The U.S. Supreme Court has narrowly upheld President Barack Obama's healthcare reform law, saying that the provision requiring individuals to purchase health insurance falls under Congress' taxing powers, not the Constitution's Commerce Clause.
Though the justices' opinions differed on the various aspects of the complex and controversial case that produced a 193-page decision complete with concurring and dissenting opinions, the 5-4 ruling means that people from southern Illinois to Washington D.C. and everywhere in between will face a penalty if they don't buy health insurance.
Belleville personal injury attorney Tom Keefe Jr. said the ruling made him "proud to be lawyer."
"The Supreme Court with this decision today demonstrated they decided this case on the rule of law, not on politics," he said. "There have always been accusations that the court is political and today, they've gone a long way toward convincing me otherwise."
Although he was surprised that the majority of the court used Congress' taxing powers, as opposed to its authority to regulate commerce, to come to its conclusion, Keefe said he understands the court's position and believes it made the right ruling.
As for how the upheld law will affect the legal community, Keefe said he's not sure.
"The public at large has had a lot of time to try to absorb what this law means, but hasn't studied it exactly and carefully because no one was sure it would be upheld as constitutional," he said. "It's a complicated law and I think the devil is going to be in the details."
Not everyone, however, is pleased with the ruling.
As someone who worked in the healthcare industry for more than four decades, Alton physician Ed Ragsdale said he is "very disappointed" that the Supreme Court upheld Obamacare.
"This law gives great power to the government over physicians and patients," Ragsdale said. "If they can make everyone buy healthcare insurance, then there is no limit to what government can do. I think there are going to be some very unfortunate decisions made that don't benefit physicians or patients."
Healthcare decisions, he said, should be made by doctors and patients, not politicians. But if politicans truly want to reform healthcare, Ragsdale said they should start by putting limitations on medical malpractice awards.
While the majority of the court held that Congress's right to regulate commerce doesn't reach so far as to allow it to require everyone to buy health insurance, it did determine that Congress can use its taxing powers to impose a tax on people who refuse to purchase insurance.
Because the court upheld the individual mandate, it did not rule on the constitutionality of the other provisions in the Patient Protection and Affordable Care Act, also known as Obamacare, with the exception of one that requires states to comply with new eligibility requirements in order to receive additional federal funding under the act's Medicaid expansion.
The court's ruling has been anticipated for months since Obamacare touches on practically every sector of society from individuals and employers to hospitals and state government. In addition to the individual mandate, the act that Obama signed into law includes provisions that end lifetime limits on benefits and forces coverage for pre-existing conditions and dependents up to age 26, among others.
Chicago attorney Jennifer Kraft, a partner at Seyfarth Shaw's employee benefits practice, said because the Obama administration already began the implementation of the act, the ruling will not create the shake-up that would have resulted had the court ruled the other way.
For her clients, most of whom are employers, Kraft said the ruling means that "everything they have already put in place will stay in place and move forward." More importantly, she said, employers will now have to decide whether they want to implement one of the act's provision set to take effect in 2014.
This provision, she said, mandates that employers provide affordable coverage to their employees at a rate that cannot exceed 9.5 percent of an employee's household income. She said employers should start planning for this and decide whether they will provide this coverage or take a penalty for not doing so.
"I don't think employers are any worse off as result of today's opinion," she said.
St. Louis University School of Law Professor Michael Wolff, who previously served on Missouri Supreme Court, said he is not surprised with the court's decision to uphold the act, but is surprised by "the rationale and where the votes were."
Had the chief justice voted the other way, Wolff said the court's decision would have been broken down along partisan lines. Roberts, a Republican, joined the court's four Democrats to form the court's majority. The remaining four Republican justices dissented from the majority, saying they believed Obamacare is unconstitutional.
"This was the most important decision of his term as chief justice," Wolff said.
Now that the much-anticipated ruling has been released, Wolff said the biggest challenge to the Obama administration is "to sell this act. No one knows what's in it," referring to how many people are aware of the individual mandate and provision providing coverage for dependents up to age 26.
"If the people who supported this act don't take this opportunity to explain to the public what the heck this act is, they are making a big mistake," Wolff said.
Maryjane Wurth, president and CEO of the Illinois Hospital Association, praised the court's ruling, saying that "Illinois hospitals have long supported the expansion of coverage for the uninsured and reforms to eliminate exclusions for pre-existing conditions and coverage caps to improve the health and well-being of Illinoisans."
"Because of this legislation, people in Illinois will no longer have a diminished quality of life, be at risk of dying merely because they lack health insurance, or be forced into bankruptcy because of a devastating diagnosis," Wurth said in a statement.
Gateway Regional Medical Center in Granite City said in a statement provided by Kate Allaria, director of public relations, that "today's Supreme Court decision means millions of uninsured Americans will soon have access to health insurance. We're glad that people who have not had access to medical care will be able to visit doctors, utilize more hospital services, and obtain preventive healthcare."
The statement added that, "Expanded coverage will also reduce the strain of uncompensated care on America's hospitals. Our hospital currently provides medically necessary emergency medical care for those who need it, regardless of whether they have insurance or the ability to pay for our services. Reducing uncompensated care will help ensure that we can continue to provide essential healthcare services for this community."
Although upheld, Obamacare is likely to become a hot button issue in the upcoming election.
Republican presidential nominee Mitt Romney has already promised to try to repeal the law if he gets elected.
U.S. Rep. John Shimkus, a Republican from Collinsville, said he was disappointed in the ruling.
"This law takes away our rights as individuals to make choices about our finances and personal freedoms, like whether or not to buy insurance," Shimkus said in a statement. "I agree with the dissenters that the law is unconstitutional."
He said that the House will once again vote to repeal Obamacare.
U.S. Sen. Mark Kirk, R-Ill, said while he respects the court's decision, "the health care law threatens our economic recovery by raising taxes, imposing new regulations and creating a drag on the economy."
Kirk added that, "Congress should repeal the health care law and replace it with common sense, centrist reforms that give Americans the right to buy insurance across state lines and expand coverage without raising taxes, while blocking the government from coming between patients and their doctors."