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Supreme Court Health Care Ruling Impacts Illinois

By Sean Powers, Craig Cohen, and Jim Meadows, with additional reporting from The Associated Press and Illinois Public Radio

The Supreme Court has upheld the Affordable Care Act's health insurance requirement for most Americans, as well as other elements of the health care overhaul. The High Court ruled in a 5-4 vote that the health insurance requirement for most Americans in the Affordable Care Act was not, in fact, a mandate, but a tax.

Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor joined Roberts in the outcome. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

Breaking with the other conservative justices, Roberts read the judgment that allows the law to go forward. He explained at length the court's view of the insurance mandate as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.

Congress called the payment a penalty, not a tax, but Roberts said the court would not get hung up on labels. Among other indications it is a tax, Roberts said, "the payment is collected solely by the IRS through the normal means of taxation."

"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts added.

Kennedy summarized the dissent in the courtroom. "In our view, the act before us is invalid in its entirety," he said.

The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."

As a result of the ruling, other elements of the Affordable Care Act remain in effect, including low-cost preventive care, drug discounts for seniors, Medicaid coverage for more low-income Americans, barring insurers from turning down patients with pre-existing conditions, and allowing young adults to remain on their parents' health insurance until their 26th birthday.

Claudia Lennhoff is Executive Director of Champaign County Healthcare Consumers. She said the court's decision to uphold President Obama's health care law will have a huge impact on area residents.

"East central Illinois has a fairly high rate of uninsured individuals, and Champaign County has a very high rate of people living in extreme poverty, so the expansion of health coverage is going to benefit thousands of local residents," Lennhoff said.

Statewide, currently, one million, nine hundred fourteen thousand Illinois residents are uninsured. That's about 15 percent of the population of the state. Meanwhile, 850 thousand Indiana residents do not have health insurance. That's about 13.4 percent of that state.

Mike Brown is the president and CEO of Provena Hospitals in Urbana and Danville. He said he is thrilled the high court upheld the law. Brown said expanding health coverage to all people is critical.

"If you're one of those folks who's without it, you want that kind of coverage," Brown said. "It also allows people to have some predictive value on where they're going to go with being able to continue to provide current level of care in a new system. I think it's imperative that people understand that the current system that we work on is effectively broken."

In order to establish a way to get more Illinoisans insured, the state has received three federal grants to study and start building a health insurance exchange. Health exchanges allow individuals to shop and compare different health insurance plans.

The Affordable Care Act calls for the federal government to subsidize these state exchanges, but thus far only 13 states and the District of Columbia have adopted plans for exchanges. And there's concern Illinois and Indiana, and the remaining states may not be moving fast enough.

Illinois has received three federal grants to study and start building its online health insurance marketplace, but the general assembly failed to pass a law establishing it.

Gov. Pat Quinn has yet to issue an executive order to create the insurance exchange. State lawmakers had been working on creating one, but speculation that the Supreme Court could kill so called "Obamacare" delayed progress. Quinn said lawmakers need to get back on track.

"We have already been working on this issue, and we've already been able to acquire resources and get people together to carry this mission out," Quinn said. "We do want our legislature to pass a law with respect to health insurance exchanges. And I want to work with legislators in a good way on making that possible."

Quinn hasn't indicated whether he will use his executive power to create a health insurance exchange, which has already happened by governors in other states like Rhode Island and New York

Illinois could pursue a federal-state partnership instead of adopting its own health insurance exchange. Jim Duffett, who is the executive director for a Campaign for Better Health Care, said that would be a mistake.

"We need to do our own state exchange," Duffett said. "We've got the ability to be able to do it. Illinois is a unique state. It's a very diverse state. By moving to a state federal partnership, you lose a lot of power to be able to develop how your exchange should look like in Illinois."

But Health Alliance CEO Jeff Ingrum said because Illinois waited too long to start up its own health insurance exchange, he doesn't think there will be enough time for state officials to figure out how to structure it.

"We'd rather have something in place that we can control some of the choices that are made within the exchange than to have a state just ramrod something through very quickly without thinking through all the details so that we have an exchange that benefits consumers in Illinois to the best possible extent," Ingrum said.

A lawmaker who worked on implementing the state's insurance exchange has said Illinois won't be able to meet a Nov. 16 deadline to get it set up.

Meanwhile, Indiana has spent the last year and a half planning for a health insurance exchange. Gov. Mitch Daniels said he wants to make sure he thoroughly understands the U.S. Supreme Court ruling on the president's health care law before he decides how Indiana will respond. Daniels said he's particularly puzzled about a provision that gives states the option to expand Medicaid eligibility.

While states grapple with how to establish exchanges, the Supreme Court's ruling also has, of course, political implications - and not just for the Presidential race.

A lot of interest groups spent the day trying to figure out what the revived law means for them. Medical providers say getting more people health coverage is a good thing.

"That was the right decision for those that are uninsured and need access to quality care going forward," said Maryjane Wurth, the CEO of the Illinois Hospital Association.

Wurth said there's a lot to like in the Affordable Care Act: the expansion of coverage, long-sought changes to insurance laws, and the government's willingness to experiment with new payment models.

"But there are also some negatives in the bill as well, such as payment reductions to hospitals and other providers," Wurth said.

A lot of the people who'll get coverage through the new law will be added to the Medicaid rolls -- the government program of health care for the poor. That's a source of concern for doctors like William Werner, head of the Illinois State Medical Society.

"Reimbursement for physicians really does not cover the cost," Werner said. "So even though Medicaid may expand and somebody will have a card that says they have insurance, they still may have difficulty finding access to care."

Even if people gain coverage through Medicaid and can find a doctor -- it's not clear who will pay for it. The Illinois General Assembly just spent months cutting benefits and increasing taxes to a plug a $2.7-billion hole in Medicaid.

Robert Rich, the director of the Institute of Government and Public Affairs at the University of Illinois, said the biggest impact for Illinois from the Supreme Court's healthcare ruling comes in the area of Medicaid. Rich said the high court's ruling barring the federal government from taking Medicaid funding away from states that refuse the Medicaid expansion in the Affordable Care Act could directly affect Illinois' financial situation.

"As you know, Illinois just went through a legislative session, where they spent a lot of time debating Medicaid cuts, and a lot of time debating what to do about Medicaid," Rich said. "Had that provision, the Medicaid provision of the law survived, by the year 2014, many, many people would have been added to the Medicaid roles, and would have increased the financial problem quite a bit."

In fact, Gov. Quinn recently approved cuts in Medicaid services, which take effect next week. Rich said he believes that ultimately, the high court ruling on the Medicaid part of the Affordable Care Act will lower the total number of Americans who gain health insurance coverage under the law.

Illinois Comptroller Judy Baar Topinka said there are hundreds of thousands of people who have been eligible for Medicaid who, for whatever reason, never bothered to enroll.

"They will now sign up for Medicaid, because it's either you sign up or you're going to be taxed," Topinka said. "It will probably run us about $2.4 billion -- which pretty well kills off and neutralizes any cuts that were made in the last round of the legislature."

Illinois Democrats and Republicans mostly fell into two camps when reacting to the Supreme Court ruling on the federal health care law.

"The Republicans said that (the) Affordable Care Act was unconstitutional and unnecessary," U.S. Sen. Dick Durbin (D-Ill.) said.

Durbin praised the Supreme Court for upholding the Affordable Care Act. The Illinois Democrat said very few people go without health insurance because they don't want it.

"I think those people are shirking their personal responsibility," Durbin said. "When they are brought in to health care coverage, it's fairer for every family, every business, everybody in America."

Republican Congressman Tim Johnson of Urbana has a different view. Johnson, who is not running for re-election, said it's his long-held view that the law does more harm than good. He said the best thing Congress could do is vote to repeal it.

"I think it expands government unduly," Johnson said. "I think it is tremendously costly. I think it will, in the long run and probably short run, affect the quality of healthcare in the United States. And I think it's an unprecedented power grab by the federal government. And as a result, I don't support it."

Johnson said there are other ways to improve access to healthcare in America, but that repealing the current law is his top priority.

The ruling handed Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they would try to use the decision against him.

At the White House, Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." Blocks away, GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if elected in November.

The Supreme Court's ruling of course has political implications - and not just for the Presidential race. The candidates for Illinois' new 13th district, who are vying to replace outgoing Congressman Tim Johnson, were quick to respond to Thursday's decision.

Republican Rodney Davis of Taylorville said the ruling is one more reason to repeal the Affordable Care Act, and replace it with what he calls a "market-based health care safety net."

"It's going to ensure that we lower the cost of the health care delivery system in this country; put the focus on the doctor and patient relationship, so that they actually have a say in what their treatment outcomes are going to be, and what the cost of those outcomes will be," Davis said. "Also, provide a true cost-effective safety net, to those who are uninsured, under-insured and underserved."

But Democrat David Gill of Bloomington said the ruling protects a law that makes important improvements in health care --- just not enough of them. In his view, the Affordable Care Act relies too much on private insurance companies.

"I don't approve of forcing American citizens to purchase a shoddy private healthcare product," Gill said. "I want them to have the availability of Medicare. I think that we need a public option in there, which would extend the benefits of Medicare to more American citizens."

Independent candidate John Hartman of Edwardsville gives the ruling his qualified approval. He thinks the health care law does some good things, but that more needs to be done, including greater efforts to rein in costs.

The 13th District House race is just one battleground where the debate over the Affordable Care Act continues. Its outcome will help decide the impact of the Supreme Court's ruling upholding the law.