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Obama calls health care decision a victory for people across U.S.

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President Barack Obama speaks in the East Room of the White House in Washington, Thursday, June 28, 2012, after the Supreme Court ruled on his health care legislation. (AP Photo/Luke Sharrett/Pool)
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Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the court's ruling was announced. Associated Press
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With the Capitol in the background, Republican presidential candidate, former Massachusetts Gov. Mitt Romney speaks about the Supreme Court's health care ruling, Thursday, June 28, 2012, in Washington. Associated Press

The Supreme Court on Thursday upheld the controversial Patient Protection and Affordable Care Act — known as “Obamacare” — but the much-anticipated ruling will not end debate over the government’s requirement that Americans buy health insurance.

The decisive vote in the 5-4 ruling came from Chief Justice John Roberts, a conservative appointed by President George W. Bush. Roberts said the requirement that individuals pay penalties for failing to obtain health insurance can be characterized as a tax.

“Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness,” Roberts wrote for the court’s majority. He was joined by Stephen Breyer, Elena Kagan, Ruth Bader Ginsburg and Sonia Sotomayor, the four most liberal justices.

The court’s ruling unleashed a flurry of praise and protest throughout the day, with President Obama calling it “a victory for people all over this country.”

Mitt Romney, the presumptive Republican presidential nominee, repeated his vow to repeal the law because it is too costly and allows government to interfere with people’s health care decisions.

“What the court did today was say that Obamacare does not violate the Constitution,” Romney said. “What they did not do is say that Obamacare is good law, or good policy.”

Four conservative justices who voted against the law — Antonin Scalia, Clarence Thomas, Samuel Alito and Anthony Kennedy — declared that the majority’s interpretation amounted to “vast judicial overreaching.”

“To say that the individual mandate merely imposes a tax is not to interpret the statute but to rewrite it. Judicial tax-writing is particularly troubling,” said Kennedy, who delivered the dissent from the bench.

Pa. insurance exchange in works

The law, which for the most part will go into effect in 2014, is expected to extend health insurance coverage to more than 30 million people while preventing insurers from discriminating against people with pre-existing ailments. Some key elements are in place, such as allowing children and young adults up to age 26 to remain on their parents’ insurance policies.

Nearly 1.3 million uninsured Pennsylvanians are expected to gain health coverage in 18 months. State officials are working to put in place a so-called insurance exchange that would offer individuals and small businesses an online marketplace to shop for health plans, a feature of the law.

“Today’s Supreme Court ruling is a victory for millions of Pennsylvania families, seniors and small business owners,” said Antoniette Kraus, a project director for the Pennsylvania Health Access Network. “Millions of Americans have already benefited from the Affordable Care Act, and millions more will benefit from additional consumer protections and a new insurance marketplace that will provide affordable health care options to small businesses and families.”

The complex ruling said the government cannot force states to expand the Medicaid program for the poor, which had been a key provision of the law. That means states can opt out of expanding the program without putting themselves at risk of losing federal funds. The law would have allowed the government to withhold all Medicaid money to states that didn’t expand the program.

“The financial ‘inducement’ Congress has chosen is much more than ‘relatively mild encourage­ment’— it is a gun to the head,” Roberts wrote. “The threatened loss of over 10 percent of a State’s overall budgets … is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.”

Americans watched as the decision was announced on live TV and on social media sites such as Twitter.

“I’m in a state right now where I’m reluctant to go to the doctor because of the cost of it,” said Rick Mossinghoff, 63, of Robinson.

Mossinghoff has several chronic illnesses, including diabetes and high blood pressure. He has used up his allotted doctor visits for the year and has to decide whether to pay anywhere from $90 to $240 to get care. “I’m just thrilled that the Supreme Court basically upheld the law, and I believe it’s been misrepresented and misunderstood by a lot of people.”

‘Small businesses will be overwhelmed’

Officials at Highmark Inc., the state’s largest insurer, said they are happy more people will have access to care but remain worried about the escalating cost of providing care.

“We do not have high value, high quality for the dollars we’re spending,” said Dr. Donald Fischer, Highmark’s chief medical officer. He talked up the insurer’s partnership with West Penn Allegheny Health System as a way to improve care and said people often have a hard time getting a doctor’s appointment.

Some business groups expressed disappointment with the ruling, calling it an assault on personal freedom.

“The tragedy in this ruling is that Pennsylvania residents are now at the mercy of politicians from other states and bureaucrats in Washington whose decisions won’t be based on what is best for Pennsylvania,” said Kevin Shivers, Pennsylvania state director for the National Federation of Independent Business, which was a plaintiff in the Supreme Court challenge. “Small businesses here will be overwhelmed by mandates, taxes and burdens imposed on them by people whom we cannot as easily hold accountable.”

The National Association of Manufacturers said the Affordable Care Act does little to control skyrocketing health care costs, the chief concern of most manufacturing companies.

“Today’s ruling, although a dramatic moment in our nation’s history, still leaves a lot of work to be done to reduce soaring health care costs,” CEO Jay Timmons said.

Legal experts surprised

University of Pittsburgh constitutional law professor David Herring called the 193 pages of opinions “surprising,” because most legal experts had not expected a majority of justices to uphold the individual mandate under Congress’ taxing powers. It is a very complex and confusing set of opinions, he said.

Herring said Roberts had to make a convoluted argument to come to the conclusion that the individual mandate can stand as a tax. If the individual mandate is a tax, then the law can’t be challenged until someone pays the tax, which won’t happen until 2014.

Instead, the chief justice argued that the mandate is a penalty for the purposes of whether the court can consider the challenge and rule now, but it’s a tax for the purposes of constitutional review.

“Roberts has to do some somersaults to get to that,” Herring said. “It’s like being a lawyer’s lawyer. … I would expect most people to not quite understand that reasoning, but it’s a common approach in law.”

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

That number could be higher, depending on whether any states refuse to participate in an expansion of Medicaid, the government’s health insurance program for the poor and disabled. Pennsylvania and 25 other states went to court to fight the mandated expansion.

“This was a groundbreaking, historic decision,” said Duquesne University Law School Dean Ken Gormley, an expert in constitutional law. “Whether or not one agrees with Congress’ decision to pass the Affordable Care Act, the court was saying it has enormous discretion in this area under the Constitution.”

The Associated Press and staff writer Adam Wagner contributed to this report. Luis Fábregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or [email protected]. Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928.

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