Experts, Officials, Media Offer Their Two Cents on U.S. Supreme Court’s Decision on Affordable Care Act

By John Stahl, Esq.

The U.S. Supreme Court announcing its decision that the Affordable Care Act, also known as ACA and Obamacare, was constitutional was a “where were you” moment in American history. Key quotes from the majority and dissent opinions are provided below.

The experts on the left, the right, and the middle who made the following statements regarding the entire decision either witnessed the Court issuing it or were glued to their television, computer, or cell phone.

Effect on Workers’ Compensation

Reaction from workers’ comp experts:

“I tend to think the Supreme Court's ruling today, while obviously important to the nation as a whole, is essentially neutral when it comes to the workers' compensation system. On the one hand, a full implementation of the Affordable Care Act that increases the number of insured Americans over the long haul would be positive for the comp world: the result may lessen the incentive for the uninsured worker to associate the sting and discomfort in his or her lower back to moving the 45-pound box of merchandise at work instead of picking up the worker's six-year-old child at home. On the other hand, if the medical care delivery system is flooded with newly insureds seeking immediate care, the wait for routine medical care in connection with work-related injuries may be significantly increased. While Chief Justice Roberts ruling is now in, the ‘jury’ is still out with regard to the full effects on the comp system.” Thomas A. Robinson, J.D., LexisNexis Author, Larson’s National Workers’ Compensation Advisory Board: Executive Committee Member

“I am relieved that the Supreme Court upheld the Affordability Care Act and hope the public will realize ‘Obamacare’ is in a positive light and is in everyone's best interest. I am hopeful this is a first step to a single payer system that incorporates 24 hour care so we do not need a separate medical system for work injuries. I believe our workers' comp system would be better off with medical treatment being seamless with preservation of some kind of medical-legal system that evaluates permanent disability separate and apart from treatment. Of course, ERISA would have to be revised by our divided Congress if we ever head in the direction of 24 hour care...” Robert G. Rassp, Esq., Author, Lawyer's Guide to the AMA Guides and California Workers' Compensation (LexisNexis); Chairman of the Board of Directors, Friends Research Institute

“In addition to carrying workers' compensation coverage just in case they get hurt at work, employers are now mandatorily required to provide health care for their employees general well being, extend that coverage to their children longer and absorb pre-existing conditions, and nearly double the Medicare contribution so those employees have medical benefits when they become old or disabled, however less of them because the ACA also cuts Medicare spending.” Jennifer C. Jordan, Esq. General Counsel, MEDVAL, LLC, Editor-in-Chief, The Complete Guide to Medicare Secondary Payer Compliance (LexisNexis)

“When injured workers have [insurance] coverage, there is no need for WC to pay for non-occ conditions for injured claimants.” Joseph Paduda, Principal, Health Strategy Associates

Key Passages

        The majority opinion states in relevant part:

The Federal Government may enact a tax on an activity that it cannot authorize, forbid, or otherwise control. See, e.g., License Tax Cases, 5 Wall. 462, 471 (1867). And in exercising its spending power, Congress may offer funds to the States, and may condition those offers on compliance with specified conditions. See, e.g., College Savings Bank v. Florida Prepaid Postsecondary Ed. Expense Bd., 527 U. S. 666, 686 (1999). These offers may well induce the States to adopt policies that the Federal Government itself could not impose. Chief Justice Roberts (p. 11)

        The dissent states in relevant part:

Congress has impressed into service third parties, healthy individuals who could be but are not customers of the relevant industry, to offset the undesirable consequences of the regulation. Congress’ desire to force these individuals to purchase insurance is motivated by the fact that they are further removed from the market than unhealthy individuals with pre-existing conditions, because they are less likely to need extensive care in the near future. If Congress can reach out and command even those furthest removed from an interstate market to participate in the market, then the Commerce Clause becomes a font of unlimited power. Dissent (p. 134)

Reaction from officials, media:

“Each state will take the lead in designing their own menu of options. And if states can come up with even better ways of covering more people at the same quality and cost, this law will allow them to do that too.” President Barack Obama

“Something that Obamacare does not do that must be done in real reform is helping lower the cost of healthcare and health insurance, which is becoming prohibitively expensive.” Mitt Romney

“Growth in spending on health care programs is one of the central fiscal challenges facing the federal government. Health care spending per person has grown faster than the nation's economic output per person by nearly 2 percentage points per year, on average, for the past several decades. This rapid growth poses a challenge for federal health care programs like Medicare and Medicaid, and also for state and local governments and for the private sector. CBO devotes a large share of its resources to studying proposals that would make narrow or broad changes in the nation's systems for delivering and financing health care.” Congressional Budget Office

“Our Massachusetts healthcare law, passed under Governor Romney and the model for the ACA, envisioned tackling this [high-cost and poor outcome] problem in a two step fashion. First, by making health insurance mandatory for all citizens, and, second, by attacking the high costs. We've succeeded with step one. About 98% of all Massachusetts citizens are now insured. Two years ago, we dove into the deep end of the pool to begin the serious work of controlling costs. Since then, we've seen improvement, but we still have a long way to go.” Tom Lynch, CEO, Lynch Ryan

“Legal scholars are still parsing today's complicated ruling, which upheld the mandate as a tax and precluded the federal government from withholding Medicaid funds from states that choose not to participate in the law's Medicaid expansion. In that sense, there remains some uncertainty as to how the landscape of the uninsured might vary state-by-state once the law is fully implemented in 2014. Still, regardless of any potential variation in Medicaid expansion, one thing at last seems certain: This map of uninsured Americans will soon look very, very different.” The Atlantic Cities

“Conservative states (based both on the percentage of state residents who identify as conservatives (.58) and the percentage of who voted for McCain in 2008 (.60) have a higher percentage of uninsured citizens. Economics also comes into play. There is a positive correlation between the percent of a population that is uninsured and the poverty rate (.58). Blue-collar and working class states also boast a higher level of uninsured (.40).” The Atlantic Cities

Limits on Federal Taxation Power

       The majority opinion states in relevant part:

Our precedent demonstrates that Congress had the power to impose the exaction in [26 U.S.C.S.] 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. Chief Justice Roberts (p. 45)

Under the [individual] mandate, if an individual does not maintain health insurance, the only consequence is that he must make an additional payment to the IRS when he pays his taxes. See [26 U.S.C.S.] §5000A(b). That, according to the Government, means the mandate can be regarded as establishing a condition—not owning health insurance—that triggers a tax—the required payment to the IRS. Under that theory, the mandate is not a legal command to buy insurance. Rather, it makes going without insurance just another thing the Government taxes, like buying gasoline or earning income. And if the mandate is in effect just a tax hike on certain taxpayers who do not have health insurance, it may be within Congress’s constitutional power to tax. Chief Justice Roberts (p. 38)

Reaction from media:

“The court found that power to fine, in the taxing power of Article I [of the Constitution.] Now the president will have to figure out a way to make the fines in the law -- which are weak and toothless -- real.” Howard Fineman, Editorial Director, AOL Huffington Post Media Group

States’ Rights

       The majority opinion states in relevant part:

Nothing in our opinion precludes Congress from offering funds under the Affordable Care Act to expand the availability of health care, and requiring that States accepting such funds comply with the conditions on their use. 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. Chief Justice Roberts (p. 61)

       The dissent states in relevant part:

The principal practical obstacle that prevents Congress from using the tax-and-spend power to assume all the general-welfare responsibilities traditionally exercised by the States is the sheer impossibility of managing a Federal Government large enough to administer such a system. That obstacle can be overcome by granting funds to the States, allowing them to administer the program. That is fair and constitutional enough when the States freely agree to have their powers employed and their employees enlisted in the federal scheme. But it is a blatant violation of the constitutional structure when the States have no choice. Dissent (p. 129)

Reaction from media:

“A number of largely Republican-led states that gambled on delay now face the unsettling prospect that the federal government could take over their responsibilities, particularly in setting up the health insurance marketplaces known as exchanges, where people will be able to choose among policies for their coverage.” New York Times

“The ruling did limit one significant portion of the law, which sought to expand Medicaid to cover millions more poor and disabled people. The program is a joint federal-state effort, and the court said the law’s requirement that states rapidly extend coverage to new beneficiaries or lose existing federal payments was unduly coercive.” Washington Post

Bottom Line (or Your Moment of Zen)

“It [the decision] was very confusing. Unless, of course, you read up to page four.” Jon Stewart, Host, The Daily Show With Jon Stewart

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