Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Supreme Court Upholds Constitutionality of the PPACA

As described further below, on Thursday the Supreme Court upheld the individual mandate and other contested provisions of the Patient Protection and Affordable Care Act (PPACA).  In an unexpected 5-4 decision by Chief Justice Roberts and Justices Breyer, Ginsburg, Kagan and Sotomayor (the latter appointed by Democratic presidents), the court held that the tax code penalty used to enforce the individual mandate is a “tax” and, thus, the mandate and the related penalty are constitutional.  The opinion struck down, however, the Administration’s argument that the mandate is constitutional under the commerce clause.  

Republican leaders were quick to label the individual mandate enforcement penalty a “tax” on the middle class that the President and congressional Democrats had previously argued was not a “tax.”  House Republican leadership announced they will hold a vote on July 11th to repeal the entire PPACA.  Republicans indicated that repeal efforts on individual parts of the PPACA also are not out of the question this year, at least in the House.  

As to House efforts to repeal the law, Senate Majority Leader Harry Reid pronounced “The Supreme Court has spoken—the matter is settled….” and said the scheduled House vote to repeal the law is just a “a show vote.”  Senate Republicans threatened to use budget reconciliation next year (requiring only 51 votes) in an attempt to curtail the law.  

On the other hand, President Obama reacted to the opinion, favorable to his signature legislative achievement, by stating “Whatever the politics, today’s decision was a victory for people all over this country whose lives will be more secure because of this law, and the Supreme Court’s decision to uphold it….”  He also touted the law’s benefits to the 30 million Americans who do not yet have health insurance by offering them in 2014 an array of quality, affordable, private health insurance plans to choose from under new health insurance exchanges.  

In a statement disputed by Republicans, the President also maintained that the 250 million Americans who already have health insurance can keep their coverage and that it will be more secure and affordable.  Republican presidential candidate Mitt Romney reacted to the decision by declaring, if elected, he will act to repeal the law on his first day in office in order to avoid adding trillions of dollars to the federal deficit that would burden future generations.  He said he will act to replace the law with real reform that would allow people who want to keep their current insurance to do so and protect those with pre-existing conditions from losing their health insurance coverage.  

Of note, the Supreme Court decision also clears the way for the federal courts to proceed on numerous other federal cases involving other issues connected to the PPACA, including among other suits: the constitutionality of the Independent Payment Advisory Board; whether First Amendment rights are violated by the PPACA’s mandate for religiously affiliated hospitals and other organizations to provide contraception and other services they say violate their religious values; and whether the law unconstitutionally prevents the expansion of doctor owned hospitals.  See the Appendix for a summary of the Supreme Court decision in NATIONAL FEDERATION OF INDEPENDENT BUSINESS ET AL. v. SEBELIUS, SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL.

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