which is currently $14,404 for an individual. The federal government will pick up the total cost of the expensive expansion for the first three years, after which the funding will phase down to 90%. The expansion could reduce the number of uninsured adults with incomes under 133% of poverty by more than 11 million by 2019, according to a Kaiser Family Foundation estimate (Luhby, 6/29).

Des Moines Register: Will Branstad Resist Letting 150,000 More Iowans Onto Medicaid?
Iowa Gov. Terry Branstad declined to immediately say whether he would resist an expansion of Medicaid, which the U.S. Supreme Court ruled today cannot be forced on states. … Branstad spokesman Tim Albrecht said today that his office couldn’t immediately comment on how the governor might handle the matter (Leys, 6/28).

Health Policy Solutions (a Colo. news service): Supreme Court Ruling Clears Way For Sweeping Health Reform
In Colorado, the ruling clears the way for sweeping multi-million dollar health reform to move forward. Only one part of the massive law appeared to be in doubt. Analysts in Colorado and around the country were trying to figure out exactly how the ruling on Medicaid expansions would affect them. … Gov. John Hickenlooper said in a statement that millions of Coloradans have already benefited from the Affordable Care Act (ACA) including thousands of young adults and people with pre-existing conditions who have been able to qualify for health insurance, seniors who have taken advantage of preventive screenings, and hundreds of thousands of Coloradans who no longer have lifetime limits on their health coverage (Kerwin McCrimmon, 6/28).

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'Tax' Term Looms Over Health Law Decision

By upholding the individual mandate as a tax, the Supreme Court's ruling on the health law could be a potent political weapon for conservatives, news organizations report.

The Fiscal Times: Upholding The Conservative Centerpiece Of Reform
For nearly a century, progressives have dreamed of enacting a universal insurance scheme that provides affordable access to health care for all Americans. That's what led reform advocate Ron Pollack of Families USA on Thursday to call the Supreme Court decision "a hallelujah moment" (Goozner, 6/29).

The New York Times: Justices Allow The Term 'Tax' To Embrace 'Penalty'
But by calling the penalty for not buying health insurance a tax, the Supreme Court on Thursday effectively created a tax that people will pay only if they do not buy something. That decision led some opponents of the health care law to proclaim that it was a large tax increase, something the sponsors of the bill had explicitly denied when the law was passed (Norris, 6/28).

The Fiscal Times: Why The Health Care Mandate 'Tax' Is A Paper Tiger
The financial consequences to small businesses, investors and consumers are now top of mind following today's Supreme Court ruling that left intact almost all of the Affordable Care Act, otherwise known as Obamacare. Attorney Mike Carvin, who argued against the ACA before the high court, told Fox News that as a result of the decision, "Obamacare will go into effect absent a political solution and will impose enormous costs on small businesses. It will lead them to do one of two things: Either never get over 50 employees, which means they might have to fire some people; or get over 50 employees and pay onerous health insurance; or, they may just drop health insurance entirely and pay the penalty" (Mackey, 6/28).

The Hill: High Court Gives New Weapon On Taxes
Republicans have seized on the Supreme Court's decision that the health insurance mandate is a tax, believing it will help them argue a second term for President Obama would be devastating for the economy. Presumptive GOP nominee Mitt Romney employed the line of attack shortly after the ruling came down, asserting "Obamacare raises taxes on the American people by approximately $500 billion" (Stanage and Parnes, 6/29).

Reuters: Supreme Court Ruling Casts Tax Shadow Over U.S. Health Care Law
Republicans seized on a momentous U.S. Supreme Court ruling on Thursday to accuse President Barack Obama of hiding a tax increase in his health care law, an argument likely to intensify a congressional tax policy war already underway. The court ruled the 2010 law was valid because Congress has the power to impose taxes. The Obama administration played down the tax factor, but Republican opponents pounced on the decision, seeking to elicit political points from a legal issue (Dixon and Drawbaugh, 6/28).

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Health System Changes Move Forward

Press reports detail the steps that might happen next in terms of the health law's implementation as well as what the decision might mean for consumers.  

Los Angeles Times: Ruling Allows Healthcare Changes To Proceed
After two years of heated debate, the Supreme Court, in largely upholding President Obama's healthcare law, provided much-needed clarity to consumers, insurers, states and others. While some provisions of the law have already gone into effect, many of the most significant ones — including a requirement that almost all Americans have health insurance — won't kick in until 2014 (Geiger, 6/29).

The Washington Post: Health-Care Decision: What Happens Now?
The Supreme Court’s decision to uphold all but one provision in the Affordable Care Act means that for now, at least, one of the most far-reaching overhauls of the nation’s health-care system will be the law of the land. New rules for insurers that have taken effect will remain in place, while new opportunities to gain health-care coverage will begin in 2014 (Aizenman, 6/28).

USA Today: What's Next In Health Care? Implementation Of Law Goes Ahead
The waiting game is over for consumers, employers, health care providers and insurers. Thursday's Supreme Court ruling that upheld the 2010 health care law means ongoing trends will continue, and those who waited on the sidelines for the court will now have to implement their parts of the law. For consumers, that means that those intimidated by what opponents called the overly complex part of the law will have to learn what will affect them, particularly if they have to buy their own insurance or pay a penalty for skipping it. Employers who fought the law as a job killer will now have to come to grips with it and minimize the parts they don't like (Kennedy, Lloyd and Szabo, 6/28).

The Washington Post: The Impact: What Does The Supreme Court's Health-Care Ruling Mean For Me?
The court's decision to uphold all but one component of the health-care law means new rules for insurers that have already taken effect will remain in place. Beginning in 2014, virtually all Americans will have to obtain health insurance or pay a penalty (6/28).

McClatchy Newspapers: Consumers Who Benefit From Health Care Law Relish Supreme Court Ruling
The health care law also requires plans with dependent coverage to insure adult children up to age 26. A government report found 3.1 million young adults gained health coverage because of the provision. From September 2010 to December 2011, the percentage of young adults ages 19 to 25 with health insurance has increased from 64.4 percent to 74.8 percent. They include people like 21-year-old Abby Schanfield of Minneapolis. Schanfield was born with toxoplasmosis, a rare parasitic infection, which forces her to undergo regular brain and eye surgeries, and she could eventually lose vision in one eye (Rudansky and Pugh, 6/28).

Market Watch: What The Health-Care Ruling Means For You
The Supreme Court’s decision Thursday to uphold the bulk of the landmark health-care overhaul will leave intact some popular provisions, such as requiring insurers to accept people with pre-existing conditions and to cover children up to age 26 on parents’ plans, but it may mean higher health costs ahead. The ruling delivers a huge victory to President Barack Obama on the signature law of his presidency—a law that promises to make insurance available to a good number of the 49 million Americans who are currently uninsured (Coombes and Gerencher, 6/28).

Reuters: Sick Americans Relieved At High Court Health Ruling
Americans who were relying on a U.S. healthcare overhaul to provide them with health insurance heaved a collective sigh of relief after the Supreme Court upheld the law, which aims to extend coverage to more than 30 million people (Steenhuysen, 6/28).

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Immediately After The Decision: Confusion

Because two cable TV networks initially were wrong in their reports about the court's verdict, lawmakers, candidates and even the president were confused about the court's findings.

The Wall Street Journal: In Moments After Decision, Confusion
The first word President Barack Obama received of the ruling on his signature legislative achievement was that he had lost. It took mere seconds for erroneous reports by a pair of cable news channels, CNN and Fox News, to set off a flurry of confusion among lawmakers, candidates and even the president, all of whom had carefully prepared multiple responses for the moment, based on different potential outcomes (Lee and Lippman, 6/28).

Reuters: Chaos, Confusion Mark Cable TV Reports On Supreme Court Ruling
Sometimes, breaking news requires a little fixing. The antique traditions of the U.S. Supreme Court collided with the now-now-now news media on Thursday, resulting in chaos and chagrin as two U.S. cable television networks wrongly reported that the heart of President Barack Obama's signature healthcare law had been overturned by the nation's highest court (Jacobs, 6/28).

Reuters: Obama Hears Health Law Overturned; Moments Later, Thumbs-Up
President Barack Obama was standing outside the Oval Office when he saw the news on television just after 10 a.m. Two networks, CNN and Fox News, were reporting the Supreme Court had struck down the centerpiece of his landmark healthcare law. He looked quizzically at the TV screen. Moments later, his face brightened. White House Counsel Kathryn Ruemmler walked in and flashed him two thumbs-up. The court had in fact upheld the Patient Protection and Affordable Care Act. The TV networks had reported it wrong (Mason, 6/28).

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Roberts' Position Dismays Conservatives, Surprises President

The chief justice treads a very narrow path to find the health law constitutional and helps to redefine the public's view of the court.

NPR: Chief Justice Robert's Vote Saves Health Care Law
By a vote of 5-4, the Supreme Court upheld almost all of the 2010 health care law. Chief Justice John Roberts joined the court's four more liberal members in saying it is constitutional under Congress' right to levy taxes (Totenberg, 6/29).

The Wall Street Journal: Roberts Straddles Ideological Divide
With the ruling he crafted that largely upheld President Obama's Affordable Care Act, Chief Justice Roberts reframed the court and his tenure at its helm (Jones and Kendall, 6/28).

The Fiscal Times:  Roberts Saves Health Law And Maybe Obama's Job
With a vote that shocked conservatives, Roberts joined the liberal wing of the court to preserve the heart of the landmark legislation designed to extend coverage to 33 million uninsured Americans. By calling the penalties for failing to buy insurance a tax, Roberts was able to join the four liberals on the nine-member court to form a majority in favor of the law. The stunning turnabout after months of speculation that the court would strike down the individual mandate – if not the entire law – was an unalloyed political victory for Obama (Pianin, 6/29).

USA Today: Chief Justice's Role Takes Ironic Turn
Chief Justice John Roberts delivered the opinion for a fractured court Thursday, joining the court's four liberal justices in upholding the central pillar of the health care overhaul, which requires that Americans have health insurance or pay a penalty. It was an unusual lineup for a court that often cleaves along predictable lines, and it put the usually conservative chief justice between two factions on the court with dramatically different views of how powerful the federal government should be (Heath, 6/28).

Reuters: Analysis: Why Roberts Saved Obama's Healthcare Law
In the end, it all came down to Chief Justice John Roberts, the sphinx in the center chair, who in a stunning decision wove together competing rationales to uphold President Barack Obama's healthcare plan. Roberts' action instantly upended the conventional wisdom that he would vote with his four fellow conservative justices on the U.S. Supreme Court and undercut the agenda of a Democratic president, who as a senator in 2005 had opposed Roberts' appointment to the bench (Biskupic, 6/29).

The Associated Press: Roberts Delivers For President Who Had Opposed Him
As a junior senator, Barack Obama voted against John Roberts' nomination to the Supreme Court, fearing he would favor the powerful over the weak. Now it is Roberts who has saved the signature achievement of Obama's presidency, the health care overhaul, in a ruling that challenges critics' assertions that the chief justice is nothing more than a conservative ideologue (Benac, 6/28).

Los Angeles Times: Supreme Court Healthcare Ruling Gives Obama A Political Boost
The Supreme Court's surprise healthcare ruling was a lift for President Obama, preventing what would have been an embarrassing setback in an election year. And it came from an unexpected source — a conservative jurist whose confirmation Obama voted against as a senator (West, 6/29). 

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Administration News

How The High Court's Decision Contributes To Obama's Legacy

News outlets report on how the health law, and the Supreme Court's review of it, will be important parts of President Barack Obama's place in history.  

The New York Times: A Vindication, With A Legacy Still Unwritten
For Barack Obama, who staked his presidency on a once-in-a-generation reshaping of the social welfare system, the Supreme Court’s health care ruling is not just political vindication. It is a personal reprieve, leaving intact his hopes of joining the ranks of Franklin D. Roosevelt, Lyndon B. Johnson and Ronald Reagan as presidents who fundamentally altered the course of the country (Landler, 6/28).

The Washington Post: Ruling Secures For Obama A Larger Place In History
Until Thursday, it wasn't clear that future generations would have much to assess about the enduring legislative legacy of the Obama presidency. There had been no victory on climate change, no shift in the way Washington worked, no grand bargain to cut the deficit. And it looked as if a hostile Supreme Court was going sour on the Obama administration's one big policy accomplishment — the marquee law achieving the liberal movement’s decades-long goal of near-universal health care (Wallsten, 6/28).

In other news -

Los Angeles Times: Scorned After Oral Arguments On Healthcare, Verrilli Emerges A Winner
Solicitor General Donald B. Verrilli Jr., who was widely criticized in March for having flubbed the defense of President Obama’s healthcare law before the Supreme Court, may actually have been the person who saved the law, employing a move that went largely unnoticed at the time (Savage, 6/29).

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Health Care Marketplace

Most Health Care Firms Expect To Benefit From Health Law

The court's decision to uphold the law is expected to help nearly every corner of the health care industry, The Associated Press reports. But other outlets also note that insurers are concerned about new rules.

The Associated Press: High Court Ruling Benefits Most Health Care Firms
The Supreme Court's decision Thursday to uphold President Barack Obama's historic health care overhaul is expected to benefit nearly every corner of the health care industry by expanding coverage to millions of Americans. But it's not a slam dunk. Hospitals and drugmakers are expected to be flush with new customers because of the law's requirement that most Americans have insurance by 2014 or pay a fine. Insurers also are expected to experience a boon, but they'll face a new round of fees and restrictions. It's unclear if medical device makers will get the same jump in business, and the law calls for them to pay new taxes (Johnson, 6/28).

The New York Times: In Health Care Ruling, Investors See A Mixed Blessing
Hospitals will gain millions of paying customers. Insurers, by contrast, could face crimped profits from restrictive rules. Medical device and pharmaceutical companies will bear new taxes and other higher payouts, but they were already expecting such costs (Pollack and Thomas, 6/28).

Reuters: Hospitals Win In Health Ruling, Mixed View For HMOs
Hospitals and insurers providing Medicaid plans for the poor emerged as the main corporate winners from the U.S. Supreme Court's decision to uphold President Barack Obama's health care law, while investors in large insurers were left deflated. The ruling paves the way for hospitals to see a massive influx of insured customers from the law which is expected to broaden coverage to more than 30 million uninsured Americans (Krauskopf, 6/28).

Reuters: NYC Public Hospitals See Big Financial Hit From Health Care Law
The New York City Health and Hospital Corporation expects to lose $2.3 billion over eight years from the Medicaid cuts included in President Barack Obama's new health care law. … Alan Aviles, the HHC chief executive officer, said on Thursday that although more people will have insurance, this will not make up for the loss of Medicaid funds (6/28).

USA Today: Insurers Like That Health Law Ruling Sets Their Path
Insurance companies hailed the Supreme Court's ruling upholding the Affordable Care Act, saying it gives them certainty about the rules they'll face as they push to cut administrative costs and reward doctors who contain health care costs by emphasizing preventive care (Mullaney, 6/28).

Kaiser Health News: Hospitals Celebrate Decision, But Threats Remain
Even if President Barack Obama is re-elected, the ruling letting states refuse the act's Medicaid expansion puts at risk billions of dollars in potential federal funding of medical care. "We have a lot of questions about that," said Richard Umbdenstock, CEO of the American Hospital Association. "It wasn’t an area that people focused on." That’s a financial risk for all hospitals in those states that opt out but especially for "safety net" hospitals that serve the uninsured poor. Not only would the hospitals miss out on the expansion of Medicaid coverage; over time the health act reduces the Medicare and Medicaid surpluses they collect for handling a disproportionate share of low-income patients (Hancock, 6/29). 

Philadelphia Inquirer: Hospitals Delighted By High Court's Ruling; Other Health Sectors Mixed
Hospital executives were delighted Thursday by the U.S. Supreme Court's decision -- called an "unexpected twist" by one -- to uphold the nation's embattled health reform law. "This is good for hospitals because 32 million people will now have some kind of coverage, which they didn't have previously. We had bad debts from this group because they didn't have funds to pay," said Alan B. Miller, chairman and chief executive of King of Prussia hospital operator Universal Health Services Inc. Investors agreed with Miller's assessment, bidding up hospital stocks by an average of 7 percent (Brubaker, Sell, Burling and Von Bergen, 6/29).

Arizona Republic: Obama Health Care Decision Stands To Benefit Hospitals, Insurers
Surprise, confusion and skepticism -- but also a little relief. Those are reactions from the health-care industry and the broader business community after the U.S. Supreme Court's decision to uphold the core of President Barack Obama's Affordable Care Act. Reginald M. Ballantyne III, senior corporate officer at Vanguard Health Systems in Phoenix, is a former chairman of the American Hospital Association. Though conceding the law has "complexities, nuances and imperfections," he calls it an important step to reforming the health-care system (Wiles, 6/28).

CT Mirror:  Connecticut Businesses Concerned About Ruling’s Impact
Groups representing Connecticut businesses Thursday were wary of the Supreme Court's landmark health care decision, concerned it will drive up costs and even prompt some small businesses to stop offering health insurance altogether. "This is basically a devastating loss for small businesses, which are at the mercy of the law, the law that has already driven up the cost of insurance premiums," said Andrew E. Markowski, state director of the Connecticut chapter of the National Federation of Independent Businesses. While it is too early to predict the full impact of the ruling, he said that, anecdotally, he has heard that many small businesses plan to stop offering health insurance coverage (Merritt and Phaneuf, 6/28).

Los Angeles Times: Retailers, Factories, Main Street React To Supreme Court Ruling
The U.S. Chamber of Commerce said it respects the decision but called for more reforms anyway, maintaining that the ruling "does not change the reality that the health care law is fundamentally flawed." The Main Street Alliance quoted its members as saying that "this is a good day for small businesses across America ... [that] couldn't afford to go back to the nightmare scenario" before the health care law (Hsu, 6/28).

Los Angeles Times: Olive View Sees Health Care Ruling As A New Challenge
It was a historic moment for the nation's health care system, but a routine one at Olive View-UCLA Medical Center's emergency department. Patients packed the waiting room suffering from chest pains, skin infections, stomach cramps and headaches -- the least urgent cases waiting up to 12 hours to be seen (Bermudez and Zavis, 6/29). 

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Ruling On Health Care Roils The Markets

Hospital stocks surged but insurance stocks fell.

Los Angeles Times: Supreme Court Ruling Causes Big Swings In Health Care Stocks
Health care stocks swung wildly as investors scrambled to figure out how the Supreme Court's ruling on President Obama's health care law would affect companies throughout the medical industry (Hamilton and Tangel, 6/29).

The Fiscal Times:  For Businesses, Court Ruling Provides Clarity … For Now
For now, though, the ruling sent hospital stocks surging but insurance stocks lower as analysts and investors tried to glean what the ruling will mean for those industries. Insurance companies may have been pressured -- UnitedHealth Group rose 0.5 percent, but WellPoint (WLP) lost 5.2 percent, and Aetna (AET) slipped 1.1 percent -- by worries about the costs of the rules and requirements they will now face. The rise of insurance exchanges brought about by the law will increase pressure on companies like UnitedHealth and WellPoint that have relatively large individual insurance businesses, analysts at Moody’s Investors Service wrote recently (Rosenberg, 6/29).

Market Watch: How Hospital, Insurer Stocks Fared After Ruling
The sweeping health care law upheld Thursday by the Supreme Court proved to be a boon to hospital stocks and some Medicaid insurers, but commercial insurers faced selling pressure. The decision came as a surprise, as conventional wisdom said the court would strike down the purchase requirement known as the individual mandate. It apparently surprised investors in large, commercial insurers as well, though the selloff tempered as the day wore on (Britt and Lesova, 6/28).

Bloomberg: HCA Gains While Insurers Fall On Health Law Ruling
Hospital companies led by HCA Holdings Inc. (HCA) jumped in New York trading after the Supreme Court upheld a U.S. health care law that may arrest a rising tide of uninsured patients unable to pay their medical bills. Medicaid insurers also rose, paced by Molina Healthcare Inc. (MOH), after the court mostly supported a rule expanding the U.S. health plan for the poor. Commercial carriers such as WellPoint Inc. (WLP) fell in the face of the law's new regulations (Nussbaum, 6/28).

The Associated Press: Hospital Stocks Jump After Health Care Ruling
Hospital stocks rose sharply Thursday after the Supreme Court guaranteed them millions more paying customers by upholding the core of President Barack Obama's health care overhaul. Some insurance company stocks fell in choppy trading as investors fretted about the costs of rules included in the law (Wagner, 6/28).

Kaiser Health News: Hospital Stocks Soar As Court Upholds Health Act
A decision to strike down the act would have maintained hospitals’ responsibility of caring for the uninsured while removing the means for patients to gain coverage, resulting in a severe financial pinch, analysts said. So stocks of for-profit hospital companies soared on Wall Street today even as the overall market fell (Hancock, 6/28).

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Campaign 2012

What Does Ruling Mean For Politics? Dems, GOP Seek To Energize Bases

Supporters of President Obama and GOP presidential candidate Mitt Romney are using the Supreme Court health law ruling as motivation ahead of November's presidential election.

The Washington Post: Health Care Ruling Motivates Romney Supporters
If conservatives needed any more motivation to unseat President Obama, they got it Thursday from the Supreme Court, which provided fresh political opportunities for Mitt Romney even as it handed the president a legal victory. Chief among those new lines of attack is the court’s determination that the law's individual mandate -- the penalty it would impose on people who refuse to buy insurance -- amounts to a tax. Obama had previously insisted it was "absolutely not a tax increase" (Tumulty and Henderson, 6/28).

Bloomberg: Obama's Supreme Court Win May Help Now More Than November
The most important U.S. Supreme Court decision during a president's re-election campaign may not have fundamentally changed the dynamics of the 2012 race. In the hours after the court upheld President Barack Obama's health care law, both he and his Republican challenger, Mitt Romney, retreated to previously stated positions: Romney vowed to repeal and replace the law, while Obama touted its attributes and warned of the consequences of repeal. They sought to frame the issue in the larger context of what's at stake for voters and underscored the centrality of the economy in the presidential election (Goldman and McCormick, 6/28).

USA Today: Analysis: Victory For Obama Now, But What Of Election?
After the health care law passed in 2010, President Obama and his aides celebrated the passage of his signature achievement with a toast on the Truman Balcony at the White House. When the Supreme Court announced its landmark decision Thursday that upheld most of the law, the response was more muted. That was because the political impact on November's hard-fought election is at least mixed (Madhani, Kucinich and Page, 6/28).

Reuters: Romney To Campaign As Only Hope Against 'Obamacare'
The battle over President Barack Obama's landmark health care law shifted from the Supreme Court to the campaign trail on Thursday, as Republican challenger Mitt Romney asked voters to throw Obama out of office to get rid of the unpopular law. The high court's 5-4 decision to uphold the law was a setback for Romney and his fellow Republicans, who had hoped that Obama's central policy achievement would be struck down as unconstitutional (Sullivan, 6/28).

The Associated Press: Campaign Impact: Obama, Romney Seize On Ruling
Battling fiercely for the White House, President Barack Obama and Republican rival Mitt Romney implored voters to see the Supreme Court's health care ruling in different ways Thursday, with Obama appealing for people to move on with him and his challenger promising to rip up the law (Feller, 6/28).

Market Watch: Health Ruling Jolts Race For White House
The Supreme Court's decision on Thursday to uphold President Barack Obama’s health care law delivered an immediate jolt of energy to the 2012 campaign, laying down fresh battle lines between the incumbent Democrat and his Republican challenger, Mitt Romney. For Obama, the 5-4 ruling was vindication of his signature domestic initiative, and a big piece of good news for his reelection effort. It will jazz up his liberal base and give the president something to crow about to donors -- though the president himself was careful not to gloat during a post-decision statement at the White House (Schroeder, 6/28).

In the meantime, the decision has given the GOP a new focus of attack ahead of November's elections -- taxes:

Bloomberg: Republicans Focus Health Law Attack on Taxes After Ruling
Republicans in Congress are recasting President Barack Obama's health care law as a significant tax increase imperiling a fragile economy as they continue efforts to repeal the law after the Supreme Court upheld its core tenets. Moments after the court's 5-4 decision yesterday, Republican lawmakers and allies including the anti-tax Club for Growth shifted from attacking the constitutionality of the law's requirement that Americans purchase health insurance or pay a penalty to emphasizing its tax implications for millions of Americans (Przybyla, 6/29).

The Associated Press: Analysis: GOP Sees Tax Opening In Obama Court Win
For President Barack Obama to turn his Supreme Court victory into a clear-cut political win this fall, he must do something other candidates have failed to do: make voters care that GOP opponent Mitt Romney once embraced the health care policies he now fiercely criticizes. If Obama can't do that, then Romney may find it easy to fire up conservative activists who despise what they label "Obamacare," while also attracting moderate voters who simply dislike it. And the Republican will have a new anti-tax argument, thanks to the high court (Babington, 6/29).

Politico: GOP Sees Down-Ballot Gold In Supreme Court Decision
Over the course of its short life span, the Affordable Care Act has left a trail of political wreckage behind it - and while an exultant White House breathed a sigh of relief in the wake of Thursday’s Supreme Court validation, Obama’s signature policy achievement still faces a host of questions ahead. First among them: Does the party really want to embrace a measure that proved so costly to Democratic candidates in 2010 and polls so poorly? While the Supreme Court’s decision upholding the law provided the president with a major victory, the trickle down political effect isn’t quite so obvious. Put another way, for down-ballot Democrats in red or purple states, the politics of health care still aren’t so good. With Thursday’s defeat, Republicans were handed a powerful tool for motivating their base and a fresh ammo clip for use in House and Senate races across the map. It removed one arrow from the Democratic quiver -- the prospect of an outraged and highly motivated base -- and provided a new one to the GOP by defining the mandate as a tax (Mahtesian, 6/29).

The Dallas Morning News: Legal Victory On Health Care Helps Obama Campaign, But Republicans See Edge, Too
President Barack Obama bet his first term on health care and won a huge vindication Thursday at the Supreme Court. But legal victory, however stunning, won’t ensure political survival for Obama or his signature achievement. Both hang in the balance in November’s election, and the impact of Thursday’s ruling, with more than four months remaining in the campaign, may be a muddle (Gillman, 6/28).

The New York Times: GOP Vowing To Take Battle Over Health Care Law Into November
Taken aback by the Supreme Court ruling on Thursday that upheld the constitutionality of the law, Mr. Romney and Congressional Republicans pledged to intensify their efforts to repeal it, an argument that will be a crucial element of the party's quest to galvanize conservative activists and win control of the White House and the Senate (Zeleny, 6/28).

Minneapolis Star Tribune: GOP Switches To Court Of Public Opinion
The Supreme Court decision upholding the 2010 health care law provided a huge political boost for President Obama, but it also serves up a fresh new campaign issue for races in Minnesota and across the nation. Ruling that the law's controversial coverage mandate can survive as a tax, rather than as a governmental power over interstate commerce, the high court on Thursday reshaped the debate over the landmark law that extends health insurance to 30 million more Americans (Diaz and Mitchell, 6/28).

Others, including Democrats and tea party activists also look to seize on the ruling to gain a political edge --

The Associated Press: Dems Savor Victory In Health Care Ruling -- For Now
Love or hate President Barack Obama's signature health care law, its survival in the Supreme Court was sweet vindication for the Democrats who took enormous political risks -- and paid with the loss of 64 seats and their House majority -- to pass the law on their watch in 2010 (Kellman, 6/29).

Roll Call: Health Care Ruling Re-Energizes Tea Party
In upholding most of President Barack Obama's health care law, the Supreme Court handed the tea party a new lease on life. While activists spouted made-for-TV rancor through megaphones outside the court Thursday, the behind-the-scenes strategists who helped Republicans take the House in 2010 prepared for a flood of donations they said will fuel even greater gains this November (Lorber, 6/29).

Denver Post: Supreme Court Health Care Ruling Fires Up Tea Party
The U.S. Supreme Court only made the Tea Party more agitated Thursday. When the high court upheld the requirement that everyone purchase health insurance -- a 5-4 decision that surprised almost everyone -- Republicans and GOP strategists vowed to double down in politically gettable states like Colorado to try and turn the tables of power -- not only in the White House, but in the U.S. Senate and House of Representatives, too (Sherry, 6/28).

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Capitol Hill Watch

Unfazed, Republicans Ready Repeal Redux Post-SCOTUS Decision

Republicans on Thursday vowed to repeal the health care law after the Supreme Court ruling affirming the constitutionality of the law and are planning a repeal vote in the House on July 11. In the meantime, some states, including Georgia for instance, will hold off on implementing key parts of the law to see if the GOP is successful.

The Hill: 120 Republicans Introduce Bill To Repeal The Health Care Mandate
Just hours after the Supreme Court upheld the requirement to buy health care insurance or face a penalty, 120 House Republicans proposed legislation to eliminate the mandate. The bill's sponsor, Rep. Michael Turner (R-Ohio), called the mandate a tax, since that is how the court justified keeping it around. The Supreme Court said the government had no right to require the purchase of health insurance under the Commerce Clause, but said the mandate and its penalties could stand as a tax on people who choose not to buy health insurance (Kasperowicz, 6/28).

Politico: The Republican Recipe For Repeal
Republican hopes to repeal the health care law may come down to a bank shot: A GOP sweep in November and a simple Senate majority -- along with some arcane budget procedures -- could kill the individual mandate in 2013. The House will hold a symbolic vote to repeal the law on July 11, but the real long-term strategy for rolling back the law is already under way. Republicans are stoking voter anger over the law until Election Day, which they hope will produce a Mitt Romney presidency and an all-Republican Congress. And it ends by employing budget rules that would allow a fast-track repeal with a 51-vote majority in the Senate, circumventing a Democratic minority and potential filibuster (Raju and Sherman, 6/29).

CBS News: Cantor: Health Care Repeal Vote Coming July 11
The Supreme Court gave some validation to the Affordable Care Act on Thursday when it declared the law constitutional, but House Majority Leader Eric Cantor is ready to move forward with yet another House vote to repeal the controversial law. "We know that most of the American people don't like this law," Cantor said on CBS' This Morning Friday. The House, he said will "look towards the kind of health care people want," which he said is "patient-centered." Cantor said that the Republican-led House will take up a repeal vote on July 11th, after Congress comes back from its July 4th recess. The House first voted to repeal the law in January 2011, soon after Republicans took control. The move, however, was essentially symbolic (6/29).

NPR: Undeterred By Court's Decision, GOP Vows To Repeal Health Care
Congressional Republicans reacted to the Supreme Court's validation of President Obama's health care law with a promise to repeal the law (Seabrook. 6/29).

CT Mirror: Supreme Court Decision Renews Health Care Fight In Congress
The Supreme Court's decision to uphold the constitutionality of the Affordable Care Act has done nothing to close the chasm of public and political opinion about the health care overhaul. As hundreds of protesters gathered in front of the high court cheered or jeered the decision, Republicans in Congress voiced renewed commitment to overturn the law that is backed by Connecticut's Democratic lawmakers (Radelat, 6/28).

The Atlanta Journal-Constitution: Georgia Pins Hopes On Health Care Act’s Repeal
The state of Georgia, which delayed action on the federal health law in the hope that it would be ruled unconstitutional, will delay action again in the hope that Republicans win the White House and Congress and repeal the law. Gov. Nathan Deal, describing the measure as the "largest tax increase in the history of the United States," said Thursday the state will hold off on two of the most important decisions it faces — whether to go forward with a giant expansion of Medicaid and with the creation of a state-run insurance exchange (Teegardin and Williams, 6/29).

MinnPost:  Supreme Court’s Health-Law Ruling Means Full Steam Ahead For GOP Repeal Efforts
The Supreme Court’s decision today to uphold President Barack Obama's health care reform law means one thing for Congress: It's full steam ahead for the Republicans’ plan to repeal it. Such a repeal is likely to fail in the Senate and would certainly meet a veto from Obama. But House Republican leaders committed themselves to a full repeal push after the court’s decision came down, scheduling a vote for July 11. Republican members of the U.S. House delegation from Minnesota have long championed repeal and reaffirmed that today, with the state’s four congressional Republicans releasing statements opposing the law. Rep. John Kline, the delegation’s senior Republican, said the court’s decision “underscores the importance of fully repealing Obamacare” (Henry, 6/28).

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State Watch

States Prepare New Push On Exchanges Post-SCOTUS Decision -- Or Grind To A Halt With Confusion, Opposition

From the states, reactions involving confusion, celebration or stiff opposition regarding the implementation of the health law's insurance exchanges -- despite affirmation of the overhaul's constitutionality by the Supreme Court Thursday.

Modern Healthcare: No Rush On Insurance Exchanges Expected In Red States
Some Republican governors had indicated they were waiting for the ruling before deciding whether to launch the insurance marketplaces required by the law. If states do not receive federal certification by the beginning of next year that they will have exchanges ready to launch by 2014, then the federal government will create an exchange in those states. At least one federal official has indicated that up to 30 states could have been waiting for either the court ruling or the November election before deciding to proceed with an exchange. Among Republicans who believe states will continue to wait for the outcome of the November elections was Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee (Daly and Zigmond, 6/28).

KQED: OK California, What The Health Exchange Means For You
There are the politics and the spinning. There’s the talk of improved health outcomes … and then there is the bottom line. What does this mean for the state’s consumers? The California Health Benefit Exchange is the most tangible institution that Californians will interact with as a result of the law. Those newly in the market to buy insurance because of ACA, this is your go to shop. Officials estimate that’s around 3 million Californians (Dornhelm, 6/28).

Denver Post: Full Speed Ahead For Colorado Health Insurance Expansion
The Supreme Court's decision on upholding key provisions of the Affordable Care Act should speed insurance expansions to nearly all Coloradans, while opponents regroup for future fights, state officials and health experts said. The state will redouble efforts to prepare for 2014's growth in Medicaid enrollment, and a consumer "exchange" where other individuals should find affordable, uniform benefits, proponents said (Booth and Hoover, 6/29).

CT Mirror: Court Ruling Prompts Two Different Visions Of Connecticut’s Future
The U.S. Supreme Court's landmark ruling Thursday conjured two distinctly different visions of Connecticut's future. For health care advocates and other supporters of President Obama's surviving health care reform, Connecticut dodged a bullet. For opponents, the Nutmeg State caught the bullet -- right between the eyes. On one side, the image includes a massive increase in Connecticut's insured population coupled with a huge infusion of federal dollars, both for state government and needy households. On the other, health care costs continue to grow unrestrained, while state government takes on a fiscal burden that ultimately will swamp its finances (Phaneuf, 6/28).

CT Mirror: Advocates Say State Can’t Slow Down In Pursuit Of Health Care Reform
The ink had barely dried on national health care reform in May 2010 when Connecticut lawmakers adopted a plan to expand coverage for the poor. But while Connecticut has been ahead of the national curve in embracing the reforms, advocates warned that with Thursday's Supreme Court ruling, Connecticut's head start in pursuing federal health care dollars is over (Phaneuf, 6/28).

Minnesota Public Radio: Minnesota Officials Say They Will Press Ahead With New Health Care System
Gov. Mark Dayton's administration and state lawmakers have been preparing for life under President Barack Obama's health care law for some time. But their efforts got a new push Thursday when the U.S. Supreme Court upheld virtually all of the federal law. Several Republicans, however, are holding out hope the law can still be abolished. Minnesota's efforts to implement the Affordable Care Act have been a political tug-of-war so far, with Dayton aiming to enact its provisions while Republicans in the Legislature push back against him. (Scheck, 6/29).

MinnPost: Minnesota Moving Ahead With Health Insurance Exchange
Nothing in Thursday’s U.S. Supreme Court ruling is expected to keep Minnesota from moving forward with its own health insurance exchange, according to key lawmakers, state officials and interest groups. Health insurance exchanges allow some uninsured individuals and small groups to shop for a variety of tailored health coverage plans. The exchanges, typically online, have been compared to travel websites like Orbitz or Expedia, and advocates say they will help lower coverage prices. Although about 15 states already have implemented exchanges, the issue has been extremely divisive in Minnesota. Gov. Mark Dayton’s administration began preparations for an exchange in 2011 without input from the Republican legislative majorities (Nord, 6/28).

The Seattle Times: Washington State Took Steps To Be Ready For New Law
Some states, unenthusiastic about the federal health-care law and supportive of efforts to overturn it, dragged their heels on implementing its requirements. Not Washington. Betting on the come, the Democrat-controlled Legislature and policymakers here moved ahead, passing laws, applying for grants and hiring staff -- some of whom started work just weeks ago -- all in preparation for a federal law that was still in legal limbo. They could have looked really dumb (Ostrom, 6/28).

The Seattle Times: McKenna Accepts Health Care After Losing Law Suit He Was Part Of
Attorney General Rob McKenna split with many prominent Republicans in the wake of Thursday's Supreme Court ruling, saying Congress should not move to scrap the federal health care law or even its controversial individual insurance mandate. Although acknowledging disappointment in being on the losing side of the challenge to the Affordable Care Act, McKenna, the Republican gubernatorial candidate, said he's ready to implement its new health-insurance exchanges and Medicaid expansion if elected. "There are a number of good provisions in this law that ought to be maintained," McKenna said at a news conference in downtown Seattle. If some provisions "aren't workable" Congress should fix them, he said (Brunner, 6/28).

Detroit Free Press: How Health Ruling Will Change Care In Michigan
Thousands of Michigan residents -- many without health insurance for decades or with pre-existing conditions that excluded them from coverage -- won a major victory Thursday after the U.S. Supreme Court largely upheld the constitutionality of President Barack Obama's health care law. The justices, in a 5-4 decision, ruled that a controversial requirement that most Americans buy insurance by 2014 is constitutional under Congress' power to tax. That provision is the financial underpinning of the sweeping law, which aims to end inequities in health care coverage (Anstett and Spangler, 6/29).

Kansas Health Institute News: Kansas Has Small Window For Input On Health Insurance Exchange
In the wake of today's U.S. Supreme Court ruling, Kansas could still avoid ceding total control of its health insurance exchange to the federal government if it moves quickly, Insurance Commissioner Sandy Praeger said. “That’s probably the best-case scenario now from an exchange standpoint,” Praeger said. But that would require a meeting of the minds between Praeger and Gov. Sam Brownback and meeting a mid-November deadline for alerting federal officials to the state's intentions (McLean, 6/28).

Other state leaders still aren't sure how they should proceed with implementing the law, including the health insurance exchanges --

Miami Herald: Health Care Ruling Could Have Big Impact On South Florida
Several major South Florida health care leaders applauded the Supreme Court's decision Thursday on the Affordable Care Act because they say it will bring more access to the region’s large number of uninsured and allow for providers to get paid for their care. But doctors leading the Miami-Dade and Broward medical associations said they're concerned whether physicians will be reimbursed enough under the new legislation. … The stakes are huge for the region’s uninsured -- 31.8 percent of Miami-Dade residents, 24 percent in Broward and 32 percent in Monroe County, according to 2010 Census data. The national average is 16.3 percent. Among adults from 18 to 64, the potential effect is even greater: 57 percent of Hialeah residents in that age group are uninsured, 50.4 percent in the City of Miami, 48.5 percent in Deerfield Beach. Even in middle-class Kendall, almost one-third — 31.2 percent — of adults aged 18 to 64 now have no coverage (Dorschner, 6/28).

Miami Herald: Scott To Review Health Care Ruling Impact On Florida
The state that launched a two-year legal challenge to the federal health care law isn’t sure what it will do now that the law has been upheld by the U.S. Supreme Court. Florida Gov. Rick Scott, who dipped into his personal fortune to campaign against passage of the health care law and, after being elected, refused to implement it, told reporters Thursday he would need time to decide his next move. "I’ve got to read through the decision and make sure we understand it," Scott said (Mitchell, 6/28).

Des Moines Register: Will The Iowa Legislature Need A Special Session To Deal With 'Obamacare'?
A special session of the Iowa Legislature won’t be necessary to implement the new federal health care law – but only if Democrats and Republicans can work together in an informal setting, a Democratic state senator said today. State Sen. Jack Hatch, D-Des Moines, said he and Iowa Gov. Terry Branstad’s chief of staff Jeff Boeyink have talked about a summit with others interested in health care. It would hopefully take place in the next two to four weeks, organized by a neutral group such as a hospital, he said (Jacobs, 6/28).

Milwaukee Journal Sentinel: Wisconsin Lags On Health Insurance Exchange
Thursday's U.S. Supreme Court ruling leaves Wisconsin without its own plan for setting up a key insurance marketplace called for under the health care law, and Gov. Scott Walker said he would not address that issue until at least November….The plan for the insurance marketplace, called an exchange, is due to the federal government in January 2013, and Walker's administration had announced late last year that it was stopping work on such a proposal until the Supreme Court had ruled. Now, Walker wants to wait longer, until after the fall election (Stein and Marley, 6/28).

In other state news -

Los Angeles Times: Health Insurance Rate Hike Measure Won't Be On November Ballot
A proposed voter initiative to require greater regulation of health insurance premiums in California has failed to qualify for the November ballot, according to the measure's author. Jamie Court, president of the Santa Monica advocacy group Consumer Watchdog, said he was told Thursday by the secretary of state's office that a spot check by county registrars of voters fell just short of the 555,236 signatures needed to go before voters in November's presidential election (Lifsher, 6/29).

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Running Down The Varied State Reaction To The Health Law Decision

State leaders reacted to the Supreme Court health law decision in varied ways: Some hailed the decision as a victory for everyday Americans while others warned the decision will harm citizens. Still others, however, including Va. Attorney General Ken Cuccinelli, saw a mixed bag. 

The Associated Press: Coverage For Most People, A Scramble For States
The Supreme Court settled the legal argument over health care Thursday. Now people in the United States will find out if President Barack Obama's overhaul can work as advertised to provide coverage to millions of uninsured while also keeping costs in check. If it works, the U.S. will move closer to other economically advanced countries that for years have guaranteed health insurance to their citizens. If the plan falters, expect endless political wrangling over the nation's problems with high medical costs, widespread waste and millions of uninsured people (Alonso-Zaldivar, 6/29).

Los Angeles Times: Supreme Court's Health Care Ruling: The Outlook For California
Amid the cheering in many quarters over the Supreme Court's decision to uphold the federal health care law, a sobering fact remains: California's ailing health care system won't be easy to fix. Millions of Californians will still lack insurance even after a massive coverage expansion. Medical costs and premiums are expected to keep rising, at least in the short run. And many of those who do gain coverage could have a tough time finding a doctor to treat them (Terhune, 6/29).

KQED: Local Republican Leader Weighs In: The Discussion Is About Taxes Now
Duf Sundheim was the chair of the California Republic Party from 2003-2007 and remains active in the party. He lives in Los Altos Hills, CA. KQED's Stephanie Martin spoke to him today about his reaction to the Supreme Court decision (Dornhelm, 6/28).

KQED: Health Decision Will Have Big Impact On California's Ethnic Communities
Health disparities in the state are stark. "Diabetes affects 13 percent of Native Americans in the state, 11 percent of Latinos, 10 percent of African Americans," says Ellen Wu, the executive director of the California Pan-Ethnic Health Network (CPEHN). "That's compared to five percent of the white population." Wu says there's a gap in access to care too. That's why the Supreme Court decision upholding the Affordable Care Act is such a watershed moment for her (Dornhelm, 6/28).

The Washington Post: Gov. McDonnell Calls Supreme Court Health-Care Decision 'A Bad Ruling For The American People'
While Republican leaders in Richmond universally decried the ruling, their next step was less clear. McDonnell said he would meet with his staff to determine how or even if Virginia would move forward to create a health insurance exchange. McDonnell said that a state-based marketplace for insurance policies is a bad idea, but that a federally created one would be worse (Vozzella, 6/28).

The Washington Post: Ken Cuccinelli, On Second Thought, Likes Supreme Court Health-Care Decision
The reason? His first impression was based on the basic upshot of the ruling: The court had upheld "Obamacare." His second was based on a closer look at the ruling, which he found upheld individual liberty and curbed federal power even as it left the law in place (Vozzella, 6/28).

Richmond Times-Dispatch: Cuccinelli Cites Loss On Policy, Win On Commerce Clause
The way Virginia Attorney General Ken Cuccinelli sees it, opponents of President Barack Obama's health care overhaul lost the policy battle but won the constitutional war. "On the health care policy side today, our side mostly lost," Cuccinelli said of the U.S. Supreme Court's decision to largely uphold the Patient Protection and Affordable Care Act. But Cuccinelli claimed victory in the court's ruling that Congress does not have the power to use the commerce clause of the Constitution to compel Americans to buy a product -- in this case, health insurance -- but must do so by using its taxing authority (Nolan, 6/29).

Chicago Sun-Times: Quinn 'Thrilled' Over Obamacare Decisions
"This is a great day for health care in America and a great day for health care in Illinois -- we should never, ever forget this day," Gov. Pat Quinn said Thursday at the new Lurie Children’s Museum in Streeterville. "The highest court in our land has said the Affordable Care Act is the law of the land." Quinn said he would resume working with the legislature to create a health-insurance exchange through which the uninsured and small businesses will be able to purchase private coverage. In Illinois, 1,914,000 residents are uninsured, or about 15 percent. Illinois has received three federal grants to study and start building its health insurance exchange, but the initiative stalled in the Legislature last spring amid uncertainty over which way the nation’s high court would rule, a delay that heightens the likelihood of missing a key federal deadline (Pallasch and McKinney, 6/28).

Baltimore Sun: Health Care Ruling A Win For Obama, Md. Democrats
The decision also gave a lift to Maryland Democrats, particularly Gov. Martin O'Malley, who has positioned the state as a leader in implementing the law. Yet political experts said the ruling would likely have little impact on state contests this year, including the high-profile House race in Western Maryland. Rep. Andy Harris, the lone doctor in Maryland's congressional delegation, predicted that public opinion would be no more favorable for the law just because the Supreme Court upheld its legality. "The court didn't rule on the policy issues; they just ruled on whether this passed constitutional muster," said Harris, a Baltimore County Republican who made opposition to the health care law a pillar of his 2010 election. "I wouldn't be surprised if public opinion actually became more negative" (Fritze, 6/28).

Baltimore Sun: Health Reform Moves Ahead In Maryland, Nationally
Maryland had banked heavily on the law's withstanding judicial scrutiny, moving ahead of other states in creating an exchange where individuals and small businesses could buy coverage, and expanding its Medicaid rolls. The state's leaders said the high court's decision gives them the authority and funding to finally implement provisions of the law, which mostly takes effect in 2014. In the first year, they estimate that one-third of 750,000 uninsured residents will gain coverage (Cohn and Walker, 6/28).

Arizona Republic: What Will Be The Impact On Health Care For Arizonans?
Arizona economists, health-care industry officials, insurers and others will be weighing in on the Supreme Court upholding the key provisions of President Obama's health care law. [Provided are] some of their comments (Wiles, 6/28).

Boston Globe: Mass Residents React To Ruling With Relief
Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts, experienced a similar moment of exultation. "It feels like a clear validation of the framework we developed in 2006," said Dreyfus, who worked for passage of the 2006 law as director of the insurer's foundation. ... The decision to uphold the central, and most controversial, provision of the federal law — the requirement that most individuals buy health coverage or pay a tax penalty — matters little to Massachusetts, since the state already has a similar mandate that has reduced the number of uninsured to about 2 percent. But a repeal of other portions of the law could have had a significant financial impact. While the court weakened the law’s huge Medicaid expansion, ruling that states cannot be required to participate, Massachusetts already has expanded coverage to the extent required by the law. As a result, the federal government will send nearly $2 billion to Massachusetts over six years, starting in 2014, to pay for Medicaid coverage for childless adults (Kowalczyk, Conaboy and Lazar, 6/29).

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Editorials and Opinions

Viewpoints: The Law Is Now Front And Center In The Election; Right's Muddled Response

Editorials and opinion writers say the Supreme Court decision moves the debate about the health law back to voters in November.

Politico: Supreme Court Ruling Not a Big Deal For Some
Republicans are characterizing the Supreme Court health care ruling as one of the worst decisions in the court's history. Democrats, who asserted the fate of the republic — or at least of Barack Obama's presidency — hinged on the outcome, are celebrating. Both sides are already preparing to use it as fodder for fundraising and television ads. ... Chances are though, despite all the ballyhoo from the left and the right, it won’t have a major effect on the outcome of the presidential race (Linda Killian, 6/28).

Politico: GOP's Path Post-Health Care Ruling
It is critical that the GOP focus on the needs of the American people. Is a Big Government, high-cost, high-regulation program run by Washington bureaucrats really what we need to solve our health care problems? For the sake of our health, our health care and our economy, Republicans must take the lead on offering a positive alternative — one that provides higher-quality care at lower cost and with increased choice — for Americans to support this fall (Frank Donatelli, 6/28).

The Wall Street Journal: Obama Has a Good Day
ObamaCare, including the insurance mandate, was upheld. What would have been a political disaster for President Obama has been averted. He has not been humiliated, and the centerpiece of his efforts the past 3½ years has not been rebuked by the Supreme Court. ... There will be a downside: The president is left carrying the burden defending a bill nobody likes. It certainly has the worst public reputation of any new government program of my lifetime. The Republicans can say, "It may be constitutional, but it's still a bad law, and we'll get rid of it." In fact the speaker of the House said it within hours of the decision (Peggy Noonan, 6/28).

The Wall Street Journal: It's Up to the Voters Now
If there is a modicum of hope in Chief Justice John Roberts's inglorious one-man opinion Thursday, it is that Americans were reminded again that they cannot count on others to protect their liberty. Certainly judges aren't reliable. They can be turned by the pressure of the media and the whims of vanity. If Americans want to repeal ObamaCare, their only recourse is to demand it at the ballot box in November (6/28).

The Wall Street Journal: The ObamaCare Election
Politically, here's what the Supreme Court provided in upholding the president's health legislation: clarity. Ever since the March oral arguments, with their tantalizing hints the court might strike down the law, the politics of health care has been a muddle. With this week's decision, the debate refocuses. This election is now about ObamaCare—not just in its own right, but as proxy for a generational debate over liberty. Chief Justice John Roberts, in legitimizing sweeping federal powers, has left it to the U.S. electorate to serve as the check on government intrusion—and thus dramatically elevated the November stakes. That is no political victory for President Obama, though it could be an electoral game changer for Mitt Romney if he recognizes the potential (Kimberley A. Strassel, 6/28).

The Wall Street Journal: The Tax Duck
Editor's note: The duck test—if it looks like a duck, swims like a duck and quacks like a duck, it probably is a duck. As the basis for the majority opinion in the Obama health-care decision, Chief Justice John Roberts argued that the law's individual mandate to buy health insurance is valid because it is a tax, citing Congress's power under the Constitution to "lay and collect taxes" for "the general welfare of the United States." Herewith, from President Obama on down, is a sampling of Democratic denials that the individual mandate is a tax (6/28).

The New York Times: A Muddled Political Response From The Right
The future of the health care system is now back where it should be, out of the hands of judges and into those of voters. With the constitutional question about President Obama’s health care law now settled, the public will have a chance to examine Mitt Romney’s claims that it is terrible for the country. Based on his remarks on Thursday, they will not have much to go on (6/28).

Los Angeles Times: The Healthcare Law Fight Isn't Over
Logical or not, the ruling underscores the dangers of relying too heavily on the Supreme Court to solve policy problems. Conservatives should have used the time that the court was deliberating to formulate attractive legislative proposals to both repeal and replace this unpopular law. But they didn't. So where does this leave us? (Tom Miller, 6/29).

Baltimore Sun: For ACA Ruling's Winners, Perhaps A Pyrrhic Victory
The Supreme Court's action restores Obamacare to a front-and-center place in the coming fall campaign. President Obama had already resigned himself to a campaign in which he must defend his record on jobs and the economy rather than simply touting his accomplishments. Now he and his team must wage a two-front war. In addition to defending himself on jobs, he must defend a health care law that is controversial at best and deeply unpopular at worst. (Richard J. Cross III, 6/29).

Boston Globe: Federal Health Care Law Doesn't Help State Or The Nation
That’s what happens when we try to force heavy-handed Washington solutions on problems that require flexibility and creative approaches undertaken at the state level. The health care law should be repealed. We must preserve the right of states to develop and implement health care solutions that meet the unique needs of local citizens, as we were able to do in Massachusetts (Sen. Scott Brown, R-Mass., 6/29).

The Dallas Morning News: Health Care Ruling An Ironic Win For Obama
Unfortunately, the fight to repeal the law will only gain shrill momentum now. House Republicans already have scheduled a doomed vote to overturn it, and Mitt Romney, Obama’s GOP challenger, continues to promise repeal. In polls, Americans still oppose the law, despite favoring some of its planks. A wiser course would be to accept the court’s ruling and improve the parts of the law involving funding and cost containment. But that would require real leadership, another irony (6/28).

The Minneapolis Star Tribune: A Major Step Closer To Health Care For All
The still-struggling economy is bound to be the dominant campaign theme for the next four months. That’s as it should be. But by tossing the health care issue back into the political arena, the Supreme Court has given Americans a chance to be more than passive spectators of what happens next on that front. Voters should seize that chance and bone up on the ACA reforms (6/28).

Denver Post: Could SCOTUS Health Care Decision Cost Obama Re-Election?
If I were a conspiracy theorist, I would argue that conservative Chief Justice Roberts joined with liberals on the U.S. Supreme Court to support “Obamacare” for one reason and one reason alone: to cost President Obama re-election in November. Instead, let me just say this. A victory for Obama today could make winning in November a whole lot tougher (Jessica Peck, 6/28).

Houston Chronicle: Roberts Rules With Health Care Opinion
Now comes the hard part -- the politics…. The third branch of government has done its work on this issue with wisdom and integrity. It is left to the other two branches to show they can follow suit (6/28).

Journal of the American Medical Association: After Supreme Court Ruling On The Health Care Law, Focus Turns To The States … And November
But, while the court’s decision removes the legal uncertainty around implementation of the health reform law, political uncertainty remains…. Although this election is likely to be much more about the economy than health reform, Governor Romney has reiterated his aim to repeal the ACA if elected president (or, short of that, change its funding and direction). So the outcome of the election could well determine the future of the health reform law (Larry Levitt, 6/28).

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Viewpoints: Can You Blame George Bush?; A Kiss For The Chief

Some opinion writers look at the key role of Chief Justice John Roberts in the health care ruling.

The New York Times: Modesty And Audacity
In his remarkable health care opinion Thursday, the chief justice of the Supreme Court restrained the power of his own institution. He decided not to use judicial power to overrule the democratic process. He decided not to provoke a potential institutional crisis. Granted, he had to imagine a law slightly different than the one that was passed in order to get the result he wanted, but Roberts’s decision still represents a moment of, if I can say so, Burkean minimalism and self-control (David Brooks, 6/28).

The New York Times: A Confused Opinion
The stunner yesterday was that Chief Justice John G. Roberts Jr., joined by the Supreme Court's four most liberal justices, wrote the majority opinion that upheld the individual mandate in President Obama’s signature Affordable Care Act, which requires Americans to obtain health insurance or pay a penalty. In an ironic twist, the chief justice simultaneously accepted the conservative argument that Congress’s power to regulate interstate commerce did not include the power to regulate economic inactivity, like a decision not to purchase health care. The court ruled 5 to 4 on that point, with the chief justice joined by the court’s four other conservative justices (Richard A. Epstein, 6/28).

The New York Times' Opinionator: A Justice In Chief
The title "chief justice of the United States" is not in the Constitution, and neither was it in the first Judiciary Act by which Congress organized the federal courts. It came into use only casually and gradually, by the late 19th century replacing the favored "chief justice of the Supreme Court of the United States." Even today, people often mangle the title as "chief justice of the Supreme Court." The mangled title is one that John G. Roberts Jr. would have had trouble claiming on Thursday. In his controlling opinion in the health care case, he spoke largely for himself (Linda Greenhouse, 6/28).

USA Today: Court's Top Conservative Kills Federalism
In reality, the case was never really about health care but federalism — the relative authority of the federal government vs. the state. I support national health care, but I oppose the individual mandate as the wrong means to a worthy end. Indeed, for federalism advocates, the ruling reads like a scene out of Julius Caesar— a principal killed by the unseen hand of a long-trusted friend. Brutus, in this legal tragedy, was played by Chief Justice John Roberts (Jonathan Turley, 6/28).

The Washington Post: Why Roberts Did It
It's the judiciary’s Nixon-to-China: Chief Justice John Roberts joins the liberal wing of the Supreme Court and upholds the constitutionality of Obamacare. How? By pulling off one of the great constitutional finesses of all time. He managed to uphold the central conservative argument against Obamacare, while at the same time finding a narrow definitional dodge to uphold the law — and thus prevented the court from being seen as having overturned, presumably on political grounds, the signature legislation of this administration (Charles Krauthammer, 6/28).

The Wall Street Journal: We Blame George W. Bush
ObamaCare is still the law of the land, and we blame George W. Bush. In National Federation of Independent Businesses v. Sebelius, four associate justices adopted the position of Florida's Judge Roger Vinson, voting to strike down the entire law--we read Anthony Kennedy correctly back in March--and the other four voted to uphold the individual mandate as a legitimate exercise of Congress's authority to regulate interstate commerce. That left Chief Justice John Roberts, nominated by Bush in 2005, with almost the full range of options before him (James Taranto, 6/28).

Boston Globe: Chief Justice Roberts Defends The High Court
Yet Roberts seems to have grasped that doing so would have cemented the court’s image as a partisan actor and severely diminished it as an institution. As chief justice of the United States — a title bespeaking responsibility to the nation as well as the court — he had a duty not to let that happen (6/29).

Des Moines Register: Roberts' Decision Gives Liberals A Reason To Love Him
Around 9:15 a.m. Thursday, I was seized with the impulse to kiss someone I have only ever felt anger toward: Supreme Court Chief Justice John Roberts. It wasn’t personal, but in many ways, it was. The Affordable Care Act, which the court upheld thanks to his vote, directly benefits my family and every American who struggles to pay their health care bills. But more than that, Roberts’ acknowledgment that the president and Congress could pass such sweeping legislation for the good of the nation restores faith in America’s ability to progress beyond partisanship (Rekha Basu, 6/28).

Bloomberg: The Chief Justice Comes To The Rescue
This continuing debate may not have the drama of a Supreme Court decision announced at 10 a.m. on the last day of the term to a cameraless courtroom. But at least it will not have to contend with the premise that Obamacare is unconstitutional or that Congress does not have authority to legislate in this area. For that, the president may want to send a thank-you note to the chief justice (6/28).

Bloomberg: In Health-Care Ruling, Roberts Writes His Own Law
Roberts may think he has threaded a needle. He has avoided affirming an expansive reading of the Commerce Clause, which conservatives loathe, while refusing to give liberals the ammunition to call him a partisan for dismantling their cherished law. He acted cleverly. He also acted less like a judge than like a politician, and a slippery one (Ramesh Ponnuru, 6/28).

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Viewpoints: Ruling Hands Government 'A Limitless License To Coerce,' Decision Will Save Lives

A wide selection of views on the effects of the Supreme Court's health care ruling.

USA Today: Editorial: Supreme Court ObamaCare Ruling Benefits Millions
Amid all the political spin about who won and who lost as a result of Thursday's Supreme Court decision to uphold the 2010 health reform law, it's worth noting up front that the landmark ruling will benefit millions of everyday Americans. Many of the people who will be helped already know exactly how: They have pre-existing medical conditions and can't get insurance. Or they have a desperately sick child, have blown through their insurance policy's lifetime limit and now have enormous bills they can't pay. Or they've fallen seriously ill, only to have their insurance company cancel their coverage on a technicality (6/29).

USA Today: NFIB: Mandate Ends Vital Freedoms
The Supreme Court upheld the health care law, and Americans lost a large measure of the liberty they have always known. The federal government's power to tax is now a limitless license to coerce. ... Congress veered away from affordability and hurtled toward other goals. Thus, small business came to oppose the law. Congress promised cost relief, and the law delivered the opposite. Just months after its passage, the White House warned key supporters to abandon cost-cutting as a talking point. Since then, costs exploded. The law laid heavier burdens on small business than on others (Dan Danner, 6/29). 

The Wall Street Journal: The Roberts Rules
Thursday was destined to be an historic day for American liberty, and it was, though the new precedent is grim. The remarkable decision upholding the Affordable Care Act is shot through with confusion—the mandate that's really a tax, except when it isn't, and the government whose powers are limited and enumerated, except when they aren't (6/28).

The Wall Street Journal: A Triumph And Tragedy For The Law
The Supreme Court's ObamaCare decision is both a triumph and a tragedy for our constitutional system. On the plus side, as we have long argued in these pages and in the courts, the justices held that Congress's power to regulate interstate commerce cannot support federal requirements imposed on Americans simply because they exist. The court also ruled that there are limits to Congress's ability to use federal spending to force the states to adopt its preferred policies. However, in upholding ObamaCare's mandate that all Americans buy health insurance as a kind of "tax," the court itself engaged in a quintessentially legislative activity—redrafting the law's unambiguous text. The court struck down ObamaCare as enacted by Congress and upheld a new ObamaCare of its own making (David B. Rivkin Jr and Lee A. Casey, 6/28).

The Wall Street Journal: The Wrong Remedy For Health Care
The American health-care system's principal strength is its ability to produce ever more impressive innovations. The U.S. has no equal in developing new medical technologies, surgical procedures and pharmaceuticals. These extraordinary advances are not the product of government direction but rather the efforts of scientists, investors and entrepreneurs pursuing their individual goals and aspirations in a competitive market system. The Affordable Care Act puts these strengths at risk (John F. Cogan, R. Glenn Hubbard and Daniel P. Kessler, 6/28).

The New York Times: The Real Winners
So the Supreme Court — defying many expectations — upheld the Affordable Care Act, a k a Obamacare. There will, no doubt, be many headlines declaring this a big victory for President Obama, which it is. But the real winners are ordinary Americans — people like you (Paul Krugman, 6/28).

The New York Times: A Moderate Ruling With Risks Ahead
There is no underestimating the importance of the Supreme Court decision upholding most of the health reform law — politically, constitutionally and in terms of its practical effects on the nation and the economy (6/28).

The New York Times: A Pyrrhic Victory
The obvious victor in the Supreme Court’s health care decision was President Obama, who risked vast amounts of political capital to pass the Affordable Care Act. A somewhat more subtle victor, but equally important, was the rule of law more generally: in an era when so many people on the left and right view the justices, and constitutional questions, through the prism of politics, the court today made clear that law matters and that it isn't just politics by other means (Neal K. Katyal, 6/28).

Los Angeles Times: Vindication For 'Obamacare'
The Supreme Court's ruling Thursday upholding President Obama's healthcare reform law wasn't the sort of ringing pronouncement that helps define the contours of government power and individual rights for decades to come. The justices were sharply divided, and Chief Justice John G. Roberts Jr.'s controlling opinion reads like an exercise in splitting the baby. But the end result is one that Americans in general, and Californians in particular, should celebrate (6/29).

Los Angeles Times: Healthcare Cluelessness From The Supreme Court's Conservatives
In their dissenting opinion Thursday, four of the Supreme Court's conservative justices wasted little time in revealing their exceedingly narrow view of the Patient Protection and Affordable Care Act. The first sentence by Justices Antonin Scalia, Anthony M. Kennedy, Clarence Thomas and Samuel A. Alito Jr. reads, "Congress has set out to remedy the problem that the best health care is beyond the reach of many Americans who cannot afford it." Umm, no, that's not what Congress set out to do with the healthcare reform law. The goal was not just to increase access to care but also to improve quality, promote efficiency, shift incentives so providers and patients have a mutual interest in wellness, and slow the growth of costs (Jon Healey, 6/28).

Los Angeles Times: The Court Saved My Lifeline
Not to be overly dramatic, but for me the Supreme Court decision on the Affordable Care Act was a matter of life and death. Because the law was largely upheld, I will be able to continue receiving treatment for breast cancer (Spike Dolomite Ward, 6/29).

The Washington Post: A Ruling That's Good For The Country
The Supreme Court's 5 to 4 decision upholding the core of the Affordable Care Act is good news for the court and the country. Chief Justice John G. Roberts Jr. was statesmanlike in choosing to side with four more liberal justices in finding that the law’s most controversial provision, the mandate that individuals obtain health insurance, was a constitutional exercise of Congress’s power "to lay and collect taxes." That solution allows the main provisions of the law to take effect. Even more important, it is respectful, as the court should be, of congressional authority and the democratic process that underlies it (6/28).

Philadelphia Inquirer: Supreme Court Saves The Day - As Well As Lives
It may not have been his intention — in fact, we're pretty confident that it wasn't — but in providing the deciding vote in Thursday's Supreme Court decision to uphold the Affordable Care Act, Chief Justice John Roberts has saved millions of Americans from dying before their time (6/29). 

Boston Globe: Health Care Ruling Aids Obama In Three Ways
However, in justifying the mandate under the taxing power, Roberts found a far more limited construction than that followed by the liberal justices, which also restricts Congress’s power to act under the Commerce Clause. This latter power has been used to justify social welfare laws for generations and was supposed to justify the Affordable Care Act. That a majority of the court ruled that itisn’t a valid justification is an important precedent because it appears to limit federal power. Over the long term, this bodes well for conservatives eager to constrain the further growth of government. But Republicans aren't taking much solace in the decision because most of them are focused on the near term (Joshua Green, 6/29).

iWatch News:  Obamacare A Blessing For Millions Of Real Americans
As I was waiting anxiously for today’s Supreme Court decision, I knew there was a man in Colorado I’d met on the first anniversary of the Affordable Care Act who was likely far more anxious than I was. ... That man was among millions of people in this country who insurance companies have labeled "uninsurable," meaning they could not buy insurance coverage at any price because of pre-existing conditions. One of the most important provisions of the law that was upheld by the Court today was the one that will take effect on January 1, 2014, the one that will at long last make it illegal for insurers to refuse to sell coverage to people who have been sick in the past (Wendell Potter, 6/28).

Milwaukee Journal Sentinel: Supreme Court Ruling Means A Healthier America
But the bottom line today is this: The essential provisions of the Affordable Care Act stand, and the United States will be healthier for it…. Forget about repeal or waiting for repeal. What's important now is to move forward in a bipartisan effort on two equally important fronts: implementing the law fairly and stemming the rise in health care costs (6/28).

Fox News: Beyond The Obamacare Debate -- Why Does Health Care Cost So Much?
Health care spending is so far out of control that not only individuals and families, but the entire economy is buckling under the strain.  General Motors spends so much money for its employees' health care that Warren Buffet has called the corporation "a health and benefits company with an auto company attached."  Each year, General Motors, like Ford and other U.S. automakers, pays more than $1,500 in health care costs for every car they make.  ...After adjusting for inflation, we now spend as much on health care every ten days as we did in the entire year of 1950 (John Robbins and Ocean Robbins, 6/28).

Des Moines Register: Health Care Ruling Was A 'Win' For Americans
In a 5-4 ruling, (the Court) upheld the law, including the controversial requirement that all Americans purchase health insurance. Yes, that is a "win" for Democrats and President Barack Obama. It legitimizes reform they worked for more than a year to craft. But the win in this case is really for the American people (6/28).

Health Policy Solutions (a Colo. news service): Questions Remain On Implementation Of ACA In Colorado
The U.S. Supreme Court’s decision to uphold the Affordable Care Act (ACA) and especially the individual mandate provision stands to affect Colorado’s health care system – and hundreds of thousands of the state’s residents – on a variety of fronts. The Colorado Health Institute estimates that about a half-million uninsured Coloradans will gain health insurance by 2016 (Michelle Lueck 6/28).

Kansas City Star: A Winning Health Care Ruling For All Americans
With a historic and just decision from the U.S. Supreme Court, the nation has moved a giant step closer to a health care system that will work for all Americans. By ruling the individual insurance mandate constitutional under the taxing authority of Congress, the court preserved the delicately balanced structure of the Patient Protection and Affordable Care Act (6/28).

San Jose Mercury News: Supreme Court Health Care Ruling Gives Hope To Millions
The United States is a step closer to joining the rest of the developed world in making health care accessible to most or all citizens, thanks to Thursday's welcome ruling by the U.S. Supreme Court. And in writing the opinion, Chief Justice John Roberts took a step toward restoring the integrity of the nation's highest court, which, until this case, was looking more and more like an arm of the Republican Party (6/28).

Sacramento Bee: Health Reform Is One Step In Right Direction
The Supreme Court did the wise thing by upholding the Affordable Care Act. While the federal health reform law alone will not remedy all our health care system's ills, it takes significant steps in the right direction. With the court's affirmation, the public and private sectors must now work together to make the law effective (Bruce Bodaken, 6/29).

CNN Money: Beyond ACA: Health Care Reform For Entrepreneurs
The Supreme Court today affirmed the constitutionality of the Affordable Care Act. With that uncertainty behind us, I feel it's crucial for entrepreneurs to focus their energies on uniting around a single healthcare reform that will create jobs and facilitate greater innovation in America (Alex Meshkin, 6/28).

Arizona Republic: So, We'll Be Penalized With Higher Taxes
The decision affirms that ... President Obama signed a health-care law that levies a substantial, new set of taxes that, according to congressional estimates, perhaps 75 percent of people earning less than $200,000 per year will pay. If the muddled, often perplexing reasoning of Chief Justice John Roberts provides any satisfaction for the act's conservative and libertarian opponents, it is that. We know what pays at least some of the coming bill. Taxes. And lots of them (6/29).

Arizona Republic: False Premise Lets 'Obamacare' Go On
For whatever reason, Chief Justice John Roberts decided to rescue "Obamacare" from the constitutional trash heap. His reasoning in doing so should be an embarrassment to him. It certainly tossed more dirt on the burial site of the Founders' vision of a federal government with limited, enumerated powers (Robert Robb, 6/29).

The Atlanta Journal-Constitution: Health Care Ruling Not A Victory For America
Warnings to watch for judicial activism in this ruling spread far and wide, yet few suspected the court would uphold Obamacare in this manner, given the president and congressional Democrats justified the law via the Commerce Clause and not through Congress’s tax-writing power. By doing so, the court’s ruling will impact Americans just as the president intended. Americans are now forced to purchase a product or pay a price. There is little difference, in practical terms, between the president deeming that price a penalty and the court deeming it a tax (Tom Graves, R-Ga., and Phil Gingrey, R-Ga., 6/28).

The Atlanta Journal-Constitution: Verdict Is A Step Forward And Best Is Yet To Come
After more than a century of debate, President Barack Obama and Democrats in Congress won a historic victory with passage of the Affordable Care Act. Exorbitant health care costs prompted Democrats to take the lead and do what no other Congress has been able to do — put health insurance in reach for more than 50 million uninsured Americans and more affordable for everyone (Hank Johnson, D-Ga., and John Lewis, D-Ga., 6/28).

San Francisco Chronicle: Supreme Court Upholds Obamacare As Constitutional
But the high court ruling is still masterful. It keeps politics and personal views out of the Supreme Court's mainstay duty to rule on constitutional matters. It honors Congress' role to determine policy and the legislative body's intersection with politics. A sweeping health care plan was saved. So was the nation's respect for the Supreme Court (6/28).

Journal of the American Medical Association: Supreme Court Ruling On The Medicaid Expansion: Carrots Are Okay, Sticks Are Not
Because the federal government is going to fund the entire cost of the expansion initially, states will be hard-pressed to turn away free money. This will be especially difficult for those politicians running for reelection in those states. How can a state explain to its poorest constituents that they must remain uninsured because the state is refusing to accept money from the federal government that other states are accepting?... Moreover, there will likely be enormous pressure from hospitals, physicians, and others who offer health care to accept that Medicaid money, as it will eventually flow into the medical system (Dr. Aaron E. Carroll, 6/28).

Journal of the American Medical Association: The Health Care Law Stands: Now What?
The Supreme Court decision has allowed health care reform to move forward. If the act had been repealed, the nation would almost certainly have been stuck without change for the foreseeable future. Now, at least, there is a chance for progress in this arena. Whether there’s enough follow-through to make this time more successful than in the past depends on whether enmity for the law and for President Obama overwhelms the desire to do more for those in real need (David M. Cutler, 6/28). 

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Weekend Reading

Longer Looks: Native American Rehab Facility Helps Families In Ore.

Every week, KHN reporter Shefali S. Kulkarni selects interesting reading from around the Web.

The Oregonian: Native Americans Strive For Health Against Alcohol, Chaos And Trauma
Pearl Scott lifts the baby from the crib and balances the child on her hip, just as someone did with her when she was a baby 20 years ago. Her mom went through addiction treatment here in the Native American Rehabilitation Association of the Northwest's residential center. Now Scott works for NARA, operated by and for Native Americans. She helps care for the 10 children, all 5 years old and younger, of parents in treatment. ... NARA opened in 1970 solely to address alcoholism, but today provides an array of mental, social and medical services. Residents cite the cultural connection more often than any other factor as the service that helped them most in their recovery (Bill Graves, 6/26).

New York Times Magazine: When My Crazy Father Actually Lost His Mind
We were playing our card game at the Psychiatric Emergency Screening Services, or PESS, a small locked-down unit in the community hospital near my parents’ apartment in Somerville, N.J. Harsh fluorescent lighting fell on cracked and faded yellow walls. A disheveled, rail-thin woman paced and wept in the room across the way. Down the hall, a police officer guarded locked double doors. It was early December 2010. That August, my father, who was 69, became abruptly and deeply paranoid. Convinced that nameless people were trying to kill him, he slept no more than an hour or two a night and started drinking after five years of sobriety. When his suspicions grew to include his immediate family, he became violent and threatened suicide. ... In rare moments of lucidity, he would cry and apologize, confessing that he was terrified. He didn’t know what was happening to him. But we did. He was given a diagnosis of bipolar syndrome (Jeneen Interlandi, 6/22).

The Daily Beast: Home Birth: Increasingly Popular, But Dangerous
A few decades ago, home birth in the United States was mostly limited to insular religious communities like the Amish and to dedicated members of the counterculture like (Ina May) Gaskin, whose husband founded The Farm as a commune in the 1970s. In recent years, though, it's moved toward the mainstream, spurred by the rise of attachment parenting, a reaction against a dysfunctional medical system, and pro-midwife documentaries like The Business of Being Born, which featured producer Ricki Lake giving birth in her bathtub. Though still quite small, the number of home births is increasing -- according to the Centers for Disease Control, it grew 29 percent between 2004 and 2009, to 29,650. ... Yet as the number of such births grows, so does the number of tragedies (Michelle Goldberg, 6/25).

The Atlantic: Make Some Noise: Treating Mental Disorders With The Power Of Music
The term "music therapy" first appeared in The Columbia Magazine back in 1789, but it wasn't until the 1940s that music therapy began to emerge as a clinical profession when hospitals used music to treat World War II soldiers suffering from shell shock. Using music as a therapeutic medium has been shown to facilitate motivation, communication skills and social interaction, and it improves attention spans among children with autism. ... In his music therapy session, Jaden switched from his piano to a percussion set, moving swiftly between drums and cymbals. Asch accompanied him on the guitar at a languid pace, trying to slow Jaden down. Oblivious to Asch's bluesy guitar tune, the child continued his rapid drum solo (Nikhita Venugopal, 6/26).

NPR: Dementia Complicates Romance In Nursing Homes
Relationships are never easy. If the partners in love happen to be living in a nursing home, there are even more challenges. And if they're showing signs of dementia, then things get really tricky. Although no law forbids intimate relationships between people with dementia in nursing homes, staff and family members often discourage residents from expressing their sexuality, says a recent report in the Journal of Medical Ethics. Sexuality might be an uncomfortable topic for some families to discuss, but sex is a matter of dignity for many older people, says Dr. Laura Tarzia, lead author of the report and a researcher at the Australian Centre for Evidence Based Aged Care. Older people who live on their own continue to enjoy romantic relationships, even if they are in the early stages of dementia; the trouble begins when they move into a facility for care (Jessica Stroller-Conrad, 6/26).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

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The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.