Quotes from 2012 Obamacare Supreme Court Hearing

"The purpose of this lawsuit is to challenge a requirement -- a Federal requirement to buy health insurance. That requirement itself is not a tax. And for that reason alone, we think the Anti-Injunction Act doesn't apply."

Gregory G. Katsas
The Oyez Project
March 26, 2012
Library Topic

"JUSTICE KAGAN: Mr. Katsas, do you think a person who is subject to the mandate but not subject to the penalty would have standing?

MR. KATSAS: Yes, I think that person would, because that person is injured by compliance with the mandate.

JUSTICE KAGAN: What would that look like? What would the argument be as to what the injury was?

MR. KATSAS: The injury -- when that subject to the mandate, that person is required to purchase health insurance. That is a forced acquisition of an unwanted good. It's a classic pocketbook injury."

Justice Elena Kagan
Gregory G. Katsas
The Oyez Project
March 26, 2012
Library Topic

"Justice Scalia: If it’s not jurisdictional, what’s going to happen is you are going to have an intelligent federal court deciding whether you are going to make an exception. And there will be no parade of horribles because all federal courts are intelligent.

Justice Breyer: Taxes are, for better or for worse, the life’s blood of government.

Justice Ginsburg: Why would somebody not choose to obtain it? Why -- that's one puzzle to me. There's this category of people who are Medicaid eligible; Medicaid doesn't cost them anything. Why would they resist enrolling?"

Justice Antonin Scalia
Justice Stephen Breyer
Justice Ruth Bader Ginsburg
The Oyez Project
March 26, 2012
Library Topic

"Justice Ruth Bader Ginsburg: General Verrilli, can we -- can we go back to, Justice Breyer asked a question, and it kind of interrupted your answer to my question.

And tell me if I'm wrong about this, but I thought a major, major point of your argument was that the people who don't participate in this market are making it much more expensive for the people who do; that is, they -- they will get, a good number of them will get services that they can't afford at the point where they need them, and the result is that everybody else's premiums get raised.

So you're not -- it's not your -- your free choice just to do something for yourself.

What you do is going to affect others, affect them in -- in a major way.

Mr. Verrilli Jr.: --That -- that absolutely is a justification for Congress's action here.

That is existing economic activity that Congress is regulating by means of this rule.

Justice Antonin Scalia: General Verrilli, you -- you could say that about buying a car.

If -- if people don't buy cars, the price that those who do buy cars pay will have to be higher.

So you could say in order to bring the price down, you are hurting these other people by not buying a car.

Mr. Verrilli Jr.: That is not what we are saying, Justice Scalia.

Justice Antonin Scalia: That's not -- that's not what you're saying.

Mr. Verrilli Jr.: That's not -- not--

Justice Antonin Scalia: I thought it was.

I thought you were saying other people are going to have to pay more for insurance because you're not buying it.

Mr. Verrilli Jr.: --No.

It's because you're going -- in the health care market, you're going into the market without the ability to pay for what you get, getting the health care service anyway as a result of the social norms that allow -- that -- to which we've obligated ourselves so that people get health care.

Justice Antonin Scalia: Well, don't obligate yourself to that.

Why -- you know?

Mr. Verrilli Jr.: Well, I can't imagine that that -- that the Commerce Clause would -- would forbid Congress from taking into account this deeply embedded social norm.

Justice Antonin Scalia: You -- you could do it.

But -- but does that expand your ability to, to issue mandates to -- to the people?

Mr. Verrilli Jr.: I -- I -- this is not a purchase mandate.

This is a -- this is a law that regulates the method of paying for a service that the class of people to whom it applies are either consuming-- ... Or -- or inevitably will consume."

Justice Ruth Bader Ginsburg
Solicitor General Donald B. Verrilli Jr.
Justice Antonin Scalia
The Oyez Project
March 27, 2012
Library Topic

"Chief Justice John G. Roberts: Well, but it's critical how you define the market.

If I understand the law, the policies that you're requiring people to purchase involve -- must contain provision for maternity and newborn care, pediatric services, and substance use treatment.

It seems to me that you cannot say that everybody is going to need substance use treatment, substance use treatment or pediatric services, and yet that is part of what you require them to purchase.

Mr. Verrilli Jr.: Well, it's part of what the statute requires the insurers to offer.

And I think the reason is because it's trying to define minimum essential coverage because the problem--

Chief Justice John G. Roberts: But your theory is that there is a market in which everyone participates because everybody might need a certain range of health care services, and yet you're requiring people who are not -- never going to need pediatric or maternity services to participate in that market.

Mr. Verrilli Jr.: --The -- with respect to what insurance has to cover, Your Honor, I think Congress is entitled the latitude of making the judgments of what the appropriate scope of coverage is.

And the problem here in this market is that for -- you may think you're perfectly healthy and you may think that you're not -- that you're being forced to subsidize somebody else, but this is not a market in which you can say that there is a immutable class of healthy people who are being forced to subsidize the unhealthy.

This is a market in which you may be healthy one day and you may be a very unhealthy participant in that market the next day and that is a fundamental difference, and you're not going to know in which--

Chief Justice John G. Roberts: I think you're posing the question I was posing, which is that doesn't apply to a lot of what you're requiring people to purchase: Pediatric services, maternity services.

You cannot say that everybody is going to participate in the substance use treatment market and yet you require people to purchase insurance coverage for that.

Mr. Verrilli Jr.: --Congress has got -- Congress is enacting economic regulation here.

It has latitude to define essential, the attributes of essential coverage.

That doesn't -- that doesn't seem to me to implicate the question of whether Congress is engaging in economic regulation and solving an economic problem here, and that is what Congress is doing."

Chief Justice John G. Roberts
Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 27, 2012
Library Topic

"Justice Antonin Scalia: I don't know why you think that they're never going to buy it.

Mr. Verrilli Jr.: --That's the problem, Justice Scalia.

That's -- and that's exactly the experience that the States had that made the imposition of guaranteed-issue and community rating not only be ineffectual but be highly counterproductive.

Rates, for example, in New Jersey doubled or tripled, went from 180,000 people covered in this market down to 80,000 people covered in this market.

In Kentucky, virtually every insurer left the market.

And the reason for that is because when people have that guarantee of -- that they can get insurance, they're going to make that calculation that they won't get it until they're sick and they need it, and so the pool of people in the insurance market gets smaller and smaller.

The rates you have to charge to cover them get higher and higher.

It helps fewer and fewer -- insurance covers fewer and fewer people until the system ends.

This is not a situation in which you're conscripting -- you're forcing insurance companies to cover very large numbers of unhealthy people--

Justice Antonin Scalia: You could solve that problem by simply not requiring the insurance company to sell it to somebody who has a -- a condition that is going to require medical treatment, or at least not -- not require them to sell it to him at -- at a rate that he sells it to healthy people.

But you don't want to do that.

Mr. Verrilli Jr.: --But that seems to me to say, Justice Scalia, that Congress -- that's the problem here.

And that seems to be--

Justice Antonin Scalia: That seems to me a self-created problem.

Mr. Verrilli Jr.: --Congress cannot solve the problem through standard economic regulation, and that -- and -- and I do not think that can be the premise of our understanding of the Commerce Clause--

Justice Antonin Scalia: Whatever--

Mr. Verrilli Jr.: --this is an economic problem.

Justice Antonin Scalia: --whatever problems Congress's economic regulation produces, whatever they are, I think Congress can do something to counteract them.

Here, requiring somebody to enter -- to enter the insurance market.

Mr. Verrilli Jr.: This is not a -- it's not a problem of Congress's creation.

Justice Antonin Scalia: The problem is that you have 40 million people who cannot get affordable insurance through the means that the rest of us get affordable insurance.

Congress, after a long study and careful deliberation, and viewing the experiences of the States and the way they tried to handle this problem, adopted a package of reforms.

Guaranteed-issue and community rating, and -- and subsidies and the minimum coverage provision are a package of reforms that solve that problem.

I don't -- I think it's highly artificial to view this as a problem of Congress's own creation."

Justice Antonin Scalia
Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 27, 2012
Library Topic

"But what I'm concerned about is, once we accept the principle that everybody is in this market, I don't see why Congress's power is limited to regulating the method of payment and doesn't include as it does in any other area.

What other area have we said Congress can regulate this market but only with respect to prices, but only with respect to means of travel?


Once you're -- once you're in the interstate commerce and can regulate it, pretty much all bets are off."

Chief Justice John G. Roberts
The Oyez Project
March 27, 2012
Library Topic

"Justice Antonin Scalia: You're saying that all the discussion we had earlier about how this is one big uniform scheme and the Commerce Clause blah, blah, blah, it really doesn't matter.

This is a tax and the Federal Government could simply have said, without all of the rest of this legislation, could simply have said everybody who doesn't buy health insurance at a certain age will be taxed so much money, right?

Mr. Verrilli Jr.: --It -- it used its powers together to solve the problem of the market not--

Justice Antonin Scalia: Yes, but you didn't need that. --You didn't need that.

If it's a tax, it's only -- raising money is enough.

Mr. Verrilli Jr.: --providing for the -- It's justifiable under its tax power.

Justice Antonin Scalia: Extraordinary."

Justice Antonin Scalia
Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 27, 2012
Library Topic

"Justice Sonia Sotomayor: We get tax credits for having solar-powered homes.

We get tax credits for using fuel efficient cars.

Why couldn't we get a tax credit for having health insurance and saving the government from caring for us.

Mr. Clement: --Well, I think it would depend a little bit on how it was formulated; but, my concern would be -- the constitutional concern would be that it would just be a disguised impermissible direct tax.

And I do think -- I mean, I don't want to suggest we get to the taxing power to[o] soon, but I do think it's worth realizing that the taxing power is limited in the ability to impose direct taxes.

And the one thing I think the framers would have clearly identified as a direct tax is a tax on not having something.

I mean, the framing generation was divided over whether a tax on carriages was a direct tax or not.

Hamilton thought that was a indirect tax; Madison thought it was a direct tax.

I have little doubt that both of them would have agreed that a tax on not having a carriage would have clearly been a direct tax.

I also think they would have thought it clearly wasn't a valid regulation of the market in carriages."

Justice Sonia Sotomayor
Paul D. Clement
The Oyez Project
March 27, 2012
Library Topic

"Mr. Clement: It's not a limiting principle, because the justification for why this is a valid regulation of commerce is in no way limited to this market.

It simply says, these are economic decisions, they have effect on other people, my failure to purchase in this market has a direct effect on others who are already in the market.

That's true of virtually every other market under the sun.

Chief Justice John G. Roberts: And now maybe return to Justice Sotomayor's question.

Mr. Clement: I'd be delighted to, which is -- I mean, I -- you are absolutely right.

Once you're in the commerce power, there is not -- this Court is not going to police that subject maybe to the Lopez limit.

And that's exactly why I think it's very important for this Court to think seriously about taking an unprecedented step of saying that the commerce power not only includes the power to regulate, prescribe the rule by which commerce is governed, the rule of Gibbons v. Ogden.

But to go further and say it's not just prescribing the rule for commerce that exists but is the power to compel people to enter into commerce in the first place."

Paul D. Clement
Chief Justice John G. Roberts
The Oyez Project
March 27, 2012
Library Topic

"Thank you, Mr. Chief Justice, may it please the Court: I'd like to begin with the Solicitor General's main premise, which is that they can compel the purchase of health insurance in order to promote commerce in the health market because it will reduce uncompensated care.

If you accept that argument, you have to fundamentally alter the text of the Constitution and give Congress plenary power.

It simply doesn't matter whether or not this regulation will promote health care commerce by reducing uncompensated care; all that matters is whether the activity actually being regulated by the act negatively affects Congress or negatively affects commerce regulation, so that it's within the commerce power.

If you agree with us that this is -- exceeds commerce power, the law doesn't somehow become redeemed because it has beneficial policy effects in the health care--

In other words, Congress does not have the power to promote commerce.

Congress has -- Congress has the power to regulate commerce.

And if the power exceeds their permissible regulatory authority, then the law is invalid.


And my basic point to you is this: the Constitution only gives Congress the power to regulate things that negatively affect commerce or commerce regulation.

It doesn't give them the power to regulate things that are statistically connected to things that negatively affect the commerce ... because if they have that power, then they obviously have the power to regulate everything because everything in the aggregate is statistically connected to something that negatively affects commerce, and every compelled purchase promotes commerce."

Michael A. Carvin
The Oyez Project
March 27, 2012
Library Topic

"Michael A. Carvin: [Congress] can't require you to buy a car with an anti-pollution device.

Once you've entered the market and made a decision they can regulate the terms and conditions of the car that you do, and they can do it for all sorts of reasons.

What they can't do is compel you to enter the market.

Justice Stephen G. Breyer: Now we -- now you've changed the ground of argument, which I accept as -- as totally legitimate.

And then the question is when you are born, and you don't have insurance, and you will in fact get sick, and you will in fact impose costs, have you perhaps involuntarily -- perhaps simply because you are a human being -- entered this particular market, which is a market for health care?

Michael A. Carvin: If being born is entering the market, then I can't think of a more plenary power Congress can have, because that literally means they can regulate every human activity from cradle to grave.

I thought that's what distinguished the plenary police power from the very limited commerce power."

Michael A. Carvin
The Oyez Project
March 27, 2012
Library Topic

"Justice Ruth Bader Ginsburg: But the sick people, why would they insure early if they had to be protected if they get insurance late?

Michael A. Carvin: --Yes.

Well, that's -- this is the government's very illogical argument.

They seem to be saying look, we couldn't just force people to buy insurance to lower health insurance premiums.

That would be no good.

But we can do it because we've created the problem.

We, Congress, have driven up the health insurance premiums, and since we've created that problem, this somehow gives us authority that we wouldn't otherwise have.

That can't possibly be right."

Justice Ruth Bader Ginsburg
Michael A. Carvin
The Oyez Project
March 26, 2012
Library Topic

"Michael A. Carvin: I was -- they create this strawman that says look, the only alternative to doing it the way we've done it, if we condition access to health care on buying health insurance, the only way you can enforce that is making sick people not get care.

I'm saying no, no.

There's a perfectly legitimate way they could enforce their alternative; i.e. requiring you to buy health insurance when you access health care, which is the same penalty structure that's in the Act.

There is no moral dilemma between having people have insurance and denying them emergency service.

Congress has made a perfectly legitimate value judgment that they want to make sure that people get emergency care.

Since the founding, whenever Congress has imposed that public responsibility on private actors, it has subsidized it from the Federal Treasury.

It has not conscripted a subset of the citizenry and made them subsidize the actors who are being hurt, which is what they're doing here.

They're making young healthy people subsidize insurance premiums for the cost that the nondiscrimination provisions have put on insurance premiums and insurance companies.


Justice Sonia Sotomayor: --So the -- I -- I want to understand the choices you're saying Congress has.

Congress can tax everybody and set up a public health care system.

Michael A. Carvin: Yes.

Justice Sonia Sotomayor: That would be okay.

Michael A. Carvin: Yes."

Michael A. Carvin
Justice Sonia Sotomayor
The Oyez Project
March 27, 2012
Library Topic

"Thank you, Mr. Chief Justice.

Congress confronted a grave problem when it enacted the Affordable Care Act.

The 40 million Americans who can't get health insurance and suffered often very terrible consequences.

Now, we agree, I think -- everyone arguing this case agrees that Congress could remedy that problem by imposing the insurance requirement at the point of sale.

That won't work.

The reason it won't work is because people will still show up at the hospital or at their physician's office seeking care without insurance, causing the cost shifting problem.

And Mr. Clement's suggestion that they can be signed up for a high risk pool at that point is utterly unrealistic.

Think about how much it would cost to get the insurance when you are at the hospital or at the doctor.

It would be -- it would be unfathomably high, that will never work.

Congress understood that.

It chose a means that will work.

The means that it saw work in the States and in the State of Massachusetts and that, and that it had every reason to think would work on a national basis.

That is the kind of choice of means that McCulloch says that the Constitution leaves to the democratically accountable branches of government.

There is no temporal limitation in the Commerce Clause.

Everyone subject to this regulation is in or will be in the health care market.

They are just being regulated in advance.

That's exactly the kind of thing that ought to be left to the judgment of Congress and the democratically accountable branches of government."

Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 27, 2012
Library Topic

"Mr. Clement: Mr. Chief Justice, and may it please the Court:

If the individual mandate is unconstitutional, then the rest of the Act cannot stand.

As Congress found and the Federal Government concedes, the community rating and guaranteed-issue provisions of the Act cannot stand without the individual mandate.

Congress found that the individual mandate was essential to their operation.

And not only can guaranteed-issue and community-rating not stand, not operate in the manner that Congress intended, they would actually counteract Congress's basic goal of providing patient protection but also affordable care.

If you do not have the individual mandate to force people into the market then community rating and guaranteed-issue will cause the cost of premiums to skyrocket.

We can debate the order of magnitude of that but we can't debate that the direction will be upward."

Paul D. Clement
The Oyez Project
March 28, 2012
Library Topic

"Although the [health] exchanges function perfectly well in Utah where there is no mandate.

They function differently, but they function.

And the question is always, does Congress want half a loaf.

Is half a loaf better than no loaf?

And on something like the exchanges it seems to me a perfect example where half a loaf is better than no loaf.

The exchanges will do something.

They won't do everything that Congress envisioned."

Justice Elena Kagan
The Oyez Project
March 28, 2012
Library Topic

"--the -- the reality of the passage -- I mean, this was a piece of legislation which, there was -- had to be a concerted effort to gather enough votes so that it could be passed.

And I suspect with a lot of these miscellaneous provisions that Justice Breyer was talking about, that was the price of the vote.

Put in the Indian health care provision and I will vote for the other 2700 pages.

Put in the black lung provision, and I'll go along with it.

That's why all -- many of these provisions I think were put in, not because they were unobjectionable.

So presumably what Congress would have done is they wouldn't have been able to put together, cobble together, the votes to get it through."

Chief Justice John G. Roberts
The Oyez Project
March 28, 2012
Library Topic

"Thank you, Mr. Chief Justice, and may it please the Court:

There should be no occasion for the Court in this case to consider issues of severability, because as we argue, the -- the minimum coverage provision is fully consistent with Article I of the Constitution.

But if the Court were to conclude otherwise, it should reject Petitioners' sweeping proposition that the entire Act must fall if this one provision is held unconstitutional.

As an initial matter, we believe the Court should not even consider that question.

The vast majority of the provisions of this Act do not even apply to the Petitioners, but instead apply to millions of citizens and businesses who are not before the Court."

Edwin S. Kneedler
The Oyez Project
March 28, 2012
Library Topic

"Mr. Kneedler, there -- there are some provisions which nobody would have standing to challenge.

If the provision is simply an expenditure of Federal money, it -- it doesn't hurt anybody except the taxpayer, but the taxpayer doesn't have standing.

That -- that just continues.

Even though it -- it is -- it should -- it is so closely aligned to what's been struck down that it ought to go as well.

But nonetheless, that has to continue because there's nobody in the world that can challenge it.

Can that possibly be the law?"

Justice Antonin Scalia
The Oyez Project
March 28, 2012
Library Topic

"--don't you think it's unrealistic to say leave it to Congress, as though you are sending it back to Congress for Congress to consider it dispassionately on balance, should we have this provision or should we not have provision?

That's not what it's going to be.

It's going to be, these provisions are in effect; even though you -- a lot of you never wanted them to be in effect, and you only voted for them because you wanted to get the heart of the -- the Act, which has now been cut out; but nonetheless these provisions are the law, and you have to get the votes to overturn them.

That's an enormously different question from whether you get the votes initially to put them into the law.

What -- there, there is no way that this Court's decision is not going to distort the congressional process.

Whether we strike it all down or leave some of it in place, the congressional process will never be the same.

One way or another, Congress is going to have to reconsider this, and why isn't it better to have them reconsider it -- what -- what should I say -- in toto, rather than having some things already in the law which you have to eliminate before you can move on to consider everything on balance?"

Justice Antonin Scalia
The Oyez Project
March 28, 2012
Library Topic

"Justice Anthony Kennedy: --When you say judicial restraint, you are echoing the earlier premise that it increases the judicial power if the judiciary strikes down other provisions of the Act.

I suggest to you it might be quite the opposite.

We would be exercising the judicial power if one Act was -- one provision was stricken and the others remained to impose a risk on insurance companies that Congress had never intended.

By reason of this Court, we would have a new regime that Congress did not provide for, did not consider.

That, it seems to me can be argued at least to be a more extreme exercise of judicial power than to strike -- than striking the whole.

Mr. Kneedler: --I -- I -- I think not--

Justice Anthony Kennedy: I just don't accept the premise."

Justice Anthony Kennedy
Edwin S. Kneedler
The Oyez Project
March 28, 2012
Library Topic

"Justice Antonin Scalia: Mr. Kneedler, what happened to the Eighth Amendment?

You really want us to go through these 2,700 pages?

And do you really expect the Court to do that?

Or do you expect us to -- to give this function to our law clerks?

Is this not totally unrealistic?

That we are going to go through this enormous bill item by item and decide each one?

Mr. Kneedler: --Well--

Justice Sonia Sotomayor: I thought the answer was you don't have to because--

Mr. Kneedler: --Well, that is, that is the--

Justice Sonia Sotomayor: --what we have to look at is what Congress said was essential, correct?

Mr. Kneedler: --That is correct, and I'd also like to -- going -- I just want to finish the thought I had about this being a matter of statutory interpretation.

The Court's task, we submit, is not to look at the legislative process to see whether the bill would been -- would have passed or not based on the political situation at the time, which would basically convert the Court into a function such as a whip count.

That is not the Court's--

Justice Elena Kagan: And Mr. Kneedler, that would be a revolution--

Mr. Kneedler: --Yes.

Justice Elena Kagan: --in our severability law, wouldn't it?

Mr. Kneedler: It would.

Justice Elena Kagan: I mean, we have never suggested that we were going to say, look, this legislation was a brokered compromise and we are going to try to figure out exactly what would have happened in the complex parliamentary shenanigans that go on across the street and figure out whether they would have made a difference.

Instead, we look at the text that's actually given us.

For some people, we look only at the text.

It should be easy for Justice Scalia's clerks.

Mr. Kneedler: I -- I think -- I think that--

Justice Antonin Scalia: I don't care whether it's easy for my clerks.

I care whether it's easy for me."

Justice Antonin Scalia
Edwin S. Kneedler
Justice Sonia Sotomayor
Justice Elena Kagan
The Oyez Project
March 28, 2012
Library Topic

"--don't you think it's unrealistic to say leave it to Congress, as though you are sending it back to Congress for Congress to consider it dispassionately on balance, should we have this provision or should we not have provision?

That's not what it's going to be.

It's going to be, these provisions are in effect; even though you -- a lot of you never wanted them to be in effect, and you only voted for them because you wanted to get the heart of the -- the Act, which has now been cut out; but nonetheless these provisions are the law, and you have to get the votes to overturn them.

That's an enormously different question from whether you get the votes initially to put them into the law.

What -- there, there is no way that this Court's decision is not going to distort the congressional process.

Whether we strike it all down or leave some of it in place, the congressional process will never be the same.

One way or another, Congress is going to have to reconsider this, and why isn't it better to have them reconsider it -- what -- what should I say -- in toto, rather than having some things already in the law which you have to eliminate before you can move on to consider everything on balance?"

Justice Antonin Scalia
The Oyez Project
March 28, 2012
Library Topic

Mr. Farr, let's -- let's consider how -- how your approach, severing as little as possible there -- thereby increases the deference that we're showing to -- to Congress.

It seems to me it puts Congress in -- in this position: This Act is still in full effect.

There is going to be this deficit that used to be made up by the mandatory coverage provision.

All that money has to come from somewhere.

You can't repeal the rest of the Act because you're not going to get 60 votes in the Senate to repeal the rest.

It's not a matter of enacting a new act.

You've got to get 60 votes to repeal it.

So the rest of the Act is going to be the law.

So you're just put to the choice of I guess bankrupting insurance companies and the whole system comes tumbling down, or else enacting a Federal subsidy program to the insurance companies, which is what the insurance companies would like, I'm sure.

Do you really think that that is somehow showing deference to Congress and -- and respecting the democratic process?

It seems to me it's a gross distortion of it."

Justice Antonin Scalia
The Oyez Project
March 28, 2012
Library Topic

"Now, in getting back to the -- an inquiry that I think this Court actually can approach, is to look at what Congress was trying to do, you need look no further than look than the title of this statute: Patient Protection and Affordable Care.

I agree with Mr. Farr that community rating and guaranteed-issue were the crown jewels of this Act.

They were what was trying to provide patient protection.

And what made it affordable?

The individual mandate.

If you strike down guaranteed-issue, community rating and the individual mandate, there is nothing left to the heart of the Act. ...

The choice is to give Congress the task of fixing this statute, the residuum of this statute after some of it is struck down, or giving them the task of simply fixing the problem on a clean slate.

I don't think that is a close choice.

If the individual mandate is unconstitutional, the rest of the Act should fall."

Paul D. Clement
The Oyez Project
March 28, 2012
Library Topic

"The exact same argument. So that really reduces to the question of why is a big gift from the Federal Government a matter of coercion? In other words, the Federal Government is here saying, we are giving you a boatload of money. There are no -there's no matching funds requirement, there are no extraneous conditions attached to it, it's just a boatload of federal money for you to take and spend on poor people's healthcare. It doesn't sound coercive to me, I have to tell you."

Justice Elena Kagan
The Oyez Project
March 28, 2012
Library Topic

"JUSTICE GINSBURG: Mr. Clement, may I -- may I ask you -- question another line.

You represent, what, 26 States?

MR. CLEMENT: That's right, Justice Ginsburg.

JUSTICE GINSBURG: And we are also told that there are other States that like this expansion, and they are very glad to have it.

The relief that you are seeking is to say the whole expansion is no good, never mind that there are States that say, we don't feel coerced, we think this is good.

You are -- you are saying that because you represent a sizeable number of States, you can destroy this whole program, even though there may be as many States that want it, that don't feel coerced, that say -- think this is a good thing?

MR. CLEMENT: Justice Ginsburg, that's right, but that shouldn't be a terrible concern because, if Congress wants to do what it did in 1972 and pass a statute that makes the expansion voluntary, every State that thinks that this is a great deal can sign up.

What's telling here, though, is 26 States, who think that this is a bad deal for them, actually are also saying that they have no choice but to take this because they can't afford to have their entire participation in this 45-year-old program wiped out, and they have to go back to square one and figure out how they are going to deal with the visually impaired in their State, the disabled in their State -

JUSTICE SCALIA: Mr. Clement, I didn't take the time to figure this out, but maybe you did. Is there any chance that all 26 States opposing it have Republican governors, and all of the States supporting it have Democratic governors? Is that possible?

MR. CLEMENT: There's a correlation, Justice Scalia."

Justice Ruth Bader Ginsburg
Paul D. Clement
Justice Antonin Scalia
The Oyez Project
March 28, 2012
Library Topic

"CHIEF JUSTICE ROBERTS: Well, why isn't that a consequence of how willing [the states] have been since the New Deal to take the Federal Government's money? And it seems to me that they have compromised their status as independent sovereigns because they are so dependent on what the Federal Government has done, they should not be surprised that the Federal Government, having attached the -- they tied the strings, they shouldn't be surprised if the Federal Government isn't going to start pulling them.

MR. CLEMENT: With all due respect, Mr. Chief Justice, I don't think we can say that, you know, the States have gotten pretty dependent, so let's call this whole federalism thing off. And I just think it's too important, because, again, the consequence -if you think about it -- if -- the consequence of saying that we're not going to police the coercion line here shouldn't be that well, you know, it's just too hard, so we'll give the Federal Congress unlimited spending power.

The consequence ought to be, if you really can't police this line, then you should go back and reconsider your cases that say that Congress can spend money on things that it can't do directly."

Chief Justice John G. Roberts
Paul D. Clement
The Oyez Project
March 28, 2012
Library Topic

"JUSTICE KAGAN: But, Mr. Clement, that is very confusing because the idea behind cooperative Federal/State programs was exactly a federalism idea. It was to give the States the ability to administer those programs. It was to give the States a great deal of flexibility in running those programs. And that's exactly what Medicaid is.

MR. CLEMENT: Well, that's exactly what Medicaid was. The question is, what will it be going forward?

And I absolutely take your point, Justice Kagan. Cooperative federalism is a beautiful thing. Mandatory federalism has very little to recommend it because it poses exactly the kind of accountability --

JUSTICE KAGAN: Cooperative federalism does not mean that there are no Federal mandates and no Federal restrictions involved in a program that uses 90 percent here, 100 percent Federal money. It means there is flexibility built into the program subject to certain rules that the Federal Government has about how it wishes its money to be used.

It's like giving a gift certificate. If I give you a gift certificate for one store, you can't use it for other stores; but, still, you can use it for all kinds of different things.

MR. CLEMENT: I absolutely agree that if it's cooperative federalism and the States have choices, then that is perfectly okay. But when -- that's why voluntariness in coercion is so important. Because if you force a State to participate in a Federal program, then -- I mean, as long as it's voluntary, then a State official shouldn't complain if a citizen complains to the State about the way the State's administering a Federal program that it volunteered to participate in. But at the point it becomes coercive, then it's not fair to tell the citizen to complain to the State official, they had no choice.

But who do they complain to at the Federal level? There's nobody there, which would be -- I'm not saying it's the best solution to have Federal instrumentalities in every State, but it actually is better than what you get when you have mandatory federalism, and you lose the accountability that is central to the federalism provisions in the Constitution."

Justice Elena Kagan
Paul D. Clement
The Oyez Project
March 28, 2012
Library Topic

"Mr. Chief Justice, and may it please the Court:

The Affordable Care Act's Medicaid expansion provisions will provide millions of Americans with the opportunity to have access to essential health care that they cannot now afford. It is an exercise of the Spending Clause power that complies with all of the limits set forth in this Court's decision in Dole, and the States do not contend otherwise. The States are asking this Court to do something unprecedented, which is to declare this an impermissibly coercive exercise of power ."

Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 28, 2012
Library Topic

"JUSTICE ALITO: Well, let me give you a factual context. Let's say Congress says this to the States: We have got great news for you. We know that your expenditures on education are a huge financial burden, so we are going to take that completely off your shoulders. We are going to impose a special Federal education tax which will raise exactly the same amount of money as all of the States now spend on education, and then we are going to give you a grant that is equal to what you spent on education last year.

Now, this is a great offer and we think you will take it, but, of course, if you take it, it's going to have some conditions because we're going to set rules on teacher tenure, on collective bargaining, on curriculum, on textbooks, class size, school calendar, and many other things. So, take it or leave it.

If you take it, you have to follow our rules on all of these things. If you leave it, well, then you're going to have to fine -- you are going to have to tax your citizens, they're going to have to pay the Federal education tax; but on top of that, you're going to have to tax them for all of the money that you're now spending on education, plus all of the Federal funds that you were previously given.

Would that be -- would that reach the point -- would that be the point where financial inducement turns into coercion?

GENERAL VERRILLI: No, I don't think so."

Justice Samuel Alito
Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 28, 2012
Library Topic

"I think this is wrong to think about this as coercion, because this is a program that works effectively for the citizens of the State, and States' governments -- and State governments think that, and that's why it has expanded the way it has expanded, because it's providing an essential service for millions of needy citizens in these States. It's providing access to health care that they would not otherwise have."

Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 28, 2012
Library Topic

"There is an important connection, a profound connection, between that problem and liberty. And I do think it's important that we not lose sight of that. That in this population of Medicaid eligible people who will receive health care that they cannot now afford under this Medicaid expansion, there will be millions of people with chronic conditions like diabetes and heart disease, and as a result of the health care that they will get, they will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty.

And the same thing will be true for -- for a husband whose wife is diagnosed with breast cancer and who won't face the prospect of being forced into bankruptcy to try to get care for his wife and face the risk of having to raise his children alone. And I could multiply example after example after example.

In a very fundamental way, this Medicaid expansion, as well as the provisions we discussed yesterday, secure of the blessings of liberty. And I think that that is important as the Court is considering these issues that that be kept in mind. The -- the Congress struggled with the issue of how to deal with this profound problem of 40 million people without health care for many years, and it made a judgment, and its judgment is one that is, I think, in conformity with lots of experts thought, was the best complex of options to handle this problem.

Maybe they were right; maybe they weren't. But this is something about which the people of the United States can deliberate and they can vote, and if they think it needs to be changed, they can change it. And I would suggest to the Court, with profound respect for the Court's obligation to ensure that the Federal Government remains a government of enumerated powers, that this is not a case in any of its aspects that calls that into question. That this was a judgment of policy, that democratically accountable branches of this government made by their best lights.

And I would urge this Court to respect that judgment and ask that the Affordable Care Act, in its entirety, be upheld. Thank you."

Solicitor General Donald B. Verrilli Jr.
The Oyez Project
March 28, 2012
Library Topic

"Let me just finish by saying I certainly appreciate what the Solicitor General says, that when you support a policy, you think that the policy spreads the blessings of liberty. But I would respectfully suggest that it's a very funny conception of liberty that forces somebody to purchase an insurance policy whether they want it or not.

And it's a very strange conception of federalism that says that we can simply give the States an offer that they can't refuse, and through the spending power which is premised on the notion that Congress can do more because it's voluntary, we can force the States to do whatever we tell them to. That is a direct threat to our federalism."

Paul D. Clement
The Oyez Project
March 28, 2012
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"There are two Affordable Care Acts. There's the legislation passed by Congress in 2009, and then there's the mythical Affordable Care Act – the perfidious 'government takeover' decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews."

"Life-saving medical procedures and drugs allow Americans to live longer and healthier than ever before. But for a growing number of uninsured Americans, paying for that care hasn’t kept pace.

It’s been nearly a century since President Teddy Roosevelt tried to re-capture the office on a progressive platform that included the then-radical notion of universal health care. The debate over...

"This afternoon, a three-judge panel of the U.S. Eleventh Circuit Court of Appeals in Atlanta ruled that the individual mandate in the Patient Protection and Affordable Care Act (PPACA), more commonly known as Obamacare, is unconstitutional. The carefully worded and thorough (over 300 page) set of opinions may be a bit mind-numbing for the uninitiated, but they are a joy to read for those of...

According to Peter Suderman, the AARP endorsement of Obamacare seemed like a good idea at the time, but is increasingly growing less appealing to AARP's members and employees. One reason for the increased dissatisfaction with the law is the fact that AARP...

"The new health care law is known as the Affordable Care Act. But Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular.

Under rules proposed by the service, some working-class families would be unable to afford...

A commentary timeline on the history of health care reform from President Franklin Roosevelt to George W. Bush.

"All eyes will be on the Supreme Court on Thursday morning, as justices are expected to hand down their ruling on the controversial healthcare reform law passed by President Barack Obama and a Democratically-controlled Congress in 2010."

"Two-thirds of Americans say the U.S. Supreme Court should throw out either the individual mandate in the federal health care law or the law in its entirety, signaling the depth of public disagreement with that element of the Affordable Care Act.

This ABC News/Washington Post poll finds that Americans oppose the law overall by 52-41 percent. And 67 percent believe the high court should...

"The nation's universities are opening more medical schools as graduate medical education transforms to address the nation's physician shortage."

"In an interview with The Daily Caller, the president of the American Medical Student Association (ASMA) praised President Barack Obama's health-care overhaul, denying that it is a 'political' issue and insisting that medical students are better equipped to determine the best course for U.S. health care than seasoned but less idealistic physicians."

"Last Friday, the White House announced that it would revise the controversial ObamaCare birth-control mandate to address religious-liberty concerns. Its proposed modifications are a farce."

In this brief speech, Dennis Lockhart discusses why many businesses are not hiring during the recession. According to Lockhart, one of the big reasons behind this is uncertainty over the upcoming healthcare bill.

"The Catholic University of America has joined dozens of Catholic institutions across the country in filing suit against the U.S. government because the administration has refused to take seriously our profoundly held conviction that the mandate from the Department of Health and Human Services intrudes on our constitutionally protected religious liberty by attempting to compel us to provide surgical sterilization and contraceptives to those whom we insure."

"President Obama's national health care law will cost $1.76 trillion over a decade, according to a new projection released today by the Congressional Budget Office, rather than the $940 billion forecast when it was signed into law."

"Earlier this week, the Congressional Budget Office released its revised estimates of what Obamacare will cost, now that the Supreme Court has weighed in. As I read the report, it occurred to me to ask: how have the CBO's estimates changed over time? It turns out that, even when you compare the years that are common to each CBO report, a clear trend emerges. Today, the CBO believes that...

"President Obama has called Rep. Paul Ryan's budget 'an attempt to impose a radical vision on our country,' but as this week's chart illustrates, if something radical doesn't happen, entitlement spending will nearly double by 2050. The amount of spending on Medicare, Medicaid, Social Security and Obamacare subsidies will soar over the next 38 years, leaving future generations with an alarming...

"President Obama has reassured Americans that if they like their current health insurance, they can keep it.

'If you've got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan,' Obama insisted on Oct. 15, 2008.

But two years after signing the Patient Protection and Affordable Care Act into law, Obama gave many...

"Americans who feel overtaxed already are in store for a shocker: Obamacare will add 17 new taxes or penalties for a whopping cost of $502 billion over its first 10 years."

"Many people are still unsure what the coming health insurance tax will cost them.

Business Insider's Henry Blodget detailed the costs earlier today... specifically in regards to what the 'penalty' is if you don't buy insurance (as mandated)."

"The Children's Health Insurance Program (CHIP, formerly the State Children's Health Insurance Program (SCHIP)) was created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-income children who are ineligible for Medicaid but cannot afford private insurance. States receive an enhanced...

Despite a few recent rulings declaring the Patient Protection and Affordable Care Act unconstitutional, Ian Millhiser insists that the Act is not outside constitutional bounds. Millhiser argues that Congress has power to tax, "regulate the...

"The Obama administration's decision requiring church-affiliated employers to cover birth control was bound to cause an uproar among Roman Catholics and members of other faiths, no matter their beliefs on contraception."

Setting the stage for a historic constitutional confrontation over federal power, the Supreme Court on Monday granted three separate cases on the constitutionality of the new federal health care law....

"An April Kaiser Family Foundation Tracking Poll found that only 51 percent of respondents believed they had enough information about how the law would affect them personally. However, when asked their opinion about specific provisions of the law -- 'the law will prohibit insurance companies from charging women higher premiums than men' -- typically a strong majority approved. When voters...

"The biggest legal threat to the White House's birth control mandate could come from a decades-old law that was championed by liberal Democrats, according to legal experts."

This piece provides an interesting analysis on the unintended consequences of the individual mandate. Goodman discusses the problem of "free riders" and then shows how the individual mandate could actually encourage "free riders" rather than eliminate them. Furthermore, Goodman explains the flaws with the current system and then briefly describes a...

"The American Medical Association lost 5 percent of its membership last year as the physician group faced fallout from its endorsement of Obamacare and refusal to retreat from the law's most controversial provisions."

Responding to a column by Peter Orszag in which he declared that Obamacare "is an essential element to keeping future health care costs down," Veronique de Rugy argues that "ObamaCare has nothing to do with cutting costs." Ms. de Rugy then uses a...

"When an Obamacare regulations goes into effect tomorrow, 47 million women will benefit from the guaranteed coverage of preventive services — including contraception coverage — without co-pays. The new rules will require most insurance plans to begin including the services at no additional cost at the next renewal date that falls on or after August 1, according to a news release from the...

"Five days ago, Democrats were cheering the selection of Paul Ryan as Mitt Romney's choice for Vice President. Democrats thought that Ryan's efforts at Medicare reform would terrify seniors (with their encouragement, of course), thereby handing the election to President Obama. Contrary to their expectations, however, it has been the Obama campaign that has been forced to defend its $716...

"A majority of voters still supports repeal of President Obama's national health care law and believes it will increase the federal deficit and the cost of health care."

This brief article reports on public opinion polling for Obamacare. From March 2010 to March 2011, public support for repeal of the Patient Protection and Affordable Care Act only dropped 1% (from 55% to 54%). However, as...

"The latest analysis of health care reform – out today from bean counters at Medicare – shows reform will raise health care spending slightly over the next 10 years, not reduce it as promised by President Obama. That won't make selling it on the stump any easier. Yet there's a glimmer of hope in the out years of the 10-year projection that the plan will begin to 'bend the cost curve.'"

"If the health care reform vote succeeds today, the $940 billion bill would be the biggest change to domestic policy in a generation. The rich and the health industry would pick up most of the tab."

"In February 2009, as the Obama administration was beginning to make its pitch for a major health care overhaul, then-White House budget director Peter Orszag made his closing pitch for the law at a summit in Washington: 'To my fellow budget hawks in this room and in the rest of the country, let me be very clear: health care reform is entitlement reform,' he said. 'The path of fiscal...

Commenting on the court battle over the constitutionality of Obamacare, Doug Bandow declares that "we all have much at stake in maintaining the Constitution's limits on federal power." Bandow uses this article to briefly discuss state vs. federal jurisdiction, while also...

"Well, Obamacare is now official, which means that a lot more people in the United States will have health insurance.

And it also means a lot more people will be paying more taxes.

(You didn't think Obamacare was free, did you?)"

"A pivotal moment in the health care debate came when the president went before Congress and said this: 'Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.'


"We're probably going to be talking about the Affordable Care Act a lot between now and November. So it's worth taking a look at what actually pays for the health-care law and what that means for the future of Medicare and other programs.

There are two broad ways that Congress paid for the health-care law: It cut into government spending and created provisions that raise revenue, giving...

"There are 600,000 physicians in America who care for the 48 million seniors on Medicare. Of the $716 billion that the Affordable Care Act cuts from the program over the next ten years, the largest chunk—$415 billion—comes from slashing Medicare's reimbursement rates to hospitals, nursing homes, and doctors. This significant reduction in fees is driving many doctors to stop accepting new...

This article offers a clear, concise description of the Medicare reimbursement process. Included in the piece is information regarding the cost the doctor charges, the patient's portion of the payment, and the amount that Medicare actually gives...

"President Obama's health care reform law, which expands preventative care and lets young people remain on their parents' health insurance plans well into their 20s, is a central part of his election year pitch to college students.

And perhaps nowhere are students more critical to the president's re-election chances than in North Carolina, a state jam-packed with colleges and...

In studying the House and Senate health care bills, Michael Cannon found that Obamacare would affect the wages of the poor as well as the wealthy. According to Cannon, the individual mandate would discourage hard work and economic progress. Cannon also notes that the...

Although Jonathan Turley believes that "strong arguments can be made for health care reform and the individual mandate," he also declares that "these are matters that should not be decided by mere fiat of Congress but rather by the courts." This...

"Ordinary people — not just a small fringe group of zealots — are really afraid today. They see the country they adore being attacked at all levels; they see their freedoms under assault, their life savings genuinely in jeopardy, an endlessly anemic economy, a longer period of sustained unemployment than we've experienced in a half-century and a national financial crisis, born of world-...

Describing the court decision in which Judge Roger Vinson struck down the individual mandate portion of Obamacare, Thomas Miller notes how the Obama administration's lawyers unintentionally backed themselves into a corner with their argument. Miller also describes the clear court...

"Are you having trouble finding a doctor who will see you? If not, give it another year and a half. A doctor shortage is on its way.

Most provisions of the Obama health law kick in on Jan. 1, 2014. Within the decade after that, an additional 30 million people are expected to acquire health plans—and if the economic studies are correct, they will try to double their use of the health-...

According to Julian Pecquet, "Maine is the first state to get a[n Obamacare] waiver. Three other states — New Hampshire, Nevada and Kentucky — have pending waiver...

"Many states are waiting for a Supreme Court decision or even the November election results, to see whether central elements of the new [Health Care] law might be overturned or repealed. But that will be too late to start work. By Jan. 1, 2013, the Obama administration will decide whether each state is ready to run its own exchange or whether the federal government should do the job instead...

"Sen. Marco Rubio (R-Fla.) introduced a bill on Monday that would override the Obama administration's new rule on birth control coverage and allow religious hospitals, universities, and other organizations that morally oppose contraception to refuse to cover it for their employees."

"Two years ago, when introducing then promptly enacting Obamacare, the president stated that healthcare law reform would not cost a penny over $1 trillion ($900 billion to be precise), and that it would not add 'one dime' to the debt. It appears that this estimate may have been slightly optimistic… by a factor of 1700%."

"If states choose to accept Obamacare's huge expansion of Medicaid, it would burden both federal and state budgets. States are already struggling to afford the program."

"Recently on 'Meet the Press,' Republican presidential candidate Mitt Romney raised eyebrows when he promised to keep portions of President Obama's health care law in place if elected. The two candidates will no doubt spar over how they'll deal with health reform in the debates, which kick off this month."

Comparing the single payer health care system to the Wizard of Oz, Bob Moffit suggests that "some in Congress want to make the Wizard even more powerful." Moffit demonstrates this assertion by describing the changes that Congress wanted to make to Medicare payments during the Summer of 2009. According to Moffit, these changes...

"Missouri voters on Tuesday overwhelmingly rejected a key provision of President Barack Obama's health care law, sending a clear message of discontent to Washington and Democrats less than 100 days before the midterm elections.

About 71 percent of Missouri voters backed a ballot measure, Proposition C, that would prohibit the...

"Obamacare has suffered a devastating blow. On Friday, the Eleventh Circuit Court of Appeals ruled that the individual mandate in President Barack Obama’s signature health care legislation is unconstitutional. With its ruling, the court affirmed the principle that the Constitution means what it says—Congress does not have unfettered power to force the American people to comply with any and all...

"Amid continued concern about errors by overworked medical residents, hospitals would be forced to curtail shifts and increase supervision of some doctors-in-training under proposed new guidelines for residency programs released Wednesday."

"The Congressional Budget Office has estimated that Obamacare will reduce the deficit, by coupling a multi-trillion-dollar expansion of federal health spending with cuts to Medicare and higher taxes. Now, a new study by a Medicare trustee suggests that the law will actually increase deficits, over the next ten years, by between $346 and $527 billion. Why do the trustee's numbers differ from...

"Obama signed the health care bill into law today, calling its historic expansion of insurance coverage 'reforms that generations of Americans have fought for and marched for and hungered to see.'

'Today, after almost a century of trying -- today, after over a year of debate -- today, after all the votes have been tallied, health insurance reform becomes law in the United States of...

This article describes how the implementation of Obamacare effects ethical and moral issues. Donovan specifically discusses the impacts of PPACA on abortion procedures and funding. Among other things, Obamacare "fails to adequately...

"Looking for some straight facts on Obamacare and its impact? Here are some of the most important numbers you need to know about President Obama's health law..."

As evidenced by lawsuits and other legal maneuvers, many legislators across the country are committed to repealing Obamacare. As Michael Cannon notes, however, many of these same, repeal-minded authorities are actually aiding and abetting the implementation of Obamacare...

"The Affordable Care Act (ObamaCare) has been knocked for its alleged unintended consequences. The bill's attracted speculation that workers will lose their health plans, college grads will stop looking for jobs, and even that fewer people will get married.

Those are just the effects related to insurance regulations. Less attention has been given to how hospitals and health systems...

"Negative signs abound for the medical community today, as the House Oversight Committee prepares to hear testimony on the impact of ObamaCare on doctors and patients. First, there's the recent Doctor Patient Medical Association poll, which found 90 percent of doctors say the medical system is on the wrong track and 83 percent are thinking about quitting...:


"Last March, I wrote a detailed piece on why Obamacare will dramatically increase the cost of insurance for young people. Yesterday, Louise Radnofsky of the Wall Street Journal reported that some colleges are dropping their student health plans for the new academic year, because the new law increases the cost of those plans by as much as 1,112 percent. And no, that's not a typo."

From time to time, I’ve posted Pollster.com’s trend estimate of all polls gauging public opinion on ObamaCare. It’s a great little tool. But recently, I noticed something.

"Thanks to Obamacare, the uninsured rate in the U.S. dropped in 2011 to 15.7 percent from 16.3 percent in 2010, and 1.4 million Americans have health insurance now who did not have coverage a year ago, according to data from the Census Bureau. 2011 was the first year in more than a decade in which the number of people with private health insurance remained steady."

"Last week, a new Congressional Budget Office (CBO) report updated the amount of money Obamacare robs out of Medicare from $500 billion to a whopping $716 billion between 2013 and 2022."

"The Supreme Court just upheld the Affordable Care Act as constitutional, affirming Congress' authority to require Americans to purchase health insurance coverage. It's no doubt an understatement to describe this as a huge victory for the law, and the Obama administration. The Affordable Care Act – after spending two years in legal limbo – now has the court's backing to move forward. That does not, however, mean the law has smooth sailing ahead. Many obstacles still stand in the law's way, ones that could derail its success nearly as much as an adverse legal ruling. Here's a rundown of what the law faces in coming months."

"President Obama's new mandate requiring all employers to purchase insurance coverage for their employees that includes abortion-inducing drugs, sterilization and contraception is an outrage, of course. But what kind of outrage is it? Most of the public outcry has understandably centered around the mandate's assault on religious liberty."

"Catholic institutions filed a series of lawsuits yesterday seeking to vindicate their rights under the First Amendment and the Religious Freedom Restoration Act. At issue is the regulation mandating that all employer-provided insurance policies cover birth control, including sterilization procedures and abortifacient drugs, in violation of church teachings."

According to Warner Huston, "111 companies and organizations were granted waivers by Obama’s Dept. of Health and Human Services so that they could get out of having to comply with Obamacare and unions were...

According to Robert Moffit, "[n]o class of American professionals will be more negatively impacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act than physicians." Moffit goes on to say that "physicians will...

According to Robert Moffit, senior citizens will especially experience an increased burden through the changes made to Medicare under the PPACA. Moffit lists increased taxes, funding cuts, and fewer doctors as some of the different changes...

"In 1850, the French economist Frederic Bastiat wrote 'That Which Is Seen and That Which Is Not Seen,' in which he noted that, while politicians liked to trumpet the visible benefits of their largess, there were often unseen costs and consequences that resulted from those policies.

It is a lesson that politicians should heed today.

Take, for example, Obamacare. The president...

"In anticipation of the Supreme Court's Obamacare decision, it is important to remember that the constitutionality of the individual mandate isn't the only problem with the law. Here's a list of Obamacare's five most destructive impacts on America's seniors."

Because of a quirk in ObamaCare, people who buy health insurance through a federally run exchange may not be eligible for premium subsidies.

This brief article offers several charts which detail the basic operating costs of a normal hospital. The charts give a breakdown of costs and include information regarding salaries, benefits, and other expenses that hospitals deal with.

This piece provides a brief look at the components of an individual mandate in regards to health care. According to this piece, "[o]ne impetus for individual mandates is to increase enrollment of younger, healthier people into insurance pools in order to...

"Private-sector job creation initially recovered from the recession at a normal rate, leading to predictions last year of a 'Recovery Summer.' Since April 2010, however, net private-sector job creation has stalled. Within two months of the passage of Obamacare, the job market stopped improving. This suggests that businesses are not exaggerating when they tell pollsters that the new health care...

According to Minnesota Rep. Michele Bachmann, Congress experienced a startling revelation about Obamacare in early 2011. In the words of Rep. Bachmann, "over $105 billion was hidden in the Obamacare legislation to fund the implementation of Obamacare."...

According to this piece, the court ruling that struck down the individual mandate central to the PPACA brings constitutional liberty and fiscal savings to the...

Americans want health care reform. They just do not want the top-down, centralized bureaucracy enacted under Obamacare. Congress should continue its efforts to fully repeal Obamacare.

According to this article, the provisions of Obamacare will greatly swell the ranks of those on Medicaid. Due to this fact, Kathryn Nix examines how an increase in Medicaid participants will...

"Lawmakers in South Dakota have proposed a bill that would require all adults to own guns, a measure intended as a protest against the individual mandate for health insurance included in President Barack Obama’s health reform law.

Adults over the age of 21 would have to buy a gun 'sufficient to provide for their ordinary self-...

In discussing the Senate portion of the PPACA, Robert Book notes that the bill "include[s] provisions that could put private health plans out of business." Book goes on to say that the bill would specifically create the following scenario:

  • "Give federal regulators the power to define minimum benefit packages;
  • Specify by law the...

This article reports on the Obama administration's response to the court ruling which determined that the individual mandate of Obamacare was unconstitutional. According to Millman, Obama officials argued that the decision would...

This piece gives a brief, three-page summary of the key aspects of the Patient Protection and Affordable Care Act. The PPACA specifies the following:

  • "Most individuals will be required to have health insurance beginning in 2014...

"A narrowly divided Supreme Court upheld President Obama's health care law Thursday in a complex opinion that gives the president a major election-year victory. The historic 5-4 decision will affect the way Americans receive and pay for their personal medical care in the future. It upholds the individual mandate that most Americans get health insurance or pay a penalty — and it was the penalty, or tax, that ultimately saved the law."

"The U.S. Supreme Court today voted to uphold the Affordable Care Act, refusing to overturn the unpopular law and sending the issue back to voters to decide in the upcoming presidential election."

"The Supreme Court's decision to uphold President Barack Obama's health care law follows a century of debate over what role the government should play in helping people in the United States afford medical care."

As the title suggests, Ezra Klein uses this piece to make a case for the necessity of the individual mandate. Klein declares, "Kill the individual mandate and you're probably killing the bill, too. The mandate is what keeps average premium costs low,...

In this piece, John Vinci explains the six types of waivers that companies and individuals are receiving under the new health care law. According to Vinci, "Obamacare waivers not only evidence a poorly conceived law, but the very...

"Since passage of the Affordable Care Act (ACA), the American Action Forum (AAF) has tracked the state of its regulatory implementation. To date, the ACA has imposed a total of $27.6 billion in new regulations – at least $20.4 billion in lifetime costs on private entities and $7.2 billion in increased burdens on state budgets. In this paper AAF examines how this $27.6 billion in new costs...

"Reducing hospital readmission rates has captured the imagination of U.S. policymakers because readmissions are common and costly and their rates vary — and at least in theory, a reasonable fraction of readmissions should be preventable. Policymakers therefore believe that reducing readmission rates represents a unique opportunity to simultaneously improve care and reduce costs. As part of the...

Commenting on the newly elected leaders of 2010 and their reform-minded approach to governing, Peter Orszag presents his beliefs on why the health care law should not be repealed. According to Orszag, the Obamacare law focused on "cost-effectiveness and...

This piece reports on a New York union's intention to stop covering the children of some of their members. The decision was made due to increasing costs, which the union partly attributes to the implementation of the Patient...

Commenting on Nancy Pelosi's statement on the need to pass the PPACA, Marguerite Higgins declares that her comment revealed the condescension the 111th Congress felt toward the American people. However,...

"But the justices found fault with part of the health-care law's expansion of Medicaid, a joint federal-state insurance program for the poor. The justices gave states the option of sitting out the law's Medicaid expansion without losing existing funding for the program."

This article reports on Speaker Nancy Pelosi's views on the constitutionality of Obamacare's individual mandate provision. When CNS News posed the constitutionality question, Speaker Pelosi responded, "Are you serious?" According to a Pelosi spokesperson, the Speaker responded...

"One of the primary goals of the Affordable Care Act (ACA), commonly referred to as Obamacare, is to reduce the number of uninsured residents. One key provision aimed at that objective is the expansion of Medicaid. The Supreme Court, however, dealt a serious blow to the Obamacare's Medicaid expansion by essentially making the expansion optional for states."

"DNC Chairwoman Debbie Wasserman Schultz described the Medicare reforms proposed by GOP Vice-Presidential nominee and House Budget Committee Chairman Paul Ryan (R-WI) as 'literally a death trap for seniors.' White House spokesman Jay Carney told reporters that Ryan's reforms would 'change Medicare as we know it.'

But it was Obamacare that already changed Medicare as we know it,...

"This week, the U.S. Supreme Court considers the case challenging the Obama administration health care plan's requirement that most Americans purchase a government-approved health insurance plan by 2014. The court should rule that this individual mandate is unconstitutional. To do otherwise would give Congress almost unlimited power."

"A recent survey by the Doctor Patient Medical Association Foundation reveals that 83 percent of physicians surveyed are thinking of quitting because of Obamacare, and 90 percent feel that the U.S. health care system is now heading in the wrong direction."

"Health care costs for a family of four rose again in 2011, with employees paying a much larger share of the rising expenses, according to a new industry report Wednesday.

American families who are insured through their jobs average health care costs of $19,393 this year, up 7.3%, or $1,319 from last year, according to independent actuarial and health care consulting firm Milliman Inc...

Chart or Graph

"The ACA's $27.6 billion in new regulations represent a cost floor, and not a ceiling to implement the ACA. Most private entities will feel these costs and $7.2 billion of the added regulatory burdens fall directly on state budgets."

"The first category, the cuts to government spending, accounts for $741 billion of the health law's financing. It's mostly changes to how the government pays the doctors and hospitals who provide care to Medicaid and Medicare patients. Here's how those changes break down, per the CBO...."

"The 2012 MMI cost is $20,728, an increase of $1,335, or 6.9% over 2011. The rate of increase is not as high as in the past, but the total dollar increase was still a record. This is the first year the average cost of healthcare for the typical American family of four has surpassed $20,000."

"Since 2002, average premiums for family coverage have increased 97% (Exhibit A)."

"The average price for a filled brand name prescription increased 17.7 percent to $268 (Figure 12)."

"As seen in Figure 6, the highest average prices paid to a facility were for surgical admissions ($29,858, an 8.5% rise from 2010) and medical admissions ($13,023, a 5.9% increase over 2010)."

"As seen in Figure 8, the highest average price paid for a visit was for outpatient surgery ($3,673, a 6.6% increase from 2010)."

"As seen in Figure 10, the highest average prices paid to a health professional were for anesthesia ($714, a 3.2% increase from 2010) and administered drugs ($396, an 11.1% increase from 2010)."

Hospitals must spend money to function and provide patient care. The main categories of expenses include salaries, supplies, depreciation, amortization, interest, and bad debt expenses.

This interactive chart details the cases challenging the Obamacare law, the date of their argument, the type of court argued in, and the parts of the Constitution that each argument was based on.

"In 2010, the CBO estimated that Obamacare's spending on new programs would amount to $929 billion from 2013-2019, and a ten-year cost of $944 billion. Those figures increased to $956 billion and $1,442 billion respectively in 2011, and $1,053 billion and $1,856 billion in 2012."

"In 2010, the CBO estimated that Obamacare's tax increases would amount to $626 billion from 2013-2019, and $631 billion over ten years. In 2011, the CBO estimated totals of $624 and $968 billion, respectively."

"In 2011, the dollars spent per capita were highest for professional procedures ($1,566), and lowest for prescriptions ($773). The 1.0 percent growth in spending on prescriptions was lower than the 2.4 percent growth for 2010 (Figure 2)."

An individual mandate will result in an increase in government spending of about 1–6 percent, as shown in Table 1. Because the subsidy cost is all borne by government, as the size of the subsidy increases, so will government spending.

We examined the public cost (subsidies plus Medicaid spending) of expanding coverage under an individual mandate. Table 2 shows the pattern we observed across all scenarios with a subsidy option. The government cost per newly insured falls as the income level at which people are eligible for a subsidy increases

This interactive chart lists the various Constitutional sections and amendments on which the Obamacare law has been challenged. Article 1 is used most frequently in the Obamacare cases.

"Contrary to their expectations, however, it has been the Obama campaign that has been forced to defend its $716 billion in cuts to the Medicare program, cuts that Mitt Romney promises to repeal. In the weeks ahead, those defenses won't hold up. Here's why."

"Overall, PPOs are by far the most common plan type, enrolling 56% of covered workers. Nineteen percent of covered workers are enrolled in an HDHP/SO, 16% in an HMO, 9% in a POS plan, and less than 1% in a conventional plan (Exhibit E)."

"The amount of spending on Medicare, Medicaid, Social Security and Obamacare subsidies will soar over the next 38 years, leaving future generations with an alarming debt burden."

The estimated effects of the Affordable Care Act on overall national health expenditures (NHE) are shown by the 'net total' curve in the ... [above] chart. In aggregate, we estimate that for calendar years 2010 through 2019, NHE would increase by $311 billion, or 0.9 percent, compared to prior law.

Figure 15 presents another way of viewing the effects of reform on family income. The figure shows family income under the case of no reform and with successful cost growth reduction of various degrees. The figure makes clear that family income will be substantially higher with reform than without.

"Four reputable research institutions have run the numbers and found that not only is Obama's claim false, but employees will be dropped from their current coverage by the millions. This week's chart outlines each of the four studies."

In the table, we show the expected total gains in life years that we estimate would result from the implementation of an individual mandate. The estimate is a function of the number of additional people with coverage, so the scenarios that produce the largest increases in coverage will also produce the largest increases in life years.

"Health care costs for a family of four have doubled in less than a decade from $9,235 in 2002 to over $19,000 in 2011."

"By 2017, the average enrollee will lose $3,714 in health care services per year, totaling $54.97 billion for all such beneficiaries. The benefit losses will vary widely by state from a low of $2,780 in Montana to a high of $5,092 in Louisiana. (See Map 2.)"

"Using Congressional Budget Office (CBO) data, the chart ... shows that the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 have left the cost curve of federal healthcare spending virtually unchanged over the next 25 years."

"Many people are still unsure what the coming health insurance tax will cost them. Business Insider's Henry Blodget detailed the costs earlier today... specifically in regards to what the 'penalty' is if you don't buy insurance (as mandated)."

"Historical and projected Medicaid expenditures for medical assistance payments and administration are shown in table 3."

The income statement (also referred to as the Profit and Loss Statement or Comparative Statement of Operations) focuses on performance over a designated period of time, usually one year. This statement provides important information about the profitability of a hospital, including information on how the hospital gets its money and how the hospital spends its money.

By establishing both an excise tax on high-value health plans and a minimum MLR, the bill creates an implicit maximum legal premium that insurers can charge.

"Women stand to gain numerous benefits under President Barack Obama's health reform law, the Affordable Care Act."

Beginning in 2014, employers must offer minimal essential coverage to full-time employees or pay a penalty. When this provision takes hold, 88% of surveyed employers are either definitely, or likely, to play by continuing to provide health benefit coverage.

The majority of employers anticipate that health care reform will increase their organization’s health benefit costs. In response, most say they plan to pass on the increase to employees (88%) or reduce health benefits and programs (74%) (Figure 4).

Table 4 shows the difference in health care subsidies to be given to cohabiting couples and similarly situated married couples under the Senate bill. The figures were calculated by subtracting the subsidy figures in Table 2 for married couples from the corresponding figures for cohabiting couples in Table 3.

"If states choose to accept Obamacare's huge expansion of Medicaid, it would burden both federal and state budgets. States are already struggling to afford the program."

Doctors may agree to limit what they charge patients to the Medicare-approved amount for the services they provide, or they may charge a higher amount. Those who do agree to accept Medicare's rates for services are said to 'accept assignment'.

"The ACA [Obamacare] includes a number of provisions that are expected to reduce Medicare spending. (See Appendix A [above chart] for the cost estimate for the major Medicare provisions in the ACA.)"

"Implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 will have a major effect on Medicare spending and policy."

According to the Congressional Budget Office, the legislation would reduce the number of uninsured Americans by about 32 million people by 2019. ... Most of those gains in the number of insured will not occur until after 2014 when the mandates and subsidies kick in.

"A key factor that drove down the number of people without insurance — 48.6 million people last year compared to 50 million in 2010 — is a provision in the Affordable Care Act allowing young adults to remain on their parents' insurance plans up to age 26."

Despite denials from the Obama administration and Democrats in Congress, the [PPACA] legislation does cut Medicare—and it should. Medicare is facing unfunded liabilities of $50 to $100 trillion depending on the accounting measure used, making future benefit cuts both inevitable and desirable.

Last week, 53% favored repeal of the health care law. Support for repeal has ranged from a low of 50% to a high of 63% since Democrats in Congress passed it a year ago.

The bureaucracy of Obamacare.

"The latest Rasmussen Reports national telephone survey finds that 53% of Likely U.S. Voters favor repeal, while 43% are opposed. This includes 45% who Strongly Favor repeal of the health care measure and 33% who are Strongly Opposed."

"Based on IRS estimates approved by the Office of Information and Regulatory Affairs at the Office of Management and Budget, ObamaCare will take American job creators and families nearly 80 million hours to comply with. Over half of that will fall on small businesses."

To illustrate, [diagram one shows] .... what the trend estimate looks like incorporating all polls. As of this month, opposition leads support by 7.3 percent (45.3 percent opposed to ObamaCare vs. 38 percent in favor).

Each bill would require low- and middle-income Americans to pay an increasing percentage of their income toward health insurance. As a result, the 'mandate tax' creates marginal rates as high as 53 percent — and that's for people making just $15,000 per year.

Obamacare waivers only last for one year and are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage. As of today, a total of 733 waivers have been granted for 2011.

Data for calendar year 2004 show the distribution of costs as a percentage of total operating costs as pictured [in chart 1]. The most significant changes in costs between calendar years 2002 and 2004 are reflected in the [second] table.

Anyone expecting to see major changes to the health care system in the next few months or years is liable to be disappointed. As Table 2 shows, the most heavily debated aspects, mandates, subsidies, and even most of the insurance reforms don’t begin until 2014 or later.

The Census Bureau recently published its latest statistics on health insurance for the 2008 calendar year. It estimated, for instance, that approximately 46 million individuals in the United States lacked health insurance during 2008. That translates into 15.4 percent of the population. … I’ve taken those census data and broken them out by age, as shown in Figure 1.

65% believed the Supreme Court would find the individual mandate constitutional.

A family policy will increase from today’s $6,328 to $15,200. If the bill hadn’t passed, it would only have increased to $13,100. ... Thus, this bill will cost a family buying their own health insurance an additional $2,100 per year in higher premiums (see Table 1).

Averaged across all levels of coinsurance, participants (including both adults and children) with cost sharing made one to two fewer physician visits annually and had 20 percent fewer hospitalizations than those with free care. Declines were similar for other types of services as well, including dental visits, prescriptions, and mental health treatment.

Averaged across all levels of coinsurance, participants (including both adults and children) with cost sharing made one to two fewer physician visits annually and had 20 percent fewer hospitalizations than those with free care. Declines were similar for other types of services as well, including dental visits, prescriptions, and mental health treatment.

The HIE was a large-scale, randomized experiment conducted between 1971 and 1982. For the study, RAND recruited 2,750 families encompassing more than 7,700 individuals, all of whom were under the age of 65. They were chosen from six sites across the United States to provide a regional and urban/rural balance.

"As in 2010, professional procedures performed by physician and nonphysician providers accounted for the largest share of expenditure in 2011 (Table 1 and Figure 1)."

"Overall, professional services made up 34.4 percent of total per capita spending, but 43.4 percent of out-of-pocket payments (Figure 1 and Figure 5)."

Figure 11 shows how the new health care law will add to the burden of future government spending. By 2050, the new law will push total government spending toward 50 percent of GDP. By the end of the century, federal government spending would become almost unfathomable, surpassing 80 percent of GDP.

"Twenty states will lose the equivalent of 300 full-­‐time employees' worth of work to filling out ACA regulatory red tape. (See Figure 3) Additionally, 27 states have a burden of over $300 million in new regulatory costs."

"This week's chart illustrates the new taxes and offers a year-by-year rundown of their annual costs. These taxes will pay for generous subsidies, an expansion of Medicare and new government spending."

"AAF examined the ten most expensive ACA regulations (see Figure 1)."

PPACA2 contains 18 separate tax increases that will cost taxpayers $503 billion between 2010 and 2019. ... Three major tax hikes make up nearly half of the new revenue raised by PPACA.

Within two months of Obamacare’s passing, the recovery stalled. Figure 1 shows net private-sector job creation from January 2009 onward.

As Figure 10 shows, adding the cost of the doc-fix, discretionary costs, and other costs that were not originally included in CBO’s score to the legislation brings the total cost over 10 years of actual operation to over $2.7 trillion.

CBO officially scored the bill as reducing the budget deficit by $138 billion over 10 years. Putting that in perspective, if true, it would amount to roughly 62 percent of the total deficit that the federal government incurred in February of 2010 alone.

This chart demonstrates the growth of government spending on health care since 1900.

Analysis Report White Paper

This report gives an extensive overview of the implementations and implications of the 2010 Health Care Act. Among other things, Tanner describes the PPACA’s effects on insurance plans and premiums, taxes and subsidies, Medicare plans, and the budget deficit.

The annual Milliman Medical Index (MMI) measures the total cost of healthcare for a typical family of four covered by a preferred provider plan (PPO). The 2012 MMI cost is $20,728, an increase of $1,335, or 6.9% over 2011. The rate of increase is not as high as in the past, but the total dollar increase was still a record.

This piece seeks to give a clear explanation of the expenses and profits of a hospital. Among other things, the authors describe the high overhead a hospital has and also how hospitals are often paid less than they charge.

With A Survey of America’s Physicians, The Physicians Foundation has endeavored to provide a 'state of the union' of the medical profession.

Among other things, the study seeks to determine how Obamacare's Individual Mandate will affect "spending," patient "health," and "waste" in the health care industry.

Michael Tanner declares that the health care law of 2010 "will fundamentally change nearly every aspect of health care, from insurance to the final delivery of care." Tanner then discusses the impacts of the health care law, some of which include increased taxes, premiums, and care rationing.

In this piece, Jonathan Gruber contends that those who wish to repeal the PPACA are severely misguided. In Gruber’s eyes, repeal would bring increased costs, deaths, and budget deficits, while keeping it would rein in runaway health care costs."

"This poll was a bipartisan collaboration between the American Action Forum and the Blue Dog Research Forum. It was designed to gather expert insight into the probable outcomes of the Supreme Court case involving the Affordable Care Act."

This paper discusses the constitutional implications of health care reform's individual mandate requirement. The authors discuss the "unprecedented nature of an individual mandate," and then describe various legal provisions under which the individual mandate could be upheld or struck down.

To provide current information about the nature of employer-sponsored health benefits, the Kaiser Family Foundation (Kaiser) and the Health Research & Educational Trust (HRET) conduct an annual national survey of nonfederal private and public employers with three or more workers. This is the fourteenth Kaiser/HRET survey and reflects health benefit information for 2012.

The Health Care Cost Institute's (HCCI) Health Care Cost and Utilization Report: 2011 tracks changes in health care prices, utilization, and spending on people younger than 65 covered by employer-sponsored private health insurance (ESI).

Critics have alleged that the health care reform bill set to be voted on by the House Sunday is a job killer. What's the reality? It could affect some businesses heavily but many others not at all.

"This survey of more than 650 mid- to senior-level benefit professionals provides a snapshot of how employers are responding to a host of health care reform challenges that have far-reaching implications for retention, recruitment, productivity, workforce planning, change management and every aspect of the evolving employer-employee deal."

This piece gives several examples of medical entrepreneurs who are providing their patients with better care for a lower cost while operating their practices and companies like a for-profit business.

As the Patient Protection and Affordable Care Act (ACA) nears its second birthday, the latest Kaiser Health Tracking Poll finds that public opinion on the law remains evenly split with sharp divisions along partisan lines, much as it has been since the law was passed.

In pondering the title question, Simon Lazarus determines that the individual mandate is definitely constitutional.

"The Affordable Care Act establishes a national framework for near-universal health coverage. Under the law, beginning in 2014, a new individual mandate will require most individuals to obtain coverage.

"This paper provides a detailed overview of Medicare spending and financing, beginning with a review of the factors contributing to the growth in Medicare spending, including the effects of the 2010 health reform law." At this point in time, projections suggest that the PPACA will decrease Medicare spending overall.

As the title implies, this piece gives a brief overview of Friedrich Hayek's economic principles and then relates them to the regulations imposed by the Patient Protection and Affordable Care Act.

According to Yelowitz, young adults are the largest uninsured age group, mainly because they are in good health and prefer to spend their money on other goods besides insurance. This piece then goes on to explain how insurance costs for young adults would drastically change with the implementation of Obamacare.

While President Obama continues traveling the U.S. heralding the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, businesses across the U.S. are growing more and more discontent—and for good reason.

The hodgepodge of new taxes that have already or will soon take effect as a result of the Patient Protection and Affordable Care Act may not all show up in the income tax tables, but their huge cost is still very real. This cost will become most apparent in lost wages and international competitiveness, and it reduces middle- and low-income families' wages.

This piece finds Brian Blase offering a one year assessment of Obamacare. Blase reviews the many promises that politicians declared the PPACA would bring and concludes that many of them have fallen to pieces.

Doctor Patient Medical Association Foundation conducted a faxed survey of random doctors in May 2012.

The Patient Protection and Affordable Care Act substantially alters Medicare Advantage and, as a consequence, reduces the access of senior citizens and the disabled to quality health care by restricting and worsening the health care plan options available to them.

This paper offers an overview of Obamacare’s effects on Medicare. Among other things, the paper describes the implementation of the "Independent Payment Advisory Board," the relationship between prescription drugs and Medicare under PPACA, and the type of care Medicare patients will be eligible for under PPACA.

This report combines a variety of the Heritage Foundation’s WebMemo pieces on Obamacare. The anthology covers everything from the constitutionality of Obamacare, to the tax burden imposed by the law, to the financial effects Obamacare promises for employers, seniors, and young people.

"Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost?"

"After decades of evolution and experiment, the U.S. health care system has yet to solve a fundamental challenge: delivering quality health care to all Americans at an affordable price. In the coming years, new solutions will be explored and older ideas revisited. One idea that has returned to prominence is cost sharing...."

Although the new Obamacare law has been touted as a way to decrease the burden on small business owners, this paper demonstrates how the opposite tends to be more likely. According to Hadley Heath, the bureaucratic burden imposed by increased taxes and regulations could crush the American entrepreneurial spirit and future economic growth.

"If the Senate bill becomes law, saying 'I do' would cost some couples over $10,000 per year." This report provides important data and charts on the increased costs married couples could incur under Obamacare.

Canadians often misunderstand the true cost of our public health care system. This lack of understanding limits Canadians’ ability to assess whether they are receiving value for their tax dollars.

"During the nine-month period leading up to the passage of the Patient Protection and Affordable Care Act, Americans were subjected to more than $200 million worth of TV, radio, newsprint and Internet ads. Almost all of these — pro and the con — were pure propaganda."


"Amid intense public interest, Congress passed the Patient Protection and Affordable Care Act (ACA), which became effective March 23, 2010. The ACA sought to address the fact that millions of Americans had no health insurance, yet actively participated in the health care market, consuming health care services for which they did not pay.

The ACA contained a minimum coverage provision by...

"Arnold Kling of EconLog talks with EconTalk host Russ Roberts about the economics of health care and his book, A Crisis of Abundance: Rethinking How We Pay for Health Care. Kling discusses whether we get what we pay for when we spend money on...

In this podcast, Roberts and Cogan declare that rising health care costs have grown because people expect free care for their small infirmities. Cogan suggests that health care would not be so expensive if individuals were required to pay for the small...

In this podcast, Russ Roberts and Henry Aaron discuss the implications of a single-payer health care system. They also discuss whether or not administrative costs play a large role in driving up insurance and other health care costs.

"Arnold Kling of EconLog talks with EconTalk host Russ Roberts about the death of his father and the lessons to be learned for how hospitals treat patients and our health care system treats hospitals."

"Steven Lipstein, President and CEO of BJC HealthCare--a $3 billion hospital system in St. Louis, Missouri--talks with EconTalk host Russ Roberts about the economics of hospitals. They discuss pricing, the advantages and disadvantages of specialization in...

This podcast discusses the argument for states rights in the Obamacare dispute. According to Michael Cannon, a glitch in the Obamacare law could make the case against the law stronger.

As the title implies, this podcast discusses the many unfortunate regulations that are occurring with the implementation of the Patient Protection and Affordable Care Act. Ms. Turner also describes some of the unappetizing changes that Americans are experiencing in their health care plans under Obamacare.

According to Michael Tanner, many of the things opponents of health care reform predicted would happen with the passage of the PPACA are most certainly happening only one year later. Tanner describes several of these occurrences and...

This podcast discusses the Commerce Clause and Obamacare and whether or not the latter's individual mandate is constitutional. To paraphrase Robert Levy, this is the first time that the government has mandated the purchase of anything, and if they can do it in one place, they can do it anywhere.

On October 22, 2009, a CNS News reporter asked Speaker Pelosi about the constitutionality of the Patient Protection and Affordable Care Act. As this brief audio clip demonstrates, Speaker Pelosi condescendingly responded, "Are you serious?"

This podcast reports on the Supreme Court's decision to hear the Obamacare case. Iyla Shapiro discusses the potential outcomes this monumental court case could bring.

This podcast discusses some of the early lawsuits and rulings against the Obamacare law. Despite the rulings, some states are still attempting to implement the law in preparation for the 2014 deadline. Cannon subsequently makes the...

"Amid intense public interest, Congress passed the Patient Protection and Affordable Care Act (ACA), which became effective March 23, 2010. The ACA sought to address the fact that millions of Americans had no health insurance, yet actively participated in the health care market, consuming health care services for which they did not pay.

The ACA contained a minimum coverage provision by...

"Reason's Damon Root attended the pivotal second day of oral arguments before the Supreme Court on the Patient Protection and Affordable Care Act (ACA), which he described as a 'Constitutional Thunderdome.' The debate over the legality of the mandate to purchase insurance at the heart of ACA was, says Root, a rough-and-tumble colloquy about the 'the role of government in our lives' and 'what...

According to Reason TV's Nick Gillespie, the three reasons why Obamacare won't cut the deficit are "legislative trickery," "higher premiums," and "bad accounting." Overall, Gillespie argues that high costs are a regular "feature of government health care plans."

"Early in this blog, I wrote my Cliffs Notes Version of the Affordable Care Act. It is popular because it provides a big picture view of the law title by title. Since some prefer video to reading, we've created a short video of the Cliffs Notes Version. I want to reach as many as possible – it is important for people [to] understand the ACA is not 'all good” or 'all bad.' Maybe after people...

"States can require people to buy insurance for automobiles and health care. So why can't the federal government? According to Professor Elizabeth Price Foley, the U.S. Constitution gives the federal government limited and enumerated powers that confine it. The Constitution gives different powers to the states than it does to the federal government. Just because states have the power to...

"The 'Individual Mandate' section of the new healthcare reform bill introduces a paradigm shift in the role of the federal government. For the first time in American history, citizens will be forced to purchase something (in this case health insurance approved by the government) against their will or else pay a fine. Some legal scholars worry that this is an egregious form of constitutional...

The Fourth Annual Rosenkranz Debate was held on November 12, 2011, during The Federalist Society's 2011 National Lawyers Convention.

"America's health care system is at a crossroads, faced with rising costs, quality concerns, and a lack of patient control. Some blame market forces. But as Michael Cannon and Michael Tanner argue in their new book, Healthy Competition: What's Holding Back Health Care and How to Free It, many troubles can be traced directly to pervasive government influence: entitlements, tax laws, and costly...

"Are you aware that over 1,000 temporary healthcare reform waivers have been granted by the Administration to organizations around the country? The reason: they can't meet the limited annual coverage without significantly increasing premiums or decreasing access to benefits. That leaves us with some looming questions: What about us, the individuals? What about the people who can't afford to be...

"Johan Norberg, author of In Defense of Global Capitalism, sits down with reason.tv's Michael C. Moynihan to sort out the myths of the Sweden's welfare state, health services, tax rates, and its status as the 'most successful society the world has ever known.'

"Senator Max Baucs addresses what Obamacare really is about after the Democrats passed the 'fix' bill and sent it back to the House."

"Down on the boardwalk, we interview a few young Americans to find out what they know about the Constitution of the United States. Can you answer the questions? Does it matter?"

"We ask moms on the street what they know about the Constitution. Can you answer the questions? Does it matter?"

"The 'Individual Mandate' section of the new healthcare reform bill introduces a paradigm shift in the role of the federal government. For the first time in American history, citizens will be forced to purchase something (in this case health insurance approved by the government) against their will or else pay a fine. Some legal scholars worry that this is an egregious form of constitutional...

"We all agree the health care system is in need of reform. That's not the issue. The debate is really what kind of reform is needed. There are those rooting for nationalizing health care - Obama Care. What's that you ask? Obama's idea of reform is a government takeover of the health care system. One of the most popular forms of government takeover is the 'Massachusetts Model.' Those of us...

"Reason's Damon Root was in attendance for the third and final day of oral arguments before the Supreme Court on the Patient Protection and Affordable Care Act (ACA), which focused primarily on the issue of severability, which brings into question whether the individual mandate be excised from the law, or if the law in its totality must be struck down.

Now that the case is in the hands...

"The Patient Protection and Affordable Care Act (Obamacare) has set forth an individual mandate that requires all Americans to have health insurance. The justification for the law rests on the idea developed since the New Deal in the 1930s that any economic activity an individual engages in could impact the national economy and therefore can be regulated by the Federal Government based on its...

"Reason's Damon Root got a coveted seat for the Supreme Court oral arguments on the Patient Protection and Affordable Care Act (ACA). Day one of this epic judicial showdown focused primarily on whether or not the individual mandate constitutes a tax. If the justices rule that the penalties associated with the mandate should be considered a tax, the challengers to ACA would have to wait until...

This brief and amusing video describes Obamacare as a medication with millions of negative side effects.

"In 2006, when Indiana small-business owner Scott Womack purchased a development agreement to expand his IHOP franchise into Ohio, he had no idea Congress would pass a massive overhaul of the health care system four years later. Today, one year after that legislative overhaul became law, Womack is very aware of Obamacare -- and of its effects on his plans for growth."

"Dr. Martha Boone, an Atlanta urologist, explains the consequences of the new health care law. Because of her fears about Obamacare, Boone moved to a less-expensive office so she could avoid dropping Medicare patients or laying off an employee."

"Obamacare expands government-controlled health care -- passing the cost to future generations of taxpayers -- and weakens families' choice of coverage. Larry Patterson describes the impact Obamacare will have on his family and the concerns he has with the new law."

"It's official, trillion is the new billion. No longer is government spending talked about in terms of a mere ten digits. With the recent flurry of government spending, we are going to need another three zeros to make sense of it all. One trillion dollars is a number that few people can comprehend, let alone your standard nine digit calculator. So what does one trillion dollars look like?"

This video offers the President's and Vice President's remarks at the signing of the Patient Protection and Affordable Care Act in March of 2010. Lauded as a historic day, the signing was received with jubilation by the many who labored endlessly to bring the President's healthcare reform to pass.

"After unveiling the Senate health insurance bill to Congress, Nevada Senator Harry Reid hailed the legislation's efforts to 'save lives, save money and save Medicare.' Without adding a dime to the deficit, the Patient Protection and Affordable Care Act will make it easier for businesses to provide working Nevadans with health insurance, while strengthening our...

In March of 2011, Representative Michele Bachmann revealed that the PPACA had a hidden implementation fund of 105 billion dollars. In this interview, Bachmann argues that it is necessary to cut funding for this provision immediately in light of national budgetary problems.

This five second clip presents Speaker Pelosi's famous remark about the Patient Protection and Affordable Care Act, namely, "we have to pass the bill so that you can find out what is in it."

"On the Senate floor today, Ranking Member Sessions announced that a new Budget Committee analysis has found that the long-term, unfunded liabilities associated with President Obama's health care law will reach $17 trillion. The Committee's analysis is based on the Obama Administration's own numbers as well as those from the Congressional Budget Office. It is a modest, conservative estimate...

This video gives the Obama administration's opinion on how much Obamacare repeal would cost the country. Ms. Cutter explains the savings families of different income levels will enjoy under the law and also describes how many jobs could be lost if the healthcare reform law is not implemented as planned.

This video provides clips of President Obama's address to Congress on his health care plan. Among other things, the President promised the American people that they could keep their insurance if they liked it and that his plan would not add more to the deficit.

"The Oregon Health Insurance Experiment is the first study ever to measure the effects of health insurance by randomly assigning subjects to receive Medicaid coverage or no coverage. At this forum, lead investigator Katherine Baicker will present the Oregon Health Insurance Experiment's first set of results and discuss further data that this revolutionary experiment will produce. The panelists...

"In a complex decision, the Supreme Court has ruled that the individual mandate component of the Patient Protection and Affordable Care Act is constitutional under Congress's taxing power. What is left of the idea that the Constitution creates a government of limited powers? What does this case-of-the-century mean for both the Constitution and our health care system and what are next steps for...

"In a complex decision, the Supreme Court has ruled that the individual mandate component of the Patient Protection and Affordable Care Act is constitutional under Congress's taxing power. What is left of the idea that the Constitution creates a government of limited powers? What does this case-of-the-century mean for both the Constitution and our health care system and what are next steps for...

"In a complex decision, the Supreme Court has ruled that the individual mandate component of the Patient Protection and Affordable Care Act is constitutional under Congress's taxing power. What is left of the idea that the Constitution creates a government of limited powers? What does this case-of-the-century mean for both the Constitution and our health care system and what are next steps for...

"One year after the passage of major health care legislation, Harvard economist Jeff Miron says more reform is still needed. Dr. Miron gives his top 3 policy proposals for fixing the U.S. health care system: 1) Throw away the notion that health care is a right; 2) Repeal Obamacare; and 3) Phase out Medicare."

According to this video, one of the leading challenges of Obamacare has to do with the individual mandate and its relation to the Commerce Clause in the Constitution. This video describes the background of the Commerce Clause and whether or not the Obamacare law violates the Clause.

"At its one-year anniversary, Obamacare continues to frustrate and confuse the medical community and American public at large. In fact, recent surveys show doctors are less optimistic about the future of medicine, with some considering exiting the medical profession entirely. Heritage's medical panel will detail their firsthand experiences with Obamacare and their...

"Does the fate of a federal government with limited powers rest in the hands of Supreme Court Justice Antonin Scalia? And if so, will he rule against broad federal powers (as he did in the Gonzales case) or in favor of the feds' right to regulate just about anything (as he did in the Raich case)?"

Primary Document

This piece presents a large variety of information on the services and costs of Medicaid, especially in regards to the recently enacted PPACA. "The Affordable Care Act will have a substantial effect on Medicaid trends over the next 10 years and beyond. In terms of the magnitude of changes to the program’s projected expenditures and enrollment, it...

"The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy."

"FOR AN ACT ENTITLED, An Act to provide for an individual mandate to adult citizens to provide for the self defense of themselves and others.


Section 1. Not later than January 1, 2012, each citizen residing in the state of South...

A leading precursor to the Patient Protection and Affordable Care Act, Senator Max Baucus' paper on health care reform called for "legislation that achieves coverage for every American while also addressing the underlying problems in our health system." According to Baucus, "this Call to Action … is not intended to be a legislative proposal. Nor is...

“In this case, the Commonwealth of Virginia …, through its Attorney General, challenges the constitutionality of the pivotal enforcement mechanism of the health care scheme adopted by Congress in the Patient Protection...

Updated in May of 2010, this document contains the full text of the health care law popularly known as Obamacare and signed into law on March 23, 2010 by President Barack Obama.

The oral argument for the first day of Supreme Court hearings on the Obamacare law.

The transcript from the first day of oral arguments before the Supreme Court on the Obamacare law.

The transcript of the second day of oral arguments before the Supreme Court on the Obamacare law.

This hearing concerned the Anti-Injunction Act issue of the Patient Protection and Affordable Care Act cases and whether it applies to the individual mandate or not.

This hearing concerned the Anti-Injunction Act issue of the Patient Protection and Affordable Care Act cases and whether it applies to the individual mandate or not.

The matter of abortion was one of the concerns raised by opponents of the PPACA. In light of these concerns, President Obama released this executive order, which declared that "it is necessary...

"Milliman, Inc. (Milliman) was retained by the Mississippi Division of Medicaid (DOM) to perform analysis related to changes to the Medicaid program resulting from federal healthcare reform. This report documents the results of our financial impact review of the Patient Protection and Affordable Care Act as amended by H.R. 4872, the Reconciliation Act of 2010. Our results calculate Mississippi...

In my message to the Congress on November 19, 1945, I said that every American should have the right to adequate medical care and to adequate protection from the economic threat of sickness.

After being asked about the constitutionality of the individual mandate requirement in the Obamacare bill, Speaker Nancy Pelosi's office issued this press release. According to the press release, the...

Using an anecdote to describe how important Obamacare health coverage is to Americans with pre-existing conditions, the U.S. Attorney General and Health and Human Services Secretary bemoan a court ruling that declared the individual...

Heavily promoted by the Clinton administration in the early nineties, the Health Security Act was a precursor to the Patient Protection and Affordable Care Act. This Act was cited as "A BILL To ensure individual and family security through health...

This document explains the components of the increasingly growing waiver system under Obamacare. The document includes a chart listing the 729 organizations that had been approved for waivers as of January 26, 2011. Among the organizations...

"As you requested, the Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have estimated the direct spending and revenue effects of H.R. 6079, the Repeal of Obamacare Act, as passed by the House of Representatives on July 11, 2012. This estimate reflects the spending and revenue projections in CBO's March 2012 baseline as adjusted to take into account the...

"The percentage of people without health insurance coverage decreased in 2011 to 15.7 percent from 16.3 percent in 2010. The number of uninsured also decreased to 48.6 million in 2011 from 50.0 million in 2010."

This article lists the names of lawsuits challenging the Obamacare law and gives a brief description about each case.

Although the Patient Protection and Affordable Care Act had many opponents, it also had many supporters. The American Medical Association was one of the latter, and this letter from the AMA's president expresses that support by stating the...

Before holding the final House vote which would eventually pass Obamacare, House Speaker Nancy Pelosi gave this speech. Pelosi urged her colleagues to vote in favor of the PPACA, noting the historical nature of the vote and declaring that “[t]he best action that we can take...

The U.S. Supreme Court's highly anticipated decision which upheld the Affordable Care Act.

"The Patient Protection and Affordable Health Care act signed into law by President Obama in late March is a complicated bill that overhauls the nation's health care system over a period of five years.

It sometimes is mentioned in the same breath with the United Kingdom's National Health Service Act of 1946 which set up that country's government-run health-care system.

But that...

"According to former Internal Revenue Service (IRS) Commissioner Fred Goldberg, and supported by the Obama Administration's own figures, ObamaCare '...in its current form will be a needless administrative and compliance quagmire for millions of Americans.'

Based on IRS estimates approved by the Office of Information and Regulatory Affairs at the Office of Management and Budget,...

This brief document lays out the fines that will be expected from those who refuse to buy health insurance under the PPACA. According to this document, “[t]hat penalty will be the greater of a flat dollar amount per person that rises to $695 in 2016 and is indexed by...

In a speech before the National Association of Counties, Speaker Nancy Pelosi discussed the economic need for more jobs and health care reform. Pelosi emphasized the need to insure Americans with pre-existing...

The Anti-Injunction Act declares that "no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such person is the person against whom such tax was assessed." In other words, pay first, sue later.

After an extensive debate in Congress, the Patient Protection and Affordable Care Act passed both the House and Senate. The transcript of the presidential signing of the PPACA legislation reflects the...

In an address to the American Medical Association, President Obama discussed some of the many problems with the American health care system. The President then went on to lay out his plan for health care reform,...

Marking the three month anniversary of the signing of PPACA, President Obama addressed the subject with a group of guests at the White House. The President focused his remarks on the positive outcomes that the PPACA was beginning to provide for Americans, while also condemning those who urge the repeal of Obamacare.

In this short speech, President Obama delightedly recognized the support and endorsement given to the Patient Protection and Affordable Care Act by the AARP and the AMA. President Obama concluded by "urg[ing] Congress to listen to...

"This report first analyzes the authority of Congress to enact the minimum essential coverage requirement contained in PPACA, as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on...

In January 2011, U.S. District Judge Roger Vinson declared that "'The Patient Protection and Affordable Care Act' [is] unconstitutional." Judge Vinson's decision was carefully thought out and related to the Constitutional "Commerce Clause." Vinson also made an...

In August of 2011, the Eleventh Circuit Court of Appeals declared that parts of the PPACA were unconstitutional. This decision addresses the constitutionality of the Individual Mandate portion of Obamacare, as well as the difference between a tax and a penalty in relation to the PPACA's implementation.

"The federal government has no constitutional authority to dictate how Americans shall pay for their medical care. It has no right to force them to turn over their earnings for the profit of private insurers or for the 'public use,' such as providing 'free' services that a federal agency dictates people should have."

Appellants, four United States citizens and federal taxpayers, seek declaratory and injunctive relief to prevent various U.S. Government officials and agencies from enforcing the minimum essential coverage provisions.

During the debate preceding and following the passage of the Patient Protection and Affordable Care Act, many opponents of the PPACA pointed to a CBO report that emerged during the health care proposals under President Clinton. This report noted the "unprecedented" nature of forcing American citizens to buy health insurance. Opponents of the PPACA...

"The Council of Economic Advisers (CEA) has undertaken a comprehensive analysis of the economic impacts of health care reform. The report provides an overview of current economic impacts of health care in the United States and a forecast of where we...

In this testimony before the House Budget Committee, Richard Foster describes some of the costs and implications the PPACA could have on Medicare and other health expenditures. In regards to these issues, Foster declares the following:


Following inquiries by Senator Tom Coburn, "[t]his memorandum responds to ... [Coburn's] request for information regarding the penalty imposed on those who fail to maintain minimum essential health benefits coverage...