The Supreme Court in a 5-4 ruling upheld the federal health reform law’s individual mandate, reaffirming the law's requirement that most U.S. residents must purchase health insurance.
The justices said that the individual mandate—the requirement that most Americans buy health insurance or pay a fine—is constitutional as a tax.
Chief Justice John Roberts—a conservative appointed by President George W. Bush—provided the key vote to preserve the landmark health care law.
The government had argued that Congress had the authority to pass the individual mandate as part of its power to regulate interstate commerce; the court disagreed with that analysis, but preserved the mandate because the fine amounts to a tax that is within Congress’ constitutional taxing powers.
The announcement will have a major impact on the nation’s health care system, the actions of both federal and state governments, and the course of the November presidential and congressional elections.
While the individual mandate remained 18 months away from implementation, many other provisions already have gone into effect, such as free wellness exams for seniors and allowing children up to age 26 to remain on their parents’ health insurance policies.
Throughout the health care reform debate, SFMS/CMA has strongly advocated for affordable access to care for California’s uninsured and for expansion of health insurance coverage. The physician organization has also supported eliminating egregious health plan rescission practices, pre-existing condition bans, and ending excessive insurer profit and administrative costs. SFMS/CMA was also instrumental in arguing for state based health insurance exchanges, rather than one national exchange of private health plan choices and urged reinvestments in primary care, public health and the physician workforce.
California Poised To Gain From Reform Law
California stands to be one of the biggest recipients of federal funding from the reform law because of its large number of uninsured residents. The state has 7 million uninsured residents, making up nearly 20% of its population.
Under the reform law, California could receive as much as $9 billion annually to expand Medi-Cal, the state’s Medicaid program. According to calculations from the Urban Institute, the state could receive an additional $6 billion annually for low- and middle-income residents who buy subsidized insurance through the state health insurance exchange. In addition, California physicians could receive an additional $700 million annually in increased reimbursements under the law for treating patients who obtain coverage under the Medi-Cal expansion.
Following the Supreme Court ruling, House Minority Leader Nancy Pelosi (D-Calif.) in a statement said, “This decision is a victory for the American people. With this ruling, Americans will benefit from critical patient protections, lower costs for the middle class, more coverage for families, and greater accountability for the insurance industry."