POSTED: 01:30 a.m. HST, Jun 29, 2012
LAST UPDATED: 08:17 a.m. HST, Jun 29, 2012
The 5-4 decision upholding President Barack Obama's health care law affects nearly every American. The law tells almost everyone they must have health coverage and guarantees it will be available to them even if they are already ill or need hugely expensive care. It helps the poor and many middle-class people afford coverage.
The high court upheld almost all of the law, including the most disputed part: the mandate that virtually all Americans have health insurance or pay a fine. The court said that fine is essentially a tax, and that's why the government has the power to impose it.
The ruling limited the law's plan to expand the Medicaid insurance program for the poor, a joint effort of the federal government and states. It says the U.S. government cannot withhold a state's entire Medicaid allotment if it doesn't participate in the expansion.
Chief Justice John Roberts sided with the court's four liberal justices -- Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor -- to form the 5-4 majority.
The court upheld Obama's signature legislative achievement. Final word from the court amplifies the most polarizing issue of his re-election campaign against Republican Mitt Romney.
"Whatever the politics, today's decision was a victory for people all over this country whose lives are more secure because of this law," Obama said Thursday.
GOP lawmakers and Romney have promised to repeal the law if they are in power after the November election.
"What the court did not do on its last day in session, I will do on my first day if elected president of the United States," Romney said Thursday. "And that is I will act to repeal Obamacare."
The 2010 health care law will keep taking effect. It's expected to bring coverage to about 30 million uninsured people. Overall, more than 9 in 10 eligible Americans will be covered.
Some parts are already in effect:
>> Young adults can stay on their parents' insurance up to age 26.
>> Insurers can't deny coverage to children with health problems.
>> Limits on how much policies will pay out to each person over a lifetime are eliminated.
>> Hundreds of older people already are saving money through improved Medicare prescription benefits.
>> And co-payments for preventive care for all ages have been eliminated.
Starting in 2014, almost everyone will be required to be insured or pay a fine. There are subsidies to help people who can't afford coverage. Most employers will face fines if they don't offer coverage for their workers. Newly created insurance markets will make it easier for individuals and small businesses to buy affordable coverage. And Medicaid will be expanded to cover more low-income people.
Insurers will be prohibited from denying coverage to people with medical problems or charging those people more. They won't be able to charge women more, either. During the transition to 2014, a special program for people with pre-existing health problems helps these people get coverage.
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 the Medicaid expansion.
All of that assumes the law stands.
The Republican-led House already has voted for repeal but can't push it forward so long as Obama's in the White House and Democrats lead the Senate -- making the November elections crucial.
Senate Republican leader Mitch McConnell called the court decision "a fresh start on the road to repeal."