Kirsten Adshead Wisconsin Reporter
MADISON – The U.S. Supreme Court, joined by Chief Justice John Roberts, largely upheld the Patient Protection and Affordable Care Act — handing President Barack Obama a major victory on what experts called one of the most significant constitutional cases of the past half century.
It was tough news, though, for conservatives who see the law as vast overreach of federal power and a threat to the nation’s economy.
And Gov. Scott Walker reiterated his stance that he will not proceed with implementing the federal health care reform law, despite the U.S. Supreme Court’s ruling that the law is constitutional.
Walker hopes that Republicans will be in control of Congress and that the White House following the November elections and that they will repeal the law.
“If there is no political remedy from Washington and the law moves forward, it would require the majority of people in Wisconsin to pay more money for less healthcare,” the governor said in his statement. “Additionally, it would increase the size and cost of government, decrease the quality of healthcare and, in our state, reduce access for those truly in need of assistance.”
University of Wisconsin-Madison assistant law professor Andrew Coan said that, based on the initial reporting of the decision, he believes the high court may have made significant decisions regarding some of the key constitutional questions in the case.
But Coan said he hadn’t seen the full ruling himself yet, and it will take a few hours to parse out the full significance of the ruling.
“I suspect that we should have a pretty good sense of what the court has done and the different positions the justices have taken by the end of the day, if not before,” he said.
In a 5-4 decision, the court upheld the so-called individual mandate, aimed at maximizing the number of people contributing to the insurance pool.
But, joined by Roberts, the court did not sustain that provision as a mandate for people to purchase insurance, but as a tax if they don’t.
The court also — although narrowly interpreting the law — said the federal government could threaten to withhold states’ Medicaid funding if states don’t agree to expand the program for low-income people.
On that question, the court held the provision is constitutional as long as states would lose only new funds if they didn’t comply with the new requirements, rather than all of their funding.
The big picture
The decision Thursday may well rank as one of the most highly anticipated Supreme Court rulings of the past several decades.
SCOTUSblog, which gives real-time announcement of Supreme Court rulings, typically has between 1,500 and 3,000 followers, according to the Washington Post. At one point Thursday, shortly after the ruling was handed down, the site reported that it had 866,000 liveblog readers.
Not only does the 2,200-page law have far-reaching consequences for health-care delivery across the country, but it’s been a cornerstone of President Barack Obama’s domestic agenda during his first term.
As such, experts said a ruling from the Supreme Court either rejecting or upholding Obamacare could have significant political implications as Obama seeks a second term this year.
The health care reform law — often called simply the Affordable Care Act, or ACA, and dubbed Obamacare by critics — addresses everything from mandating that individuals purchase health insurance to requiring Medicaid expansion to offering tax credits to help people purchase insurance.
Coan said last week that the Court’s ruling could affect more than health-care law and could fundamentally alter legal understanding of federal power.
“I think it’s always very difficult to predict how the court is going to decide any case, but this case is unusually complex and the range (of issues) … is unusually broad,” he said.
Up next in Wisconsin
The immediate effect of the ruling, at least officially, for Wisconsin may be negligible.
Walker has said he will wait to see the outcome of the November elections before taking any action implementing the law, hoping that the GOP takes control of the federal government and can overturn the law.
Under the federal law, states have until Jan. 1, 2013, to declare that they will set up health care exchanges, which the nonpartisan Kaiser Family Foundation describes as “new organizations that will be set up to create a more organized and competitive market for buying health insurance.”
States then have a year to get those exchanges up and running. If they don’t, the federal government steps in to run the exchanges.
Those in the health care industry said it will take time to process and understand what happens next.
Planned Parenthood Advocates of Wisconsin called the ACA “the greatest advance in women’s health in a generation.”
Before the ruling, Rick Abrams, chief executive officer of the Wisconsin Medical Society, which represents 12,000 medical doctors, said the next step would be to meet with care providers, including health insurers, policymaker and consumer groups, to assess the decision and to determine a response.
If legislative action is necessary, Abrams said he is optimistic that the groups can work together “for everyone’s benefit.”
“It’s a very, very organized process that really enables us to give very thoughtful analysis,” he said.
Larry Pheifer, executive director of the Wisconsin Academy of Family Physicians, which represents 2,600 members statewide, or about 85 percent of family physicians, said the academy is lauding the Supreme Court decision, asserting the law places the focus on where health care needs to be: Primary care and preventative medicine.
“I just think it’s a really important decision that supports health care for the people of the country and particularly the people of Wisconsin,” Pheifer said.
Commenting on Wisconsin Reporter’s Facebook page, however, David Gugger said, “I don’t like the government getting involved in my health care — does anyone really think they can manage anything? What will happen is a wattering (sic) down of health care in general.”
The politics of it all
The ACA ruling concludes years of legal fights over the legislation that began almost as soon as Obama signed the legislation into law on March 23, 2010.
More lawsuits, of course, still are possible as states and the health care industry grapple with the implications of the high court’s ruling.
Congress may still act to change the law, too, a possibility that increases if the November elections put the GOP in control of the White House and both chambers of Congress.
But with a Congress under dual control – Republicans have a majority in the House of Representatives and Democrats have a majority in the Senate – that has shown little inclination to compromise, it’s unclear what it can accomplish.
That is especially true with a controversial issue in an election year.
Asked about the instant move to repeal the law, Pheifer said, “The care of individuals and how to go about delivering that care is paramount. Let’s get away from right or left, who’s right who’s wrong, and get to what’s important.”
On Thursday morning, before the ruling’s release, Wisconsin Republican U.S. Sen. Ron Johnson said on “Fox & Friends” that from Republicans, “You’ll see basically a step-by-step approach, taking a look at every last one of these issues, trying to restore free market discipline back into the health care marketplace – allow people to buy insurance across state lines, really take a look at the cost of defensive medicine, try to reform our tort system. “
The health care reform, a key component of Obama’s first-term domestic agenda, is likely to be a lightning rod in the presidential race as Obama and presumptive GOP nominee Mitt Romney head toward November.
In a Washington Post-ABC poll released in May, when respondents were asked to name the most important issue affecting their choice for presidents, health care/repealing Obamacare came in second – although, at 7 percent, it fell far short of the 52 percent who said the economy/jobs.
Wisconsinites split on the issue. In the latest Marquette Law School poll, taken June 13-16, 38 percent said the entire law should be overturned, and 33 percent said the law should remain intact.
Nineteen percent wanted to simply eliminate the individual mandate, and 9 percent said they didn’t know how the Supreme Court should act.
Stay with Wisconsin Reporter throughout the day for updates and response on the Supreme Court ruling.