UPDATE: Supreme Court upholds health insurance noncompliance fee as a tax

The U.S. Supreme Court today ruled 5-4 that the mandate in the Affordable Care Act for all U.S. citizens to purchase health insurance is constitutional. The court’s decision essentially upheld the entire health care reform law.

Chief Justice John Roberts read the majority opinion, which stated that a penalty for not purchasing health insurance should be treated as a tax that Congress has the right to levy according to its constitutionally sanctioned power of taxation.

The court also ruled that a provision requiring states to comply with new eligibility requirements for Medicaid or risk losing their funding is constitutional. States only lose new funds, not all of their funding, if they do not comply with the new requirements, according to the opinion.

“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,” Roberts stated in the opinion. “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.”

The Patient Protection and Affordable Care Act was passed by Congress and signed into law by President Barack Obama in March 2010. Twenty-six states challenged the constitutionality of the insurance mandate. The Supreme Court heard 3 days of oral arguments in March.

House Speaker John Boehner, R-Ohio, issued a statement on his website shortly after the court ruling.

“The president’s health care law is hurting our economy by driving up health costs and making it harder for small businesses to hire,” Boehner said. “Today’s ruling underscores the urgency of repealing this harmful law in its entirety.”

In a statement released today in response to the decision, the American Gastroenterological Association supported the resulting increase in patients’ access to care, but called on Congress to change certain provisions of the law to better serve both patients and doctors.

“There is a gap in the law that AGA seeks to close: Patients are responsible for coinsurance when a polyp is removed during a screening colonoscopy. AGA has worked with champions to introduce legislation in the House to repeal this provision, which we worry could limit patient access to colonoscopy,” said the AGA in the statement.

The association also called for the abolition of the Independent Payment Advisory Board, a body created by the law to propose Medicare spending limits.

“This group of 15 unelected, unaccountable individuals will have the authority to make significant changes to Medicare, without the expertise of a single practicing physician on the board. It lacks the input required when making health-care decisions that could have a negative impact on patient access to quality care, physician practices and medical innovation. There is no question the rate of growth in Medicare spending is not sustainable, but the IPAB is not the answer.”

Other Reactions to the Ruling

American Medical Association:

“This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans.

“The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork. It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.”

Alliance of Specialty Medicine:

“While we certainly respect the Supreme Court's decision, we will not be deterred from working to reform or repeal certain aspects of the Affordable Care Act that are onerous to the practice of medicine and are detrimental to patients’ access to quality care."

"Provisions in the law, such as the Independent Payment Advisory Board and the Value Based Payment Modifier, only seek to further penalize health care providers without doing anything to improve patient care. Despite today’s ruling, these and other provisions of the health care law need further scrutiny, if not outright repeal. Even supporters of the law would agree with that. Additionally, we will continue our efforts to repeal Medicare’s flawed sustainable growth rate (SGR) formula and to pass medical liability reform – two critical aspects of health reform that were not addressed in ACA."

"Since the day President Obama signed the Affordable Care Act into law, the Alliance of Specialty Medicine has been operating under the assumption that it was the law of the land. That said, we have been working very hard with the Congress and the regulatory agencies to make certain doctors' voices were heard loud and clear on how this law would affect patient care. Today's ruling does nothing to deter our efforts and in fact, will only serve to bolster them.”