U.S. Supreme Court Votes to Uphold Universal Healthcare

Today, the Supreme Court of the United States (SCOTUS) voted to uphold almost all clauses in the Patient Protection and Affordable Care Act (PPACA). The most controversial part of what many call a revolutionary piece of legislation in America was the individual mandate, which would require all Americans to have health insurance from birth till death or pay a penalty. The bill, including the individual mandate, was upheld by a vote of 5-4, in a close split that Chief Justice Roberts often denounces as less than ideal. He prefers closer unanimity. Dissenting justices were Scalia, Thomas, Alito, and Kennedy.

At the end of March in their initial vote, the justices were divided 5-4 to uphold the legislation. Justice Anthony Kennedy, famous for being the traditional “swing vote” since he replaced Justice Sandra Day O’Connor in 2006, was the watched vote today. He notoriously argued that if the government can force citizens to buy insurance, it would only be a short journey to forcing them to buy broccoli. Pundits mused that after his arguments, the media overstated his opposition out of surprise at his language—but he proved true to his initial statements, voting to strike down the individual mandate.

The most surprising aspect to the 5-4 vote to uphold the PPACA in its entirety is that it was not Justice Kennedy who was the swing vote, but Chief Justice Roberts, who sided with the liberal justices in voting to uphold the bill.

The individual mandate was upheld as a tax law, as individuals who do not buy insurance will be required to pay a “penalty tax.” Whether the penalty was a tax or not was a point of contention in early arguments, but today’s vote has designated it as such. Congress can impose such a law using its taxing power. Because the mandate was upheld, the court did not need to deliberate on whether other sections of the PPACA are constitutional, except for a provision that “requires states to comply with new eligibility requirements for Medicaid or risk losing their funding,” said Amy Howe of the SCOTUS blog.

Of course the upholding of the PPACA means the medical device tax is still set to begin in 2013. “This only speaks to the need for legislative action before Jan. 1 to repeal the device tax,” chief lobbyist for Advanced Medical Technology Association (AdvaMed) J.C. Scott told the Wall Street Journal.

AdvaMed President and CEO Stephen J. Ubl emphasized that according to its principles, the association has and still does support health care reform. However, he stressed the importance of weeding out the aspects of the law that are damaging to the medtech industry.

“We have consistently opposed the $29 billion medical device tax because of its damaging effects on economic competitiveness, jobs and the research and development needed to find tomorrow’s treatments and cures,” he said. “The House has already voted to repeal the device tax, and we are heartened by the number of senators who have said they oppose the tax. We will continue to work with policymakers on both sides of the aisle to achieve this goal.”

Medical Device companies are already preparing for doomsday, as it were, with layoffs and cost cutting. Stryker Corp. laid off 1000 employees in November of last year, while Zimmer and others have layoffs in the works. Small startups will be most affected as the tax will be on totals sales rather than profits. Both Stryker and Zimmer have been lobbying for the repeal of the tax.

The Healthcare Supply Chain Association (HSCA) President Curtis Rooney had this to say today:

“Hospital budgets are already stretched thin, and as hospitals move forward with healthcare reform implementation, they will likely continue to face mounting financial pressures. [Group purchasing organizations] stand ready to continue to work with hospitals, long-term care facilities and other healthcare providers to provide critical cost savings, to identify and bring innovative medical products to market, and to help preserve affordable and accessible patient care.”

Clinicians worry other aspects of the PPACA, such as the Independent Payment Advisory Board that was formed in 2010 to save money in Medicare without affecting quality or coverage:

“We cannot overlook provisions like the Independent Payment Advisory Board that threaten the doctor-patient relationship and the administrative burdens within the law that could greatly hinder providers’ ability to deliver quality care by infringing upon exam room time,” said John R. Tongue, M.D., president of the American Association of Orthopaedic Surgeons (AAOS). “The AAOS will continue its efforts to achieve a patient-centered solution to health reform by working with Congress to best implement the beneficial provisions of PPACA; repeal the detrimental provisions that still exist, and; to solve critical issues, like achieving a permanent solution to the flawed Sustainable Growth Rate formula and addressing federal medical liability reform, that the law failed to address.”

While Congress (the House of Representatives already has voted to repeal the tax. A similar result in the Senate is less likely) continues to go through the processes of voting to repeal the 2.3 percent medical device excise tax, President Obama has promised to veto the repeal if it reaches his desk.

The full SCOTUS opinion on the PPACA is available at the New York Times