By Melissa Daniels | PA Independent
HARRISBURG — Requiring individuals to purchase health care is constitutional.
Withholding extensive federal funding from states as punishment is not constitutional.
Also: paying a tax for not buying health insurance is constitutional.
On Thursday, the U.S. Supreme Court upheld the major components Patient Protection and Affordable Care Act that includes the controversial individual mandate on the grounds that Congress has powers to levy taxes and fees.
The decision was 5-4, with Chief Justice John Roberts siding with the majority.
Upholding the act will give hundreds of thousands of Pennsylvanians access to health care, whether through an individually purchased policy or through a Medicaid expansion.
Already, millions of Pennsylvanians have received benefits under the act, from some 235,000 elderly Medicare beneficiaries who received prescription discounts to 1.5 million Pennsylvanians who received at least one preventative care treatment.
Around 4,500 Pennsylvanians now have access to health care who were previously denied for pre-existing conditions.
Keystone Progress, a Pennsylvania-based coalition of unions and progressive groups, called the decision a victory, and a leap towards achieving equitable health care across society.
“This decision will ensure that children with pre-existing health conditions will have the care they need, young adults will be able to stay on their parents’ health plans, small businesses will receive tax health insurance credits, thousands of Pennsylvanians will get rebates from their insurers this summer, and millions will no longer have out-of-pocket costs for routine preventive care,” said Keystone Progress Executive Director Michael Morrill in a statement.
Now Pennsylvania agencies, and the health care industry, will have new systems to implement to comply with the legislation. That includes the state using a $30 million federal grant to help fund the establishment of an online health insurance marketplace, or exchange, ready for use at the start of 2014.
Speaking the night before the decision, Gov. Tom Corbett, said he was confident the Insurance Department was prepared to move forward with establishing the exchange if the act was upheld.
One of the most contentious questions in the decision was if an individual could be penalized for not purchasing health insurance. That piece was upheld and interpreted as a tax.
Moving forward, someone who decides to not purchase health insurance will face an incrementally increasing individual penalty of 2.5 percent of annual income by 2016 .
“Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it,” stated the majority opinion in a more than 190-page decision.
The decision is a major victory for President Barack Obama, his supporters and the Democratic party. Given that, the partisan divide on the ACA decision is already evident:
State Rep. Greg Vitali, D-Delaware, said he wasn’t surprised by the ruling, comparing health insurance to auto insurance.
“It’s the same situation. If you don’t have it, other people have to pay for you, so I think it makes sense,” he said.
On the other side of the aisle, state Rep. Matt Gabler, R-Clearfield, said the ruling was “certainly unfortunate” and predicted it would become a central issue of the upcoming national election.
“I think it really underscores the importance of the upcoming election,” he said. “Americans will have to decide for themselves if this is the direction they want the country to go.”
In the dissenting opinion, Justice Anthony Kennedy called the legislation “invalid in its entirety.”
Some changes brought on by the act are already evident. Estimates from the House Appropriations Committee say around 65,000 Pennsylvanians under 26 have insurance as part of the act than extends benefits for dependents.
Pennsylvania has its own state law that allows people up to age 29 to have insurance with several exceptions. According to the National Conference of State Legislatures, states may continue to apply their own laws for dependent insurance to the extent that they don’t preclude federal laws.
While the expansions may seem constitutional, the majority did address one facet of Congressional control. The states who filed the case, including Pennsylvania under then-attorney general Corbett, argued the federal government could not coerce states to expand Medicaid by withholding federal funds as a penalty for opting out.
But the high court’s interpretation says the federal government cannot punish states for opting out by withholding all Medicaid dollars.
“What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding,” according to Robert’s majority decision.
State Rep. Stephen Bloom, R-Cumberland, said the Medicaid provisions in the ruling were important for Pennsylvania taxpayers because it would leave the state in control of its own fate in that regard.
“It means we will not be forced to expand the state’s Medicaid system beyond the truly needy,” he said
Many across the nation opposed the act on the grounds that Congress did not have the right to tell states what do with their health care programs. Tarren Bragdon, chief executive officer of Florida-based think tank Foundation for Government accountability, said what works in one state may not work in another, given how different the states really are.
Given that, ACA may not be the sole savior of the health care system, he said.
“Regardless of what the Supreme Court rules, our health care challenges will not go away,” said Bragdon, speaking several weeks prior to the decision. “Just as the problems are not partisan, neither are the solutions and the states have proven there are tested, proven bipartisan solutions to address the biggest needs in health care.”
Bureau Chief Eric Boehm contributed to this report.