by: Scott MacFarlane Updated:WASHINGTON —
The Supreme Court on Thursday upheld virtually all of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that nearly every American have health insurance.
The 5-4 decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.
"Whatever the politics, today’s decision was a victory for people all over this country," Obama said.
GOP presidential candidate Mitt Romney renewed his criticism of the law, calling it “bad policy” and “bad law” in a statement just hours after the decision was handed down.
The ruling closes a chapter on American politics opened more than two years earlier, when 26 states filed suit the day Obama signed the Patient Protection and Affordable Care Act. Since then, lower courts have issued conflicting rulings on the constitutionality of the law’s insurance mandate.
Obama reiterated Thursday how the system is designed to work, especially the system of exchanges and the mandate that take effect in 2014.
According to the law, people will have to show proof of health insurance during 2014 when they file their tax returns or pay a tax penalty. The size of the penalty rises over the course of a few years, eventually reaching a maximum of 2.5 percent of a person’s income or several thousand dollars.
Also starting the same year, companies that employee over 50 people will pay penalties for not offering a set level of health benefits. The penalties start at $2,000.
According to the Obama administration, the law is designed to lower the cost of health care.
Some people in Charlotte said they were happy about the prospects of cheaper insurance, while others were frustrated at a new tax, deemed as such by the Supreme Court, for people already struggling financially.
The benefits of the reform are clear to Casper Poloins, who is caring for his aging mother.
“She is real sick. (She has) knee problems, a hip replacement. I think the health care bill will help a lot,” Poloins said.
Outside the Employment Security Commission offices in east Charlotte, Cedric Johnson was waiting for an out-of-work friend. Under the plan, his 22-year-old daughter will have insurance much longer.
“Under this plan, she can stay until she is 26. That’s a great thing,” he said.
But the mandate to have insurance or pay a penalty bothers Johnson, an out-of-work teacher.
“That part is not fair. Where am I going to get the money from?” he asked.
However, administrators at Carolinas Medical Center in Myers Park were happy to have the legal fight settled. Carolinas Healthcare System president Joe Piedmont said the ruling will have no immediate change.
“It was very difficult to prepare for the future, but from our patients’ standpoint, this will have no immediate effect,” he said.
When the decision came down, a group from the American Public Health Association erupted into cheers, a stark contrast to a family who said the decision will cost them thousands of dollars.
“If they are trying to make those out of work have insurance by 2014 and people are out of work, how the heck is it going to happen?” asked Cathy Lau.
“If you don’t have any income, how are you going to do it?” asked Fred Lau.
Fred Lau has been out of work for two years. His wife, Cathy, has been out of work for a year and recently lost the family car. Under the Affordable Care Act, the Lau family will have to pay a $2,100 penalty for not having insurance.
“I just got a letter today saying no more unemployment. I’m here to fight it,” Cathy Lau said. “It might help me in the long run, but right now it’s not helping me at all.”
The Lau family’s concern is one shared by more than 1.5 million residents of North Carolina and 930,000 people of South Carolina.
At present, the GOP-controlled General Assembly crafted legislation that would prohibit the individual mandate, but Gov. Bev Perdue vetoed it. Since then, lawmakers have been unable to gather to votes to overturn the veto.
South Carolina was one of the 26 states to sign on to the lawsuit against the federal health care law and opted not to implement many of the changes after a health panel determined there were too many unanswered questions.
Law upheld, but fights far from over
The ruling on the individual mandate split the Justices 5-4, with Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito in dissent.
What surprised many people was Chief Justice John Roberts’ decision to side with the court’s four liberal Justices in voting to uphold the mandate. The majority opinion ruled that a penalty for refusing to buy health insurance is simply a tax.
At first, the federal government will pay the costs for covering people who are newly eligible under the law. Over time, its share will drop to 90 percent, with states taking on the rest of the financial responsibility.
The states that filed suit against the law said the financial burden would be crushing to their budgets.
One North Carolina conservative group said the fight over the health care law is not over. Americans For Prosperity is planning to protest the high court’s decision in Raleigh this weekend.
The group is calling the rally “Hands off my health care.”
Organizers are worried the overhaul will increase spending and mean too much government involvement. The group is also calling on Congress to step in and repeal the law.
What the decision means for November
In a span of the next two years, health coverage for Americans will change drastically.
The law will give health insurance to 32 million Americans who do not currently have coverage. It also keeps insurance companies from discriminating against people who have pre-existing conditions that can be expensive to treat.
The political debate over healthcare reform has made it from the White House, onto the campaign trail and into television ads.
Political expert Dr. Michael Bitzer said Thursday’s decision means the conversation will continue through the fall.
"Romney is going to try and tap into that conservative anger about this," he said.
Bitzer said that could help rally his base. But Bizter said this is definitely a win for the president, which will energize his supporters as well.
"Now the president can go before the American people and say, ‘Yes, this is legitimate, the Supreme Court has said so. We need to move forward,’" he said.
Bitzer said that Obama’s camp will likely try to use that energy through the Democratic National Convention and even up to the election.
But he added Romney’s camp would be better off focusing on something else, like jobs and the economy.
"It puts Romney in an awkward position because now he has to attack something that he justified using in Massachusetts," Bitzer said.
If Romney is elected president, Bitzer said it would still be hard for Romney to get the 60 Senate votes he would need for a repeal.
This November, Bitzer thinks moderate, swing voters will still focus on jobs and the economy, but that healthcare will continue to be a heated issue for voters on the right and left.
"My belief about this fall is continuing to be it's all about who is going to be in the base and show up," he said.
About three hours after the ruling was handed down, Romney’s press secretary tweeted that the campaign had already seen $1 million in contributions in the wake of the ruling.
Repeal fight starts July 11
Moments after the announcement, Republicans announced they will vote on July 11 to repeal the health care law.
Reps. Sue Myrick and Mick Mulvaney stood with fellow Republicans, who said the law is bad and that the Supreme Court has been wrong in the past.
“The court has told us in the past that slavery is legal, that separate but equal is legal. It’s been wrong in the past. If you want to get them to change, if you don’t like the law, you’ve got to get involved in the election,” Mulvaney said.
House Majority Leader Eric Cantor, R-Va., said Thursday the House will vote July 11 on whether to repeal the law, though such efforts have virtually no chance in the Democratic-controlled Senate.
House Speaker John Boehner, R-Ohio, said the health care law makes it harder for small businesses to hire workers. "Today's ruling underscores the urgency of repealing this harmful law in its entirety," he said.
But Senate Majority Leader Harry Reid, D-Nev., heaped praise on the court's decision, and the 2010 law, in a Senate speech. "Passing the Affordable Care Act was the greatest single step in generations toward ensuring access to affordable, quality health care for every American, regardless of where they live or how much money they make," he said.
House Democratic Leader Nancy Pelosi cast the decision as vindication for her work to secure passage of the far-reaching legislation.
"This decision is a victory for the American people. With this ruling, Americans will benefit from critical patient protections, lower costs for the middle class, more coverage for families, and greater accountability for the insurance industry," Pelosi said.
While the individual mandate remains 18 months away from being implemented, many other provisions of the law are already active, including wellness exams for senior citizens and extending the age children can stay on their parents’ health insurance policies to 26.