Health Care Ruling’s Winners and Losers

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Explore a collection of FRONTLINE’s reporting on the health care debate — including more on how Obama passed the Affordable Care Act, one doctor’s innovative attempts to manage costs, and an exploration of how we make complicated end-of-life decisions.

The Supreme Court’s surprising and deeply divided decision to uphold the entire Affordable Care Act — known as Obamacare — came down to a simple question of whether the mandate was a tax.

Chief Justice John Roberts concluded that it was, siding with Justices Ruth Bader Ginsburg, Justice Stephen Breyer, Justice Sonia Sotomayor and Justice Elena Kagan to uphold the law entirely. Read the full decision here [pdf]. The courts also ruled on the law’s expansion of Medicaid, deciding that states still control who has access to coverage, and that the federal government can’t withhold funding or otherwise penalize states who don’t expand it to their liking.

Now that the law remains intact, here’s our shortlist of the winners and losers:

WINNERS

President Barack Obama: Fresh off a big win in 2008, the president spent his political capital passing a comprehensive health-care law that drew contemptuous ire from Republicans. With everyone expecting the law to be overturned, this is a huge victory for the president, who will welcome the boost ahead of a close November election.

Gov. Mitt Romney: Even though his own universal law in Massachusetts provided the framework for Obamacare, Romney has promised that his first act as president would be to repeal it. With the Supreme Court upholding the law, that rallying cry will likely only get louder, giving him another opportunity to energize the Republican base.

People without insurance: About 17 percent of adults in the U.S. don’t have health insurance, a figure that’s been on the rise since 2008, as people lost their jobs and or could no longer afford their employer-based health plans. The law requires everyone to have insurance by 2014, or pay a tax.

Health Insurance Companies: The mandate is what made universal health care work for insurance companies. By requiring everyone to be insured, the law creates a larger pool, mostly of healthy people who won’t need big payouts. This gives insurance companies a larger cushion to pay for the care of sicker people, including those with pre-existing conditions.

Kids under 26:  Once the law kicked in allowing children under 26 to remain on their parents’ insurance, an estimated 3.1 million young people gained health coverage, according to a government-run National Health Interview Survey. Big insurance companies, such as UnitedHealth Group and Aetna Inc., have said they would have maintained the provision anyway because it was too popular to discard. But the affirmation gives them legal backing and a little more security.

The American Medical Association: The AMA has long backed the health reform law because it expanded access to care. They greeted today’s decision pretty warmly: “The AMA remains committed to working on behalf of America’s physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation’s health care system,” it said in a statement.

Broccoli: The vitamin-C rich vegetable finally made headlines when Scalia asked in oral arguments whether, if Americans could be made to buy health insurance, they might also be made to buy broccoli. Later, musing aloud ahead of the decision, Justice Ginsburg said: “If the individual mandate, requiring the purchase of insurance or the payment of a penalty, if that is unconstitutional, must the entire act fall? Or, may the mandate be chopped, like a head of broccoli, from the rest of the act?” With the law upheld, the broccoli keeps its legendary status — and stays intact.

LOSERS

Justice Antonin Scalia: Arguably the most conservative justice on the court, Scalia led questioning during oral arguments about the ACA that led some to question whether he’d crossed the line into partisan politics. Either way, when he was through, most people assumed the health care law would fall. But in the end, Chief Justice Roberts took an opposing view and tipped the balance toward the four more liberal judges.

The Tea Party: It’s no secret that the Tea Party has been especially opposed to the law. On their website, though, the language was particularly strong. A sample: “To simply repeal this monster implies it was a valid law to begin with! The hideous abomination from hell must be eradicated.” They’re unlikely to be pleased with the decision, and this could bring them in force to the polls in November.

CNN: Shortly after 10 a.m. Wolf Blitzer trumpeted the news that the court had killed the mandate. The network continued reporting this on-air and online even as Scotusblog, which had a reporter inside the court, was reporting the mandate was upheld. They pivoted to “conflicting reports,” before finally getting it right — and posting a correction online.

Small Businesses: Companies with fewer than 50 employees aren’t happy with the law because they worry it will increase health insurance costs, according to the National Federation of Independent Businesses, which was a plaintiff in the suit.

The American Dental Association: The group opposes a provision in the law that provides additional funding for dental therapists, who have less training than dentists but can perform basic care skills, and could offer service in areas with a lack of dentists.

Montana Shooting Sports Association: The gun-rights group, which describes itself as the “‘junkyard dog of politics” in Montana, filed an amicus brief opposing the law on the grounds that it violates states’ rights. Quentin Rhoades, one of the group’s attorneys, told the New York Times that he didn’t expect their brief to have a major impact, “Except to maybe count up the ‘for’ and ‘against,’ ” he said.

Protesters demonstrate against the health care law outside of the Supreme Court in Washington, Monday, March 26, 2012, as the court began hearing arguments. (AP Photo/Jacquelyn Martin)
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