Steve Ciccarelli of Annandale, Va., right, a proponent of President Barack Obama's health care law, argues with Susan Clark, of Washington, outside the SupremeCourt Thursday while awaiting the court's ruling on the law. (AP Photo/David Goldman)
Editor's note: Political reporter Hank Hayes is covering regional reaction to the Supreme Court ruling. Please scroll down or click here for national coverage by the Associated Press.
Here’s a rundown of the reaction related to today’s U.S. Supreme Court ruling in favor of the Affordable Care Act, also known as “Obamacare”:
From Tennessee Democratic Party Chairman Chip Forrester:
“The Supreme Court affirmed what a majority of Congress and the President already knew; that the Affordable Care Act is a constitutionally appropriate response to the health care crisis facing Tennessee families. Because of President Obama’s leadership, millions of working families, including a half a million Tennesseans, will have access to doctors and affordable health care.
“The Affordable Care Act is law, and will continue to be the law of the land. We should all come together and work in a bipartisan fashion, as did the Supreme Court, in order to ensure that all Tennesseans can take advantage of the provisions in the law that provide health and financial security.”
From Tennessee GOP U.S. Senator Bob Corker:
“Today’s ruling makes it clear that it’s up to Congress to replace the president’s health care law with common sense reforms that our nation and its citizens can afford."
From Dennis Vonderfecht, president and CEO of Mountain States Health Alliance (MSHA):
“The assurance of health insurance coverage for 32 million more Americans is a positive step, not only for those individuals currently lacking coverage, but also for the nation’s hospitals, which agreed in 2010 to absorb almost $155 billion in cuts to Medicare reimbursement over 10 years. That agreement was made with the understanding that more Americans would have health insurance coverage to make up the balance. During the past 12 months, MSHA has provided $167 million in uncompensated care. Unless hospitals can reduce their uncompensated care burden, they would not be able to sustain the scheduled reimbursement cuts from the federal government.”
From Tennessee 1st Congressional District Democratic nominee Alan Woodruff:
“I am concerned that the Supreme Court’s ruling is going to do two things: First, it may make Democrats less willing to compromise — in the interest establishing a more economically appropriate system. Second, it will make the Republicans even more likely to dig in their heels and not even consider any revisions to the (Affordable Care) Act to make it more fiscally rational.
“At some point we also have to deal with the rising cost of health care. The Act does nothing to contain the rising cost of health care, which is just as big a national problem as expanding insurance coverage.”
From Tennessee GOP U.S. Sen. Lamar Alexander:
"The Supreme Court may have failed to declare the entire health-care law unconstitutional, but it is still an historic mistake that expanded a health-care system we already knew we couldn’t afford. Congress should repeal the law and then proceed step by step to reduce the cost of health care so more Americans can afford to buy insurance.
“It means there will be about a half trillion dollars of new taxes in it. It means that for millions of Americans, premiums will go up, because when people pay those new taxes, premiums will go up, and they will also go up because of the government mandates.”
From Virginia 9th Congressional District Democratic nominee Anthony Flaccavento:
“This morning, the Supreme Court ruled to uphold the Affordable Care Act. We have already seen the positive impacts of several provisions of this law. For example, recent college graduates and other young people are able to stay on their parents’ coverage until age 26, and millions of previously uninsured children now have access to health care. As the entire law goes into full effect over the next two years, we will begin to experience the benefits of tax credits for small businesses to provide health insurance for their employees, and coverage for people with pre-existing medical conditions.
“I have always supported increased access to affordable health care and will continue to work on this issue as Congressman. While this is an important step in the right direction, there is clearly room for improvement, especially in the area of prescription drug costs. We also need to continue to improve preventive care and overall health in America to help reduce costs."
From Tennessee Gov. Bill Haslam:
“We will review the entire Supreme Court’s opinion to fully understand its impact on the State of Tennessee. From initial reports, it appears the individual mandate has been ruled Constitutional and has been upheld.
“My primary issues with ObamaCare are that it takes away the flexibility for states to encourage healthy behavior, will cost Tennessee hundreds of millions of dollars, and does nothing to solve the crisis of the cost of health care in America.
“What was unanticipated is the section of the opinion that says states cannot be forced to expand their Medicaid program. This particular portion of the ruling is significant, but it is premature to know the exact ramifications.
“Now it is up to Tennesseans and Americans to turn their attention to the November election. By electing Mitt Romney, we can be sure that the entire law will be repealed.”
From Republican Party of Virginia Chairman Pat Mullins:
“Today’s decision is extremely disappointing, but it is not the end of the story. The American people will have the final say on ObamaCare this November at the ballot box.
“And in January, I look forward to standing with President Mitt Romney, Majority Leader Eric Cantor and newly-sworn in Senator George Allen as this law is repealed and replaced with common-sense, market based reform.”
From Tennessee Republican Party Chairman Chris Devaney:
“Getting rid of ObamaCare is now in the hands of the American people, and we can accomplish that by electing Mitt Romney president in November. Today’s Supreme Court decision will increase the determination of Tennessee Republicans to defeat President Obama and put an end to his reckless policies that have failed to address the economy and are only making things worse.”
From Tennessee Lt. Gov. Ron Ramsey:
“It is intensely disappointing that this court failed to recognize what constitutionalists and conservatives know deep in their hearts: A federal government which can coerce its people to buy a product is a government unrestrained and out of control. Democrat Governor Phil Bredesen called Obamacare the ‘mother of all unfunded mandates’ and stated it will cost Tennesseans 1.1 billion dollars in the next few years. However, the fight does not end here. The court may have made its decision today but the people have yet to speak. When they do, Mitt Romney will be elected president and I will do all I can to aid him as he fulfills his solemn promise to repeal this insidious law.”
From Virginia U.S. Senate Democratic nominee Tim Kaine:
“The Affordable Care Act is an important first step in curbing discriminatory insurance company practices and increasing access to health care, but more needs to be done to bring down costs. Our government, businesses, and citizens cannot continue to spend more than any other nation on health care while getting second-rate results. As senator, I am committed to working with all stakeholders to find additional improvements to the Affordable Care Act that give all Americans affordable access to high quality services.
“While there is more work to do, it is worth noting what has already been accomplished under the Affordable Care Act. Nearly 63,000 more young people in Virginia have health coverage, more than 800,000 Virginia seniors have received free preventive care, millions of small businesses are now eligible for tax credits, and twenty million American women have access to cancer screenings and contraception without co-pays. And we’ve put an end to the egregious abuses by insurance companies that denied coverage to children with preexisting conditions, charged women higher premiums for the same coverage, and dropped folks when they got sick.
“My opponent (Republican George Allen) regularly calls for a full repeal of this law, despite the positive results it’s already delivering for Virginia. In the decade encompassing George Allen’s six years as a U.S. Senator, the average insurance premium for families more than doubled and over 12 million more Americans were uninsured. Clearly, inaction was not a solution, and neither are continued calls for repeal. Instead we must work together to strengthen this existing program and improve cost controls.”
From U.S. Rep. Morgan Griffith, R-Va.:
“I’m extremely disappointed by this decision. This law and the process in which it was drafted represent abject failures for our health care system and our country. It is no secret that our economy is chained down by this law. I was hoping that the Supreme Court would take the decisive first step to unshackle the country, but sadly they did not. Instead, nearly every person in the country will now face a new ‘tax’ if they don’t want to comply with this law.
“In line with the dissenting justices, I still think that this law is an unprecedented overreach of federal power. This overreach jeopardizes the stature of our health care system, places an extraordinary burden on our businesses and job creators, and leaves treatment in a state of limbo thanks to the Independent Payment Advisory Board (IPAB).
“Two years ago, our health care system was infinitely changed. The legislative process to bring forth that change was atrocious. The final bill was disastrous. And today’s verdict is depressing. I will continue advocating for commonsense policies until America finally achieves real health care reform. Now the only path to stop Obamacare is at the ballot box. The rule of law and our Republic suffered a huge blow today, but our spirit is not crushed and we the people will ultimately overcome it.”
From Virginia Gov. Bob McDonnell:
“Today’s Supreme Court ruling is extremely disappointing for Virginia and for America. The (Affordable Care Act) will create a costly and cumbersome system that will impair our country’s ability to recover from these challenging economic times, infringes on our citizen’s liberties, will harm small businesses, and will impose dramatic unfunded mandates on Virginia and all states. Simply put, this is a blow to freedom. America needs market-based solutions that give patients more choice, not less.
“Virginia will evaluate the steps necessary to comply with the law. While we have awaited this decision, planners have been working to identify necessary resources and issues to be addressed to ensure Virginia implements this flawed law in the most effective and least costly and burdensome way possible. In coming months, Virginia’s healthcare leaders will work to develop the best possible system to meet the healthcare needs of our citizens. It remains my hope that we will elect a new President and Senate so that the existing law will be repealed and states will be given the freedom they need to implement healthcare solutions that work best for their citizens. We will evaluate the opinion in detail in the days ahead and determine what policies are proper for the people of Virginia.”
From Virginia Republican U.S. Senate nominee George Allen:
"While disappointed in the Supreme Court's decision on President Obama's health care law, I believe it reinforces what is truly at stake during this pivotal election. This November the American people have an opportunity to choose new leadership in Washington who will listen to their voices and repeal this costly, harmful government health care law.
"My opponent (former Virginia Gov. Tim Kaine) believes this health care law is a 'great achievement,' but I believe it's an infringement on individual liberty and free enterprise. As I have traveled throughout Virginia, I have heard from families, small business owners and seniors seriously concerned about the harmful impact of this health care law and how it is increasing costs, discouraging businesses from hiring, and trespassing on religious freedom.
"I want to be the deciding vote to repeal this health care law. Virginians and Americans would be better served by reforms that deliver on the promise of reducing costs, increasing access to quality care, and put people - not government - in control of their health care. We need health care reforms that provide Americans with affordable, portable, and personal market-based health care solutions including Health Savings Accounts. I also support allowing small businesses to join together across State lines in larger risk pools for lower insurance costs and more competition and greater choice. And the States should be allowed the flexibility to manage Medicaid more smartly and efficiently.
"Virginia has proven that historic reforms can be achieved if leaders are willing to work together. As Governor, I worked with a Democrat-controlled legislature to pass major reforms including welfare reform, abolition of parole and Standards of Learning - now Washington needs the leadership and political will to achieve real health care reform."
From Republican National Committee Chairman Reince Priebus:
"Today's Supreme Court decision sets the stakes for the November election. Now, the only way to save the country from ObamaCare's budget-busting government takeover of health care is to elect a new president. Under President Obama's signature legislation, health care costs continue to skyrocket, and up to 20 million Americans could lose their employer-based coverage. A panel of unelected bureaucrats now has the unprecedented authority to come between elderly patients and their doctors. Meanwhile, the rules and regulations placed on job creators and small businesses make it nearly impossible to hire new workers at a time when Americans desperately need jobs.
"We need market-based solutions that give patients more choice, not less. The answer to rising health care costs is not, and will never be, Big Government.We must elect a president who understands the economy, respects free enterprise, and can provide the leadership we now so desperately need. On Election Day, we must elect Mitt Romney and put America on the path toward a brighter economic future and successful health care reform."
From Virginia Attorney General Ken Cuccinelli:
"This is a dark day for the American people, the Constitution, and the rule of law. This is a dark day for American liberty. This decision goes against the very principle that America has a federal government of limited powers; a principle that the Founding Fathers clearly wrote into the Constitution, the supreme law of the land. The Constitution was meant to restrict the power of government precisely for the purpose of protecting your liberty and mine from the overreaching hand of the federal government.
"This unprecedented decision says that Congress has the authority to force citizens to buy private goods or face fines - a power it has never had in American history, and a power King George III and Parliament didn't have over us when we were mere subjects of Great Britain. Since the federal government itself could never articulate to the court a constitutional limit to this power, Congress has gained an unlimited power to force citizens to buy anything.
"I am disappointed with the court's ruling and with the unprecedented attack on American liberty the president and the previous Congress have created with this law."
From U.S. Rep. Phil Roe, R-Tenn.:
“Today’s Supreme Court ruling is a major let-down for the American people. I am truly disappointed with the decision because there does not seem to be a limit to what the federal government can compel us to do.
“The federal government is literally forcing all Americans to buy health insurance. If the government can force individuals to purchase health care, what else will they require the American people to purchase? Even worse, this legislation gives the federal government the right to decide what is ‘acceptable’ coverage for individuals. Those who do not meet these standards will be taxed.
“The court’s ruling gives renewed urgency to our efforts to repeal this law. If we allow its full implementation, our health care decisions will forever be in the hands of Washington bureaucrats. Despite the disappointing ruling, I am committed to working to repeal the law and address critical health care challenges that face our nation with reforms that lower health care costs.”
Supreme court upholds Obama health care law
WASHINGTON (AP) — The Supreme Court on Thursday upheld virtually all of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that nearly every American have health insurance.
The 5-4 decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.
The ruling hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call "Obamacare," arguing that the ruling characterized the penalty against people who refuse to get insurance as a tax.
Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if elected in November.
Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. Roberts explained at length the court's view of the mandate as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.
Even though Congress called it a penalty, not a tax, Roberts said, "The payment is collected solely by the IRS through the normal means of taxation."
Roberts also made plain the court's rejection of the administration's claim that Congress had the power under the Constitution's commerce clause to put the mandate in place. The power to regulate interstate commerce power, he said, "does not authorize the mandate. "
Stocks of hospital companies rose after the decision was announced, while shares of insurers fell sharply. Shares of drugmakers and device makers fell slightly.
The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed 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 said.
The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.
The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.
Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.
Kennedy summarized the dissent in court. "In our view, the act before us is invalid in its entirety," he said.
The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."
In all, the justices spelled out their views in six opinions totaling 187 pages. Roberts, Kennedy and Ginsburg spent 51 minutes summarizing their views in the packed courtroom.
The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Majority Leader Eric Cantor, R-Va., said Thursday the House will vote the week of July 9 on whether to repeal the law, though such efforts have virtually no chance in the Democratic-controlled Senate.
House Speaker John Boehner, R-Ohio, said the health care law makes it harder for small businesses to hire workers. "Today's ruling underscores the urgency of repealing this harmful law in its entirety," he said.
But Senate Majority Leader Harry Reid, D-Nev., heaped praise on the court's decision, and the 2010 law, in a Senate speech. "Passing the Affordable Care Act was the greatest single step in generations toward ensuring access to affordable, quality health care for every American, regardless of where they live or how much money they make," he said.
After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.
"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."
Democrats said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.
"Mitt Romney is the intellectual godfather of Obamacare," said Democratic consultant Jim Manley. "The bigger issue is the rising cost of health care, and this bill is designed to deal with it."
More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.
There's also an added safety net for all Americans, insured and uninsured. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections, now standard in most big employer plans, will be available to all, including people who get laid off, or leave a corporate job to launch their own small business.
Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no copayments for preventive care. But hospitals, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.
Illegal immigrants are not entitled to the new insurance coverage under the law, and will remain one of the biggest groups uninsured.
Obama's law is by no means the last word on health care. Experts expect costs to keep rising, meaning that lawmakers will have to revisit the issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-income people.
The health care overhaul focus will now quickly shift from Washington to state capitals. Only 14 states, plus Washington, D.C., have adopted plans to set up the new health insurance markets called for under the law. Called exchanges, the new markets are supposed to be up and running on Jan. 1, 2014. People buying coverage individually, as well as small businesses, will be able to shop for private coverage from a range of competing insurers.
Most Republican-led states, including large ones such as Texas and Florida, have been counting on the law to be overturned and have failed to do the considerable spade work needed to set up exchanges. There's a real question about whether they can meet the deadline, and if they don't, Washington will step in and run their exchanges for them.
In contrast to the states, health insurance companies, major employers, and big hospital systems are among the best prepared. Many of the changes called for in the law were already being demanded by employers trying to get better value for their private health insurance dollars.
"The main driver here is financial," said Dr. Toby Cosgrove, CEO of the Cleveland Clinic, which has pioneered some of the changes. "The factors driving health care reform are not new, and they are not going to go away."
The Medicaid expansion would cover an estimated 17 million people who earn too much to qualify for assistance but not enough to afford insurance. The federal and state governments share the cost, and Washington regularly imposes conditions on the states in exchange for money.
Roberts said Congress' ability to impose those conditions has its limits. "In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement' — it is a gun to the head," he said.
The law says the Health and Human Services Department can withhold a state's entire Medicaid allotment if the state doesn't comply with the health care law's Medicaid provisions.
Even while ruling out that level of coercion, however, Roberts said nothing prevents the federal government from offering money to accomplish the expansion and withholding that money from states that don't meet certain conditions.
"What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding," he said.
Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision. She said Congress' constitutional authority to regulate interstate commerce supports the individual mandate. She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.
"So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions," Ginsburg said in a statement she, too, read from the bench.
In the courtroom Thursday were retired Justice John Paul Stevens and the wives of Roberts, Alito, Breyer, Kennedy and Thomas.
Associated Press writers Ricardo Alonso-Zaldivar, Charles Babington, Jessica Gresko, Jesse J. Holland and David Espo contributed to this report.
Visit AP's Google Plus page at 4 p.m. EDT for a Google Hangout video chat where AP reporters will be discussing the impact of today's ruling and taking your questions: —http://apne.ws/LgPvzL
Copyright 2012 The Associated Press.
This is a developing story. Please check back for updates.