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Emotions high after Supreme Court upholds health care law

By Bill Mears and Tom Cohen, CNN
updated 9:23 PM EDT, Thu June 28, 2012
STORY HIGHLIGHTS
  • NEW: Mitt Romney's campaign raises $3.2 million in hours after the ruling
  • President Barack Obama calls the ruling a victory for the American people
  • The Supreme Court finds the "individual mandate" is constitutional as a tax
  • The 2010 Affordable Care Act is the signature legislation of the Obama presidency

Washington (CNN) -- The U.S. Supreme Court's ruling upholding the health care law championed by President Barack Obama reignited an intense debate, with Democrats celebrating millions of Americans getting access to insurance while Republicans railed against what they contend is a dangerous expansion of government.

Thursday's narrow 5-4 ruling was a victory for Obama, causing elation at the White House, according to an administration official.

"Today's decision was a victory for people all over this country whose lives are more secure because of this law," Obama said in a televised White House statement.

Meanwhile, the ruling quickly became a rallying cry for Republicans who criticized the high court's reasoning and vowed to repeal the Affordable Care Act. Andrea Saul, spokeswoman for GOP presidential nominee Mitt Romney's campaign, said Friday night via Twitter that more than $3.2 million was raised in the hours after the decision was announced.

Beyond the election, Thursday's decision affects how Americans get medicine and health care and also provides new court guidelines on federal power.

Supporters of the health care legislation celebrate after the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act in a 5-4 ruling Thursday, June 28. Supporters of the health care legislation celebrate after the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act in a 5-4 ruling Thursday, June 28.
Health care and the high court
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Photos: Health care and the high court Photos: Health care and the high court

The most anticipated Supreme Court ruling in years allows the government to continue implementing the health care law, which was passed in 2010 but doesn't take full effect until 2014. That means popular provisions that prohibit insurers from denying coverage for pre-existing medical conditions and allow parents to keep their children on family policies to the age of 26 will continue.

What the health care ruling means to you

In the ruling, the court decided the most controversial provision -- an individual mandate requiring people to have health insurance -- is valid as a tax, even though it is impermissible under the Constitution's commerce clause.

"It is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance," Chief Justice John Roberts wrote in the majority opinion. "Such legislation is within Congress's power to tax."

He later added: "The federal government does not have the power to order people to buy health insurance. ... The federal government does have the power to impose a tax on those without health insurance."

Read the court ruling (PDF)

Roberts joined the high court's liberal wing -- Justices Stephen Breyer, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan -- in upholding the law.

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Four conservative justices -- Samuel Alito, Antonin Scalia, Anthony Kennedy and Clarence Thomas -- dissented. "To say that the Individual Mandate merely imposes a tax is not to interpret the statute but to rewrite it," the justices wrote in their dissenting opinion. "Imposing a tax through judicial legislation inverts the constitutional scheme, and places the power to tax in the branch of government least accountable to the citizenry."

The polarizing law, dubbed "Obamacare" by many, is the signature legislation of the president's time in office.

It helped spur the creation of the conservative tea party movement and will be a centerpiece of the presidential election campaign.

Romney -- who, as governor of Massachusetts, signed a law that also had an individual mandate -- blasted Obamacare as bad policy and a bad law on a federal level, adding that defeating Obama in November is the only way to get rid of it.

"What the court did not do in its last session, I will do on the first day if elected president of the United States, and that's to repeal Obamacare," he said after the decision was announced.

How Thursday's ruling affects that election remains to be seen, especially given Americans' mixed views on the law itself.

An NBC News/Wall Street Journal poll released Tuesday indicated 37% of Americans would have been pleased if the law was found unconstitutional, compared with 28% who would have been pleased if it had been found constitutional. The poll of 1,000 U.S. adults also found nearly four in 10 surveyed would have "mixed feelings" had the justices struck down the whole law.

On Thursday, Obama used the focus on the issue to spell out the law's benefits. The principle upheld by the high court's ruling is that no American should go bankrupt because of illness, the president said.

Ruling plays into campaign narrative for both sides

"I know the debate over this law has been divisive," Obama said. "It should be pretty clear that I didn't do this because it was good politics. I did it because I believe it is good for the country."

He said the country can't afford to "to refight the political battle of two years ago or go back to the way things were."

Other Democrats celebrated the victory for their major policy objective.

House Democratic leader Nancy Pelosi of California, who helped push through the law when she was House speaker, cited the late Sen. Edward Kennedy of Massachusetts, a longtime proponent of health care reform who died before the bill became law.

"Now he can rest in peace," she told reporters, echoing what she'd earlier told Kennedy's widow by phone.

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And former White House chief of staff and current Chicago Mayor Rahm Emanuel lauded his former boss for having "courage to bend the needle of history and did something presidents have tried to do for 60 years," he said of broadening health care accessibility.

In his opinion, Roberts skirted the political debate, stating outright that "we do not consider whether the act embodies sound policies."

"That judgment is entrusted to the nation's elected leaders," the opinion said. "We ask only whether Congress has the power under the Constitution to enact the challenged provisions."

The narrow focus of the ruling on key issues like the individual mandate -- limiting it to taxing powers rather than general commerce -- represented an effort by the court to limit the government's authority.

Republicans seized on the ruling by accusing Obama of lying to Americans when he said during the protracted political debate on the bill in 2009 that it wasn't a tax.

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In an interview then with ABC, Obama said various provisions of the health care law were intended to create an all-inclusive system, so that penalizing people who refused to join was not a tax.

"For us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase," Obama said, noting that "right now, everybody in America, just about, has to get auto insurance. Nobody considers that a tax increase. People say to themselves, that is a fair way to make sure that if you hit my car, that I'm not covering all the costs."

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Republican Rep. Michele Bachmann of Minnesota, a leading tea party voice, complained the ruling "means now, for the first time in the history of the country, Congress can force Americans to purchase any product, any service."

"This is truly a turning point in American history. We'll never be the same way again," she said.

Roberts, however, wrote in the majority opinion that Congress exercised an authority it held to assess a tax, rather than create any new taxing authority.

In another part of Thursday's decision, the high court ruled that a part of the law involving Medicaid must change.

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The law calls for an expansion of eligibility for Medicaid, which involves spending by the federal government and the states, and threatens to remove existing Medicaid funding from states that don't participate in the expansion. Thursday's ruling said the government must remove that threat.

The entire act passed Congress along strictly partisan lines in March 2010, after a lengthy and heated debate marked by intense opposition from the health insurance industry and conservative groups. The debate on the sweeping piece of legislation has encompassed almost every traditional hot-button topic: abortion and contraception funding, state and individual rights, federal deficits, end-of-life care, and the overall economy.

How the Supreme Court justices voted, what they wrote

When Obama signed the bill -- which stretched to 2,700 pages -- later that month, he said it marked a "new season in America."

While it was not the comprehensive national health care system liberals initially sought, supporters said the law would reduce health care costs, expand coverage and protect consumers.

In place of creating a national health system, the law bans insurance companies from denying coverage to people with pre-existing medical conditions, bars insurers from setting a dollar limit on health coverage payouts and requires them to cover preventive care at no additional cost to consumers.

Breaking down the court's decision

It also requires individuals to have health insurance, either through their employers or a state-sponsored exchange, or face a fine beginning in 2014. There are, however, a number of exemptions. For instance, the penalty will be waived for people with very low incomes who are members of certain religious groups, or who face insurance premiums that would exceed 8% of family income even after including employer contributions and federal subsidies.

Supporters argued the individual mandate is critical to the success of the legislation, because it expands the pool of people paying for insurance and ensures that healthy people do not opt out of having insurance until they need it.

Critics say the provision gives the government too much power over what they say should be a personal economic decision.

Timeline of the health care law

Twenty-six states, led by Florida, went to court to say individuals cannot be forced to have insurance, a "product" they may neither want nor need. And they argued that if that provision is unconstitutional, the entire law must go.

The Justice Department countered that since every American will need medical care at some point in their lives, individuals do not "choose" whether to participate in the health care market.

Four federal appeals courts heard challenges to parts of the law before the Supreme Court ruling, and came up with three different results.

Courts in Cincinnati and Washington voted to uphold the law, while the appeals court in Atlanta struck down the individual mandate.

A fourth panel, in Richmond, Virginia, put its decision off until penalties for failing to have health insurance take effect in 2014.

Basics: Health care reform issues

In March, the the Supreme Court heard three days of politically charged hearings on the law formally known as the Patient Protection and Affordable Care Act.

The challenge focused primarily on the law's requirement that most Americans have health insurance or pay a fine.

During those arguments, Justice Anthony Kennedy said the law appeared to "change the relationship between the government and the individual in a profound way."

Liberal justices, however, argued that people who don't pay into the health system by purchasing insurance make care more expensive for everyone. "It is not your free choice" to stay out of the market for life, Justice Ruth Bader Ginsburg said during arguments.

Roberts argued then that "all bets are off" when it comes to federal government authority if Congress was found to have the authority to regulate health care in the name of commerce. He maintained that reasoning in his ruling out Thursday, even while he saved the law itself on other grounds.

Earlier today, CNN incorrectly reported that the Supreme Court struck down the individual mandate. We regret the error.

CNN's Rachel Streitfeld, Jessica Yellin, Michael Martinez, Richard Allen Greene and Jim Acosta contributed to this report.

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