The U.S. Supreme Court’s 5-4 decision Thursday upholding almost all of the key provisions of the Affordable Care Act, including the individual mandate to purchase health insurance at its core, is an epic victory not just for the Obama administration and its Democratic supporters. It is, more importantly, a long-sought and urgently needed victory for all Americans. It sets the course for secure, affordable, comprehensive and universal health care — a level of care that cannot be capriciously denied by a callous health-care industry that has long elevated outsized profits over provision of adequate care for all Americans.
Surprisingly, the court’s majority decision hinged on — and was written by — Chief Justice John G. Roberts Jr., and not Justice Anthony Kennedy, the usual swing vote between the court’s conservative and liberal wings. More surprising was Chief Justice Robert’s view that the constitutionality of the health-care reform act — and, specifically, the individual mandate to purchase health insurance — is rooted in the federal government’s right to impose a tax in needed circumstances, and not in its authority to regulate interstate commerce. The administration had argued for the latter, which the federal government has used for more than 60 years to regulate economic activities that broadly impact Americans everywhere.
Either should be acceptable. The ACA’s individual mandate, facilitated with the help of wage-based subsidies for most middle-class Americans, would necessarily function as a health care tax for a system that more fairly regulates and funds basic comprehensive universal health care.
Insurance exchanges upheld
Under the reform act, state governments are required by 2014 to establish insurance exchanges in which insurers must offer competitively priced health insurance under minimum comprehensive care standards for all comers at flat rates. With federal subsidies for most wage-earning Americans, that will enable the needed expansion of insurance pools for ordinary Americans in the gap between Medicaid for the truly poor and Medicare for seniors. That’s especially needed in states like Tennessee, where less than 55 percent of employers sponsor employee health care insurance, which in many cases is skeletal at best.