Editorial: Roberts rules and health law lives
Yesterday’s Supreme Court ruling upholding the Affordable Care Act is a big political victory for President Obama, and a step toward a better, more rational health care system for the nation, most notably its 50 million uninsured. While we have issues with the legal reasoning of Chief Justice John Roberts, who wrote the majority opinion, we are grateful that, in a politically charged atmosphere and on a politically divided court, he followed the law as he saw it, broke with fellow conservatives and preserved a crucial element of the law, the “individual mandate.”
That’s the one requiring nearly every American to have health insurance. If they don’t already have it through an employer, government program like Medicare or Medicaid, or private policy, then they must purchase it from a health insurance company or state-sponsored exchange, with the help of federal tax credits. If they choose not to, they’ll have to pay, by 2016, a maximum of $695 for an individual and $2,085 for a family, or 2.5 percent of their income, whichever is higher. Congress called this a penalty and the law’s critics call it a tax.
Ironically, given conservatives’ antipathy for taxes, it was Judge Roberts’ characterization of this payment as a tax that saved the scheme. Roberts didn’t accept Congress and the Obama administration’s argument that the individual mandate was a legitimate use of federal power under the Commerce Clause. He opined that the Commerce Clause gives the federal government the right to regulate economic activity, but not to compel it by requiring someone to buy a product — in this case, health insurance — that he doesn’t want.
The fact is, though, that health care in this country is one giant market, and nobody is ever really out of it, whether he wants to be or not. The uninsured, when they need care, still get it, but usually in the most expensive setting, a hospital emergency room. And the insured pay for it through higher premiums, while taxpayers pay through government reimbursement to hospitals to compensate for charity care.
But while Roberts wrongly rejected the Commerce Clause argument, he allowed the individual mandate to stand because, he said, the required payment in lieu of coverage was really a tax, and the court gives the government the widest latitude in that area. He also said that, according to previous court rulings, the only time a tax can be challenged is after it has been paid, when people can sue for a refund.
The individual mandate is fairer because it ends the free rides. It also provides the numbers, and healthy bodies, necessary for health insurers to handle other important parts of the law, like the requirement to take patients with pre-existing conditions. It’s interesting to note that the individual mandate was a key part of Republican presidential candidate Mitt Romney’s health plan when he was governor of Massachusetts, which was a model for the federal plan. And that it became part of the federal plan only after the Republicans complained about President Obama’s preferred public option and pushed the individual mandate as an alternative.
We hope the battle over “Obamacare” is finally over, but with the election coming and Washington as polarized as it is, we suspect otherwise. And even if the law survives any repeal attempts, big problems remain, many of them having to do with the huge and ever-growing cost of a system that relies so heavily on private insurance. We still think a single-payer, government system would be the most efficient, but, thanks to Justice Roberts, we now at least have the universal coverage that has eluded this country for so long.