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The PPACA Ruling At A Glance

There is little doubt that most Americans are just not interested in this particular subject right now. It’s confusing, it’s messy, it’s complex.  We can’t sort it out,  we don’t want to deal with it, nobody seems to agree about any of it – this makes avoidance and denial a perfectly acceptable position – right?   And anyway, especially during this final run-up to the elections, the economy is the real issue.  Still, we need to think about the healthcare reform situation – it’s not going away and it does matter, a lot actually.  So here’s a gentle little refresher.

Allison Bell, of LifeHealthPro, did a great job recently, breaking down ten things we need to know about the Supreme Court ruling in June, which we outline here.

Who wrote the majority opinion?

Chief Justice John Roberts wrote the main core opinion, joined by two other justices, Elena Kagan and Stephen Breyer (in the section on the PPACA Medicaid expansion provisions).  In the majority opinion, Roberts wrote that neither the Commerce Clause nor the Necessary and Proper Clause of the US Constitution permit Congress to impose an individual health insurance mandate; that the individual mandate is a tax; and that the Taxing Clause of the Constitution does allow Congress to impose the individual mandate penalty payment requirement.

What did the court say about that individual health insurance ownership mandate?

The Commerce Clause of the US Constitution does not grant Congress the authority to compel individual to purchase commercial products, but that same document does give Congress the authority to “lay and collect Taxes” on individuals who fail to buy commercial products.

Just what does the Supreme Court take the PPACA individual health insurance ‘shared responsibility payment’ to be?

A tax.  According to Chief Justice Roberts,

Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage.   But taxes that seek to influence conduct are nothing new.  Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry…Today, federal and state taxes can compose more than half the retail price of cigarettes, not just to raise more money, but to encourage people to quit smoking.  And we have upheld such obviously regulatory measures as taxes on selling marijuana and sawed-off shotguns.

Does taxing some type of inactivity makes that inactivity illegal?

No.  According to Chief Justice Roberts,

While the individual mandate clearly aims to induce the purchase of health insurance, it need not be read to declare that failing to do so is unlawful….Neither the Act not any other law attached negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS.  The Government agrees with that reading, confirming that if someone chooses to pay rather than obtain health insurance, they have fully complied with the law.

But if taxing inactivity made the inactivity illegal, how many ‘outlaws’ would PPACA create?

About four million.  Again, according to Roberts,

It is estimated that four million people each year will choose to pay the IRS rather than buy insurance….We would expect Congress to be troubled by that prospect if such conduct were unlawful.  That Congress apparently regards such extensive failure to comply with the mandate as tolerable suggests that Congress did not think it was creating four million outlaws.

How can Congress put pressure on the states to expand their Medicaid programs?

Congress can attach strings on how states use new money, but it cannot change the rules governing the use of existing Medicaid funding.

Before this ruling, there was a lot of talk about how the court could have killed off all of PPACA by finding one part to be invalid.  So why didn’t the restrictions on the PPACA Medicaid provisions kill all of PPACA?

Chief Justice Roberts said,

We have no way of knowing how many States will accept the terms of the [PPACA Medicaid funding] expansion, but we do not believe Congress would have wanted the whole Act to fail, simply because some may choose not to participate….The other reforms Congress enacted, after all, will remain ‘fully operative as a law,’… and will still function in a way consistent with Congress’ basic  objectives in enacting the statute….Confident that Congress would not have intended anything different, we conclude that the rest of the Act need not fall in light of our constitutional holding.

So what does the Supreme Court majority actually think about PPACA?

The court offered no opinion whatsoever about the wisdom of PPACA.

What about the four dissenting justices?  What did they say?

The dissenters considered that the majority opinion amounts to “vast judicial overreaching”.

And finally, how many times do the majority, dissenting and concurring options refer to “broccoli”?

12.

Okay, then.  We’ve faced our fears.  We’ve reviewed the ruling.  Next up – but not right away! – what might happen next.

Again, special thanks to Allison Bell, LifeHealthPro 2012.

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