Supreme Court Decision in 24 hours

[TotallyOz]

It is going to be an interesting day tomorrow when they rule on this decision. I do not think it will go the way I want and IMHO we need to throw away Life Time Appointments for all Federal Court Justices.

How do you think this vote will go?

[lookin]

As posted on the other site, I'd be surprised if the law were upheld in its entirety or struck down in its entirety. But I do think that when the dust settles, we'll be closer to universal health care than we were a year ago. Perhaps that's all we can hope for and perhaps that's all Obama intended.

Getting over the hurdle of universal opposition by the insurance companies, who torpedoed Clinton almost two decades ago, was, in my opinion, a major achievment by the Obama administration. I think he used the individual mandate as a carrot to bring them along. If that's struck down, and everything else is upheld, the insurance companies will have to start changing their business model to put more premium dollars toward improved health outcomes. As well they should.

Here's an interesting article, out today, that discusses possible rulings and implications:

Possible outcomes in pending health care law case

Jun 27, 4:02 AM (ET)

By RICARDO ALONSO-ZALDIVAR and MARK SHERMAN

​

WASHINGTON (AP)

Saving its biggest case for last, the Supreme Court is expected to announce its verdict Thursday on President Barack Obama's health care law. The outcome is likely to be a factor in the presidential campaign and help define John Roberts' legacy as chief justice. But the court's ruling almost certainly will not be the last word on America's tangled efforts to address health care woes. The problems of high medical costs, widespread waste and tens of millions of people without insurance will require Congress and the president to keep looking for answers, whether or not the Affordable Care Act passes the test of constitutionality.

A look at potential outcomes:

---

Q: What if the Supreme Court upholds the law and finds Congress was within its authority to require most people to have health insurance or pay a penalty?

A: That would settle the legal argument, but not the political battle.

The clear winners if the law is upheld and allowed to take full effect would be uninsured people in the United States, estimated at more than 50 million.

Starting in 2014, most could get coverage through a mix of private insurance and Medicaid, a safety-net program. Republican-led states that have resisted creating health insurance markets under the law would have to scramble to comply, but the U.S. would get closer to other economically advanced countries that guarantee medical care for their citizens.

Republicans would keep trying to block the law. They will try to elect likely presidential candidate Mitt Romney, backed by a GOP House and Senate, and repeal the law, although their chances of repeal would seem to be diminished by the court's endorsement.

Obama would feel the glow of vindication for his hard-fought health overhaul, but it might not last long even if he's re-elected.

The nation still faces huge problems with health care costs, requiring major changes to Medicare that neither party has explained squarely to voters. Some backers of Obama's law acknowledge it was only a first installment: Get most people covered, then deal with the harder problem of costs.

---

Q: On the other hand, what if the court strikes down the entire law?

A: Many people would applaud, polls suggest.

Taking down the law would kill a costly new federal entitlement before it has a chance to take root and develop a clamoring constituency, but that still would leave the problems of high costs, waste and millions uninsured.

Some Republicans in Congress already are talking about passing anew the more popular pieces of the health law.

But the major GOP alternatives to Obama's law would not cover nearly as many uninsured, and it's unclear how much of a dent they would make in costs. Some liberals say Medicare-for-all, or government-run health insurance, will emerge as the only viable answer if Obama's public-private approach fails.

People with health insurance could lose some ground as well. Employers and insurance companies would have no obligation to keep providing popular new benefits such as preventive care with no copayments and coverage for young adults until age 26 on a parent's plan. Medicare recipients with high prescription drug costs could lose discounts averaging about $600.

---

Q: What happens if the court strikes down the individual insurance requirement, but leaves the rest of the Affordable Care Act in place?

A: Individuals would have no obligation to carry insurance, but insurers would remain bound by the law to accept applicants regardless of medical condition and limit what they charge their oldest and sickest customers.

Studies suggest premiums in the individual health insurance market would jump by 10 percent to 30 percent.

Experts debate whether or not that would trigger the collapse of the market for individuals and small businesses, or just make coverage even harder to afford than it is now. In any event, there would be risks to the health care system. Fewer people would sign up for coverage.

The insurance mandate was primarily a means to an end, a way to create a big pool of customers and allow premiums to remain affordable. Other forms of arm-twisting could be found, including limited enrollment periods and penalties for late sign-up, but such approaches probably would require congressional cooperation.

Unless there's a political deal to fix it, the complicated legislation would get more difficult to carry out. Congressional Republicans say they will keep pushing for repeal.

Without the mandate, millions of uninsured low-income people still would get coverage through the law's Medicaid expansion. The problem would be the 10 million to 15 million middle-class people expected to gain private insurance under the law. They would be eligible for federal subsidies, but premiums would get more expensive.

Taxes, Medicare cuts and penalties on employers not offering coverage would stay in place.

---

Q: What if the court strikes down the mandate and also invalidates the parts of the law that require insurance companies to cover people regardless of medical problems and that limit what they can charge older people?

A: Many fewer people would get covered, but the health insurance industry would avoid a dire financial hit.

Insurers could continue screening out people with a history of medical problems - diabetes patients or cancer survivors, for example.

That would prevent a sudden jump in premiums. But it would leave consumers with no assurance that they can get health insurance when they need it, which is a major problem that the law was intended to fix.

Obama administration lawyers say the insurance requirement goes hand in hand with the coverage guarantee and cap on premiums, and they have asked the court to get rid of both if it finds the mandate to be unconstitutional.

One scenario sends shivers through the health care industry: The Supreme Court strikes down the mandate only, and delegates other courts to determine what else stays or goes.

---

Q: What happens if the court throws out only the expansion of the Medicaid program?

A: That would limit the law's impact severely because roughly half of the more than 30 million people expected to gain insurance under the law would get it through the expansion of Medicaid, the federal-state health insurance program for low-income people.

But a potentially sizable number of those low-income people still might be eligible for government-subsidized private insurance under other provisions. Private coverage is more expensive to subsidize than Medicaid.

States suing to overturn the federal law argue that the Medicaid expansion comes with so many strings attached it amounts to an unconstitutional power grab by Washington. The administration says the federal government will pay virtually all the cost and says the expansion is no different from ones that states have accepted in the past.

---

Q: What happens if the court decides that the constitutional challenge is premature?

A: The wild card, and least conclusive outcome in the case, probably also is the most unlikely, based on what justices said during oral arguments.

No justice seemed inclined to take this path, which involves the court's consideration of a technical issue.

The federal appeals court in Richmond, Va., held that the challenge to the insurance requirement has to wait until people start paying the penalty for not purchasing insurance. The appeals court said it was bound by the federal Anti-Injunction Act, which says federal courts may not hear challenges to taxes, or anything that looks like a tax, until after the taxes are paid.

So if the justices have trouble coming together on any of the other options they could simply punt.

The administration says it doesn't want this result. Yet such a decision would allow it to continue putting the law in place, postponing any challenge until more of the benefits are being received. On the other hand, it might give Republicans more ammunition to press for repeal in the meantime.

[Guest EXPAT]

I think if they only strike down the individual mandate then the SCOTUS will make things worse. If insurance companies must take anyone that applies then what is to stop a young person from not getting any health insurance until they get sick. Then the only people they will be supporting are sick people and that will make rates sky rocket.

[lookin]

Once the health insurance exchanges are in place, I think competition will provide an incentive to make plans more affordable.

Then, there's the availability of subsidies for folks who still can't afford them.

And, finally, while the public option was eliminated during the horse-trading leading up to passage, I believe it will make a comeback one day. If private insurers offer nothing but plans priced at triple the cost of Medicare, for example, there will be strong pressure to make a public plan like Medicare available to more folks. Which is what I was hoping for from the get-go.

I think there's a lot more to the ACA than most folks realize at this point, and I think it could take a decade for it to play out in full. At the end of that time, I hope that we will join the rest of the developed countries who have figured out how to provide high-quality healthcare to all of their citizens. Those who say it's impossible just aren't looking around.

[TampaYankee]

I have said it many times and it bears repeating... The MOST IMPORTANT reason to vote for a Presidential candidate is the Supreme Court Appointments. No other decisions that a President makes, short of nuclear war, will have as lasting an impact on the course of the country over decades. Bad decisions can last a century, if not for eternity. Everything else pales in comparison. Much of modern day America is owed to the SOTUS: Labor rights, Civil Rights, Voting Rights, gun rights, Bedroom Privacy rights, Birth Control and Choice rights, declared corporations to be people, the right to buy elections through unlimited anonymous money, even the power to decide who will be president. The list goes on and on. Now they will decide the right to have accessible affordable health care.

Do not let the fact that you didn't get all you want or were otherwise disappointed with some aspects of your candidate deter you from voting for the person running who most closely represents your overall views, especially of the Supreme Court. Failure to do so could have a lifetime impact.

Don't make perfection the enemy of the good. NO candidate is perfect, only better or worse than the opponent and his course for the country and the SOTUS.

[TotallyOz]

TY, your words are also my sentiments. I have voted in every election for this reason. And, as much as I bitch and moan about Obama, I know I'll show up and vote for the above reason.

On the front page of CNN there was a lady holding a sign saying "Obamacare is immoral"

OMG, how is that possible? Healing others is immoral? Isn't that what Christianity taught? The religious nuts are really getting to me. They are about as stupid as my Maltese and he is fucking slower than a turtle.

[Lucky]

Color me surprised:

Supreme Court upholds health-care law, individual mandate

[Guest EXPAT]

Good article regarding the healthcare law being upheld:

http://thinkprogress.org/health/2012/06/28/507940/breaking-supreme-court-upholds-individual-mandate-as-a-tax/?mobile=wp

[marcanthony]

Obamarobertscare!

[JKane]

I can has health insurance now soon?

[caeron]

I am delighted. I am outraged that this has become a partisan football.

If we can afford the most expensive military in the world, we can afford to make sure everybody has basic healthcare.

[Guest EXPAT]

John Bonehead Boehner has stated that he will have a vote to repeal ObamaCare on July 11th. Sad that these Republicans don't really care about the American people and only care about making Obama look bad and getting him out of office.

[TampaYankee]

This decision gives me a glimmer of hope for Roberts. He hasn't exactly been a favorite of mine. He has lead many decisions I disagreed with. He undoubtedly still will.

But maybe, just maybe, Roberts is beginning to see a bigger picture to the role of the Supreme Court and the fabric of the nation. A nation made up by more than just Corporations and business interests and indivdual cases of people against the state. Maybe Roberts is beginning to understand the role of the SOTUS is more than simply interpreting sterile law in a centuries old context and that the SOTUS has a role in helping maintain the status of legitimacy of our legislative process as well as our judicial process in meeting the needs of the nation in the 21st Century, not the 18th.

I believe that Roberts is very sensitive to the perceived legitimacy of the Court. That legitimacy would suffer grievously if the Court were perceived to undermine legislation based on political differences rather than the law. That is probably the primary reason for his decision. At least that is what he said and I believe him. He took the path of looking for a way to declare the law legitimate, a law enacted by a duly elected Congress. Others took the path to look for a way to declare the law illegitimate. That certainly separates him from the four other conservatives, at least this time.

Several 'conservative appointments' to the SOTUS in the past have 'evolved' beyond their supposed conservative credentials, once on the court, to see a broader perspective that the Court has in guaranteeing that the fundamental rights and principles of our nation are given to all in the context of the times we live, not exclusively rooted in the times of our Founding Fathers. Our Founding Fathers proffered those rights and principles as best the could in a time and place that necessarily limited their vision of the issues to be faced in future times. Even so, they laid out principles and rights to be applied to the present times, not just rooted in concrete in their time. Can anyone doubt that those mostly brilliant men thought that issues would remain static through time. That those principles and rights would be applied only to the circumstances of their times. I certainly do not believe most of those men believed that. That is why they proscribed detail in the Constitution itself (how to set up government and how it relates to the people) and painted the Bill of Right in broad strokes to see that those rights applied in the broadest circumstances whatever the times. That is why more recent 'rights amendments' have been written broadly, even though they were discussed in the specifics of their time too.

I have hope for Roberts that he sees the larger role of the Court as part of the fabric of our nation, rooted in present times and not the past and that it must shore up the legitimacy of the other branches of government in order to guarantee its own. I am hopeful because of why he decided the for the Majority even though his politics naturally run counter, and even though he knew there would be severe blowback from those who appointed him and from their supporters. Each of those Justices of the past that 'evolved' had to face that barrage and chose to because they felt it was the right path. That shows men of character and principle. I believe this decision by Roberts puts him in that class. I hope so.

Citizens United gives me pause about too much too expect as it was recently reinforced by Roberts. But maybe, as I supsect, the 'evolution' of some of these conservative justices in our past had their watershed moment on a specific case that forced them to delve deeper into meaning of the Constitution -- not just its words but its intent -- in the rights it bestows to Americans, not in history but in present times. (Cases like Brown v Board of Education, Poll Tax Laws, etc.) Perhaps this was Robert's watershed moment. I suspect he will still group with the other conservatives on most decisions. But on really big ones that mark a major turn for the country maybe, just maybe, he will be more independent and be the swing vote in the balance again.

I am hopeful for Roberts, but I have not bet the 401K on it.