Health care issue back before public

An estimated 26 million people will remain without health coverage once the law is fully implemented, including illegal immigrants, people who don’t sign up and elect to face the fine instead, and those who can’t afford it even with the subsidies.

WASHINGTON  _ The momentous Supreme Court ruling that upheld the heart of President Barack Obama’s health care overhaul has thrown the hugely divisive issue right back into the center of the political fight gripping the country in a presidential election year.

The 5-4 ruling by the conservative-dominated court handed Obama a major election-year political victory by leaving in force the legislative centerpiece of his term, a law aimed at covering more than 30 million uninsured Americans.

While the ruling was a big victory for Obama in that it validated the major piece of legislation he had pushed through Congress at a cost of much political capital, it remained unclear how the decision will affect the election. It could energize Obama voters. But it also may build a fire under conservatives supporting challenger Mitt Romney.

The case was the most closely watched one to go before the court since the 2000 ruling that resulted in George W. Bush’s being declared the winner of the presidential election.

The legal issues largely settled, opposition Republicans, most notably Romney, immediately vowed if elected to repeal the health care law, pounding on the theme of what the party sees as federal government over-reach and an increase in taxes.

Ironically, Chief Justice John Roberts, a conservative who wrote the majority opinion, sided with the court’s four liberals and reasoned that the law was constitutional because its centerpiece _ the requirement that all Americans obtain health insurance or face a federal fine _ was actually a tax that legally could be imposed by Congress.

Roberts, appointed by former President George W. Bush, sided in his opinion, however, with the four other conservative justices in holding that the nationwide insurance requirement could not be upheld under federal government’s constitutional power to regulate interstate commerce. The Obama administration had sought to defend the law on those terms.

Polls show a majority of Americans do not support the health care overhaul, which was based on a plan put in place in Massachusetts when Romney was governor there. The Massachusetts law has been widely supported by residents since it took effect in 2006.

While Romney defends the Massachusetts plan, he has said such changes should be left to the individual states and not be imposed by the federal government. He has promised to revoke the health care overhaul if he wins the White House in November.

After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against “Obamacare” and attacking it as a tax increase. His campaign said it raised more than $1 million in the hours after the court announced the ruling.

And Romney was quick to turn the court ruling into a campaign attack against Obama and a rallying cry for the small-government, low-tax Republican base.

“Our mission is clear,” Romney said. “If we want to get rid of Obamacare, we’re going to have to replace President Obama. … Help us defeat Obamacare. Help us defeat the liberal agenda that makes government too big, too intrusive, and that’s killing jobs across this great country.”

Rep. Eric Cantor, the No. 2 Republican in the House of Representatives, said the chamber would vote July 11 to repeal the entire health care law. That was unlikely to hold any meaning beyond the symbolism of the vote because the Democratic-controlled Senate was unlikely to even take up such a measure.

Republican Party Chairman Reince Priebus added in a statement: “Today’s Supreme Court decision sets the stakes for the November election. Now, the only way to save the country from ObamaCare’s budget-busting government takeover of health care is to elect a new president.”

Obama, obviously pleased with the high court ruling, spoke on national television from the White House and  acknowledged that the health care law was not politically popular.

“It should be pretty clear by now that I didn’t do this because it was good politics,” he said. “I did it because it was good for the country.”

Polls show a majority of Americans do not support the overhaul in its entirety but do back many individual parts of the law, especially sections that allow young people to remain on their parent’s health insurance policies until age 26 and that forbid insurance companies from refusing coverage to people who are ill.

The central issue in the ruling concerned the means for financing the coverage changes in the law. In order to keep insurance companies from suffering significant losses by being required to insure people who are ill or prevented from dropping them from coverage if they become ill, the law requires all Americans to have insurance.

That would include the large number of uninsured young people who do not currently enter the insurance market until they grow older and more likely to need coverage. Those who don’t buy insurance will be subject to a federal fine, payable through the federal tax collection body, the Internal Revenue Service.

Most Americans already are insured. The law provides subsidies to help uninsured middle-class households pay premiums and expands federal health care for poor people.

An estimated 26 million people will remain without health coverage once the law is fully implemented, including illegal immigrants, people who don’t sign up and elect to face the fine instead, and those who can’t afford it even with the subsidies.

The court did find problems with the law’s expansion of Medicaid _ federal-state health coverage for the poor _ but even there, it said the expansion could proceed as long as the federal government does not threaten to withhold states’ entire Medicaid allotment if they don’t take part in the law’s extension.

The court’s four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the decision. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

Associated Press Wire Service

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