Vol. 76/No. 27      July 23, 2012

The court also held it unconstitutional to force states to expand Medicaid or lose all federal funding.

It allows the central provisions of President Barack Obama’s self-proclaimed Patient Protection and Affordable Care Act (ACA) signed into law in March 2010 to stand.

By forcing all workers to buy health insurance under penalty of fines, the one thing “Obamacare” will guarantee is a profit bonanza to insurance, drug and hospital corporations.

In the 5-4 vote, Chief Justice John Roberts, appointed by George W. Bush, joined with those on the Court associated with the Democratic Party.

“The requirement that individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax” and therefore falls within Congress’ power to “lay and collect taxes, duties, imposts and excises,” Roberts wrote in the majority ruling. He added that taxing people to influence their conduct is nothing new, citing taxes on tobacco and sawed-off shotguns as examples.

“It is not our job to protect the people from the consequences of their political choices,” Roberts wrote in favor of expanding government taxing power.

But in fact this is precisely the role delegated to the court by the U.S. Constitution—to judge the legality of the actions of the congress and the president.

The vote “shocked the nation and jolted the presidential campaign,” the New York Daily News commented the following day.

The Roberts-led decision reflected intense political pressure. “The fate of health care shouldn’t come down to 9 justices. Try 19,” was the headline of an article by Jonathan Turley in the June 22 Washington Post. Pointing to moves by President Franklin D. Roosevelt to pack the Supreme Court with six additional appointees in 1937 to get rulings he wanted, Turley argued for Obama to take similar steps today.

Obama had argued repeatedly that the penalty to be imposed on anyone who could or would not buy insurance under the law was not a tax.

Supporters of the law, such as Supreme Court justice Ruth Bader Ginsburg, claimed the power to force everyone to buy insurance came from the Constitution’s Commerce Clause, arguing that “the market for medical care is one which all individuals inevitably participate.” The court’s ruling rejected this argument.

In 2016 the tax will be 2.5 percent of household income—at least $695. By 2017 it is expected to bring in $4 billion in federal income.

Justice Anthony Kennedy wrote in dissent that taxing people for what they don’t do, like failure to buy insurance, is “to extend federal power to virtually all human activity.”

Some 50 million in the U.S. had no health insurance in 2009. More than 60 percent of them visit an emergency room every year, the one place that supposedly cannot turn them away regardless of their ability to pay.

Going after them is a big part of the bill. Judges Ruth Bader Ginzburg and Sonia Sotomayor express this most bluntly in a separate opinion backing the ruling. Without the bill the uninsured get a “free ride,” they say, and distort the whole health care market.

The market is massive. In 2009 people spent collectively $2.5 trillion on health care, 17 percent of the gross national product. By 2020 it is expected to reach 20 percent, close to $5 trillion. The average cost per individual was $7,000 in 2010. A typical bill for a hospital stay is $10,000.

Stock prices for hospital chains such as Tenet Healthcare Corp., HCA Holdings Inc. and Community Health Systems climbed by 5 to 10 percent in the days after the ruling.

The Act will inflate the bloated federal bureaucracy, a growing army of overseers appointed to “help people” and exact penalties against those who can’t pay for the compulsory insurance.

Meanwhile, the number of people with employer-based health insurance is going down. It was 44.5 percent at the end of 2011 compared to 70 percent in 2001, and the process has accelerated since the capitalist economic crisis deepened in 2008. And companies shift more and more of the premiums onto the workers.

Many unionists who have been locked out or forced out on strike over the past few years know that the question of health care coverage has been one of the main issues in their battles with the bosses.

Medicare is on the chopping block in the Act. It imposes cuts to providers of $575 billion in the first 10 years. An Independent Advisory Board will regulate the Medicare budget and be responsible for making the cuts.

The court struck down 7-2 the Act’s expansion of Medicaid as a violation of the Constitution. ACA would have extended Medicaid to cover the entire non-elderly population with an income below 133 percent of the poverty level of $23,050 for a family of four. States that didn’t comply would have lost their Medicaid funding altogether.

Medicaid, which more than 58 million people rely on, with the number growing as the bosses’ economic squeeze on working people deepens, has been continually cut in recent years. “From New Jersey to California states are cutting Medicaid payments to doctors and hospitals, limiting benefits to Medicaid patients, requiring larger co-payments and expanding the use of managed care,” the New York Times noted last year.

After the court ruling, a number of state government officials around the country, including the Governor of Florida and Attorney General of Maine, have announced they will refuse to expand Medicare and are considering eliminating more people from the program.

Kathleen Sibelius, the administration’s Health Secretary, has urged state governments not to cut people off, instead suggesting they save money by “cutting back on benefits,” the Wall Street Journal reported.

The court left untouched the Act’s exclusion of any coverage for undocumented workers and abortion services are not covered by the Act at all.  
 
 
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