By Katie Kerwin McCrimmon
The U.S. Supreme Court’s 5-to-4 ruling upholding the Affordable Care Act inspired celebrations Thursday among Obama supporters who toasted a major victory, while stunned conservatives vilified Chief Justices John Roberts Jr. as a “turncoat” for siding with four liberal justices. They vowed to take the fight against Obamacare to the political arena.
In Colorado, the ruling clears the way for sweeping multi-million dollar health reform to move forward. Only one part of the massive law appeared to be in doubt. Analysts in Colorado and around the country were trying to figure out exactly how the ruling on Medicaid expansions would affect them. The health law requires states to provide health coverage for a much larger number of poor people under Medicaid programs, which are funded by both federal and state governments. The justices found that the federal government can require those expansions, but can’t threaten to take away current Medicaid funding if states fail to allow new people into already cash-strapped Medicaid programs.
Gov. John Hickenlooper said in a statement that millions of Coloradans have already benefited from the Affordable Care Act (ACA) including thousands of young adults and people with pre-existing conditions who have been able to qualify for health insurance, seniors who have taken advantage of preventive screenings, and hundreds of thousands of Coloradans who no longer have lifetime limits on their health coverage.
“More Coloradans will benefit when the Affordable Care Act is fully implemented in 2014,” Hickenlooper said. “We will continue to operate within the law’s framework and with the General Assembly while making state-level decisions that work for everybody.”
Hickenlooper said there is still more work to be done on cutting health costs, which have been outpacing economic growth for years.
Colorado Attorney General John Suthers, who on behalf of the state of Colorado had challenged the landmark health law along with 25 other states and the National Federation of Independent Business, said he was deeply disappointed and called the ruling a “very strange result.”
“I was very surprised by how they did it,” Suthers said, noting that President Obama and Congress had always claimed that the requirement that all individuals would have to buy insurance did not amount to a tax.
“I don’t think this bill would have ever passed had Congress called it a tax,” Suthers said.
Nonetheless, “the court has spoken. That’s the end of the line. There are no more appeals,” Suthers said.
Now, the fight over health reform will land squarely in the political arena, Suthers said. He believes that the debate will become even more hard-fought since the Supreme Court has declared the mandate a tax and not upheld the law under the Commerce Clause of the U.S. Constitution.
“I do think it becomes more of a volatile issue, having been based on a tax,” Suthers said. “Americans understand taxes.”
Suthers attended the oral arguments before the Supreme Court in March and listened to the debate over whether the justices would consider the mandate a tax. He thought it was unlikely that they would, but then it became clear on Thursday that Roberts was willing to make a compromise with the liberals. He refused to uphold the mandate under the Commerce Clause, but agreed to go along with the liberals if they would call the mandate a tax. Suthers called that a “pyrrhic victory for the states.”
“One has to believe that this is the result of a very, very dynamic compromise in the court,” Suthers said. “The bottom line is that the mandate is upheld as a tax.”
Tony Gagliardi, Colorado state director for the National Federation of Independent Business, said he was also disappointed.
“This is a sad day for main street businesses. It’s a sad day for the freedoms of the American public,” Gagliardi said.
“It will just be an exacerbation of the uncertainties on Main Street. I wouldn’t look for job creation to take an enormous jump.”
Gagliardi said that the NFIB will continue to challenge health reform through regulatory and legislative means.
“We respect the decision, but we will continue our fight for actual, legitimate health care reform. This act does nothing to address the real cost of health care.”
Colorado’s health exchange board is proceeding at full speed to build a new health insurance market by October of 2013. Health exchange managers have signed a $66 million dollar contract with the technology firm, CGI, for technology work to help build and run the exchange through 2018. CGI is also building a $94 million exchange system for the federal government. Exchange executive director and CEO Patty Fontneau noted that the CGI contract is “one significant piece of a series of contracts that will implement and operate the exchange through 2018.”
Fontneau said it’s impossible at this point to predict exactly how much it will cost to build and run the exchange. Under the Colorado law that created the exchange, funding cannot come from the state. So far, Colorado has been developing the exchange with a $1 million federal grant that was followed by a $17.9 million follow-up grant from the U.S. Department of Health and Human Services. Those funds will keep the exchange funded through October. Then, Colorado will need new federal funding to keep the health exchange viable.
Gretchen Hammer, who is chair of Colorado’s health benefit exchange board and executive director of the Colorado Coalition for the Medically Underserved, said the Supreme Court ruling clarifies Colorado’s path to reform.
“This decision really allows us to stay on track with the work that we are already doing to build a new insurance marketplace. It’s full steam ahead,” Hammer said.
“We are very proud of the work that we have been doing in Colorado to improve the health care system. We are a leader in terms of access to care for underinsured and underserved patients and in providing medical homes. So, we are really pleased that all of those good things that are currently in place can continue,” Hammer said.
Among other reactions to the high court ruling:
U.S. Rep. Cory Gardner, Republican from Yuma:
“Today’s decision is very disappointing. The Supreme Court effectively granted Congress unprecedented power to tax people who don’t spend money and buy what Congress wants them to buy. But just because something is deemed constitutional does not make it good policy. Our fight to curb the overreaching power of government will continue. While today’s decision may have been a setback, the vision of our Founding Fathers and their notion of limited government still lives in the hearts and minds of many Americans. This ruling only energizes us for November.”
U.S. Sen. Mark Udall, Democrat from Eldorado Springs:
“The Affordable Care Act has expanded health coverage for thousands of Coloradans and made preventive care more accessible and affordable for millions of Americans across the country. I am pleased to see that the U.S. Supreme Court affirmed the bill’s constitutionality.
“We have already seen the positive impacts of the law, including keeping prescription drugs affordable for our nation’s seniors and prohibiting insurance companies from denying health insurance to children with pre-existing conditions. I look forward to working with my Senate colleagues, and the administration, to ensure that this important law continues to be implemented in a smart and effective manner.”
Patty Fontneau, executive director and CEO of the Colorado Health Benefit Exchange:
“The high court decision allows us to stay on track with the work of building a new health insurance marketplace that increases access, affordability and choice for Coloradans and fulfills the vision of our state enabling legislation, Senate Bill 200.
“When we open for business in October 2013, our marketplace will make it easier for individuals and small businesses in Colorado to shop for and purchase health insurance. We have a tremendous amount of work ahead of us and we are grateful to be able to stay focused on opening an Exchange that meets the needs of Colorado.”
Dede de Percin, executive director of the Colorado Consumer Health Initiative:
“This is the best economic news we could have heard. Coloradans will have more money in their pockets because we will continue to reap the benefits of increased access to more affordable health care. Colorado families now will have the peace of mind that they will be able to get the care they need when they need it … Colorado has already begun expanding Medicaid coverage because as a state, we believe families should be able to get the health care they need. The Medicaid finding on reimbursements will not affect us. And not only has the Court upheld the law but Colorado has spoken – voters rejected an anti-health reform initiative and passed bipartisan legislation to establish an health benefits exchange. We will continue to move forward with increasing access to quality health care for all Coloradans.”
Colorado House Majority Leader Rep. Amy Stephens, Republican from Monument, who helped sponsor the law creating the Colorado Health Exchange:
“Today’s ruling by the U.S. Supreme Court sets a dangerous constitutional precedent that will derail our fragile economic recovery.
“Federally mandated health care oversteps congressional authority and will hamstring entrepreneurship and impose impossible-to-manage costs for all employers here in Colorado and across the country.
“House Republicans will continue to look for ways Colorado can fight federally mandated health care and introduce consumer-driven solutions that respect states’ rights and best fit Colorado’s unique needs.”
Anthem Blue Cross and Blue Shield in Colorado, which has about 950,000 members in Colorado:
“From the early days of the debate on health care reform, we’ve stated our desire to build a health care system that provides access to all Americans and ensures high quality, affordable health care. Anthem Blue Cross and Blue Shield in Colorado will continue to move forward with our efforts to improve our nation’s health care delivery system…
“The road to implementing health care reform will be a challenge; however, we look forward to working constructively with policymakers and other key stakeholders to build a health care delivery system that provides security and affordability to all Americans.”
Elisabeth Arenales, health program director for the Colorado Center on Law and Policy:
“We celebrate the ruling because it means that all Coloradans have the security of knowing they can get the care they need when they need it.
“In the past two years, the Affordable Care Act has helped nearly 2 million Coloradans gain access to health care, expanded services and peace of mind. That includes:
- More than 40,000 young adults in Colorado under the age of 26 have gained health insurance.
- In 2011 alone, 39,000 Colorado Medicare recipients saved over $22 million on their prescription.
- 291,000 children in Colorado with pre-existing conditions can never be denied coverage.
- Many Coloradans are opening the mail this month to find rebates from their insurance companies.
“These are a few of the positive changes that are a direct result of the Affordable Care Act. Colorado can now continue moving forward implementing other provisions of the act and ensuring that all Coloradans are secure in the knowledge they have access to quality, affordable health care when they need it.”
The Colorado Trust:
“This morning the U.S. Supreme Court upheld the Affordable Care Act, affirming this landmark law. The court’s ruling represents a significant step forward in helping to provide more affordable, meaningful health coverage for Americans, including the nearly one-third of Coloradans who are uninsured and underinsured.
“Most of the provisions required through the Affordable Care Act closely align with the recommendations of Colorado’s own Blue Ribbon Commission for Health Care Reform, including Medicaid expansion. Today’s ruling assures that our state will have access to federally funded Medicaid expansion, and underscores the need to maintain our commitment to Medicaid, working within the realities of our state budget.
“The Colorado Trust stands firm behind its commitment to work closely with partners to achieve access to health for all Coloradans. The court’s ruling offers renewed hope for realizing this goal, and underscores the importance of providing Coloradans with good information, encouraging them to speak up about health care challenges and to be actively engaged in achieving workable solutions.”
Colorado Organization for Latina Opportunity and Reproductive Rights executive director Lorena Garcia:
“The Supreme Court’s decision to allow the Affordable Care Act to stand is a victory for Latinas and their families, including the 50 million Americans currently without insurance.
“Today, one in three Latinos in the United States is uninsured, more than any other racial or ethnic group.
“Colorado women should have access to the health services they need, without postponing care, unable to pay for treatment, and making care more costly and dangerous in the long term. We look forward to participating in conversations as we build an exchange in Colorado that focuses on increasing access to quality health care for all Coloradans.”
Stat Sen. Irene Aguilar, M.D., Democrat from Denver:
“This is a wonderful outcome for 480,000 of our 829,000 Coloradans without health insurance. The Patient Protection and Affordable Care Act will help working families afford health insurance, and allow Colorado to expand its safety net for those living in poverty. Colorado can move forward on its work on the exchange without further delays and diversions. The Supreme Court’s decision will help our economic recovery tremendously.”
“The ACA has given Coloradans security in their health care that they have never experienced before, prohibiting insurance companies from dropping those who get sick, using annual or lifetime limits to bill people into bankruptcy or discriminating against individuals with a pre-existing conditions.”
Polly Anderson, chief policy officer for the Colorado Community Health Network:
“By upholding the constitutionality of the ACA, the U. S. Supreme Court has assured that 32 million uninsured Americans, including 510,000 Coloradans, will have the opportunity to gain insurance coverage over the next few years. The decision also assures continued expansion to primary and preventive health care and that consumers will have vital protections and benefits under the law.
“Nearly $50 million in grants from the ACA has gone to communities across Colorado to expand existing community health centers and to build new centers to care for more people in Colorado. Health Centers are working hard to provide access to high quality, affordable primary health care in underserved communities, regardless of people’s insurance status. The continuation of the ACA means that Colorado community health centers will continue to provide health care homes to the 600,000 people who visit community health centers now.”
Vicki Cowart, president and CEO of Planned Parenthood Votes Colorado:
Cowart called the Affordable Care Act “the greatest advance in women’s health in a generation” and said the ACA will have a “profound and concrete impact” on millions of people’s lives.
“The law will provide access to birth control and cancer screenings without co-pays, guaranteed direct access to OB/GYN providers without referrals, and an end to discriminatory practices against women, such as charging women higher premiums and denying coverage for pre-existing conditions.
“This decision will have a profound and concrete impact on millions of people’s lives. Affordable, quality health care will now be available to millions of women who had no coverage or inadequate coverage before. Today, we are closer than ever to realizing the promise of health care for all.”