The Supreme Court upheld the Affordable Care Act this morning. I’ll post updates all day with local analysis and reaction.
5:04 p.m.: A memo from the Planned Parenthood League of Massachusetts said the law represents “the greatest advance in women’s health in a generation,” requiring coverage of preventive care, such as mammograms and pap tests, without copays and prohibiting the practice (already outlawed in Massachusetts) of charging women higher premiums.
“Expanding preventive care for women allows doctors to detect illnesses early before they get more expensive to treat resulting in a huge cost savings four our country,” said Dr. Paula Johnson, chief of the Division of Women’s Health at Brigham and Women’s Hospital. “Given that chronic illness among women costs our nation’s health care system over $460 billion each year, these cost savings will be substantial. From allowing young women access to health insurance through their parents’ plans to assisting older women with prescription drug affordability by closing the Medicare ‘donut hole,’ the ACA is historic in its ability to provide women with access to comprehensive health care across the lifespan.
Johnson was a member of an Institute of Medicine panel that recommended which preventive services for women should be covered under the law.
4:20 p.m.: John McDonough, a Harvard health policy professor and former director of the consumer group Health Care for All, said the court decision is the latest in a series of major obstacles that advocates of the law have overcome. And they aren’t done yet, he said.
“Anybody who wants to sort of sit back and relax after this should appreciate that there are equally monumental threats ahead,” chief among them being the presidential election, said McDonough, who had a hand in crafting both the federal law and the 2006 Massachusetts law that served as a model.
While the decision was more in his favor than he was expecting, McDonough said it was “not a slam dunk.”
The court said essentially that the federal government may not use the threat of cuts in Medicaid funding as leverage to force states to expand the program.
Jean Sullivan, director of the Center for Health Law and Economics at the University of Massachusetts Medical School expressed a similar concern, said that aspect of the decision undercuts the goal of expanding coverage.
“It puts a big dent in the extent to which the ACA will bring coverage to the poorest of the uninsured,” she said.
But, McDonough said, state leaders would face a political risk if they chose not to participate in the expansion. The federal government would pick up the full cost of new enrollees starting in 2014, declining to 90 percent in 2019.
“If a Republican governor wants to turn down that amount of federal support, that will be enormously beneficial to not just the newly insured low-income people in their state but to the entire health care system of the state, then that’s going to be their right,” McDonough said. “I would predict that, before this decade is out, every state will sign up and participate in this expansion.”
McDonough also noted the significance of Chief Justice John Roberts upholding the law.
“It puts his legacy and his profile in a different place,” he said. “He is simply not one of a gang of five. He has now struck out on a very different path for himself.”
But, McDonough said, “he’s got tenure, so he will have many opportunities in the years ahead to satisfy the conservative base.”
3:40 p.m.: Staff at the Massachusetts Health Connector, the agency which built the state’s online health insurance exchange, gathered in a conference room this morning to watch for news of the court decision. When it broke, Executive Director Glen Shor, said he and others there felt “immense pride.”
“You can understand how people around the room felt that their work had been validated,” he said.
Shor’s office has been working to change the structure of the Connector market to make it compliant with the federal law. The state must offer partial subsidies to a new group of people, those who earn between 300 and 400 percent of the federal poverty level. Others will be moved from the Connector market into Medicaid coverage. And small businesses will be eligible for higher tax credits.
The state also is working to create a website where people can input their personal and financial information and automatically find out whether they qualify for subsidized coverage.
On efforts to control health costs in the state, Shor said, the Legislature and the Patrick administration will continue “full steam ahead.”
“I think the decision is sort of wind in our sails in Massachusetts, but I think we were already quite committed to cost containment,” he said.
3:12 p.m.: The Pioneer Institute, a conservative research and policy group, today called for an alternative to the federal law. Executive Director Jim Stergios said the ruling is “a lose-lose for everyone.”
“The fact that this decision was made, in essence, by a single justice highlights the need for real solutions that can gain broad consensus across the country,” Stergios said in a press release. “The Court’s decision today will set off further state and federal conflicts that will likely end up in the courts once again.”
Joshua Archambault, the group’s director of health care policy, said the law “went too far.”
“There are many unintended consequences when Washington tries to design a policy that meets the very different needs of states as diverse as Massachusetts and, say, New Mexico,” he said.
2:48 p.m.: A statement from Lora Pellegrini, president of the Massachusetts Association of Health Plans:
“MAHP and our member health plans will continue our efforts with state and federal policymakers on implementing the Affordable Care Act in Massachusetts, and we remain committed to working with the governor and members of his administration, the attorney general, and the Legislature on payment reform legislation that creates a more effective health care system and provides meaningful cost savings for Massachusetts employers and working families.”
2:38 p.m.: Dr. Gene Lindsey, chief executive of Atrius Health, said in a press release that, now that the court has ruled, “the focus doesn’t change.”
“The responsibility still rests with the health care system to keep costs down and to figure out how to take the excess costs out of the system,” he said. “This ruling means our job won’t be even harder than we know it already is.”
2:31 p.m.: Here’s more from the Massachusetts Hospital Association:
President Lynn Nicholas said hospitals on balance “are very grateful that the law has been upheld,” even though it means they will receive $5 billion less in Medicare payments than expected between now and 2019. The cuts to the Medicare increases are one way the Accountable Care Act is being funded.
“These cuts are to help pay for the rest of the nation (to cover people). Even so, we still support this because it’s the right thing to do,’’ she said. “But it means our commitment to reduce the cost of care becomes even more of an imperative.’’
At the same time, the state’s hospitals are hoping to recoup some of those losses with increased Medicaid payments, which will become a major lobbying effort by the industry. The federal laws will send the state an additional $400 million yearly to cover expansion of the Medicaid program.
“Our position is that we need to make sure those funds are spent on improving Medicaid rates,’’ Nicholas said.
-- Liz Kowalczyk, Globe staff
2:22 p.m.: U.S. Senate candidate Elizabeth Warren said in a press release that the court’s decision “ensures that millions of children, seniors, and families will continue to benefit from health care reform.”
“Now is not the time to refight the battles of two years ago,” she said. “Our country needs to move forward to create jobs and opportunity for all Americans—not fight endless political battles. Massachusetts led the way in health reform, and we will continue to lead the way in our efforts to reduce the costs of health care and ensure a level playing field for middle class families.”
1:58 p.m.: M.I.T. economics professor Jonathan Gruber, who was a key consultant for former governor Mitt Romney during the crafting of Massachusetts’ landmark 2006 health care law, said he is feeling relief in the wake of the Supreme Court ruling.
“I feel proud, but I think I feel more relieved because I don’t think we should have been in this situation in the first place,” Gruber said.
Using an analogy from his 15-year-old son, Jack, Gruber said he was surprised so many people seemed amazed that the justices upheld the health care law.
“It’s like your baseball team blows a lead in the 9th but comes back and wins in the 12th,” Gruber said. “And all of a sudden people are amazed.”
Gruber, who has been a paid consultant of the Obama administration on the federal law, also took a shot at Romney, who has tried to distance himself from the Massachusetts law during his presidential campaign.
“Romney doesn’t believe in this law, despite the fact that it’s his law, he suddenly doesn’t believe in it at the national level,” Gruber said. “We’ve still got to face the election and then if the election goes the right way, and President Obama wins, I think the law will be as successful as it has been here in Massachusetts.”
Still, Gruber said, the federal law will likely hit some rocky roads ahead, particularly with controlling health care costs – something Massachusetts is still wrestling with. Gruber sits on the Connector board, which implements Massachusetts’ health care law and runs its exchange, the marketplace for people to shop and buy insurance.
“Health care is a huge problem that we are going to struggle with this for the future of our country,” Gruber said. “Did we solve it? No. But what you do is to step forward and keep moving. You don’t keep the baby penned up until it can run. You crawl and then you walk and then you run.
“As a society we need to keep at this problem.”
-- Kay Lazar, Globe staff
1:45 p.m.: Senator Scott Brown, who has repeatedly voted to repeal the Affordable Care Act, sent this statement:
“The federal health care law may be constitutional, but it is wrong for jobs and the economy. In Massachusetts, we had already dealt responsibly with the problem of our uninsured without raising taxes or cutting care to our seniors. All we got out of this massive new federal entitlement is higher taxes, cuts in Medicare and additional debt at a time when we can least afford it. The bottom line for me is this law makes it harder for our economy to add jobs and for that reason I continue to oppose it.”
1:40 p.m.: Globe reporter Brian Ballou was at the governor’s press conference.
“Congress acted in 2009 for the same reasons our Legislature and Governor Romney acted in 2006, because health is a public good, and everyone deserves access to it,” Patrick said.
1:30 p.m.: The reaction from the business community has been somewhat mixed.
James Roosevelt Jr., chief executive of Tufts Health Plan in Watertown said the decision “provides certainty for insurers and businesses, and establishes the principle that we’re already comfortable with in Massachusetts: that of consumer protection and everyone paying their fair share.”
“For insurers nationally, this provides clarity but it means they will be moving forward with a lot of change,” Roosevelt said, to Globe reporter Robert Weisman.
George Scangos, chief executive of Weston biotechnology company Biogen Idec Inc., said a “data exclusivity” provision giving biotechs 12 years of protection before other companies can introduce generic versions of their drugs “strikes a nice balance between giving companies incentives to develop new drugs and getting biosimilars onto the market that can provide similar benefits at lower costs.” But another provision creating an independent payment advisory board charged with keeping the rate of health care cost increases below a target “may be well-meaning, but it’s ill-conceived and will have unintended consequences.”
“There are aspects of the law that got it right, and there are aspects that need work,” he said. “We want a set of policies that enable us to do what we came to Biogen, and to biotech, to do: develop innovative drugs.”
The bottom line, said Bill George, professor at Havard Business School and former chief executive of medical device company Medtronic Inc., is that the Affordable Care Act is “the law of the land.”
“We’ve had three and a half years of politics,” George told Weisman. “I believe it’s time to get on and make this health care law work. The only way to make it work is to go upstream and make Americans healthy. We have to work on fitness, we have to work on diet. Employers need to take responsibility and give their employees financial incentives to be healthy. The only way for the United States to be competitive is to reduce the rate of health care cost increases.”
1:20 p.m: Governor Deval Patrick said during a press conference this afternoon that the court’s decision is “a victory for the proper role of government and a victory for our system of constitutional checks and balances.”
“It’s a victory for the American people because it sustains a law that gives families security, holds insurers accountable, and helps Americans get the care they need,” he said. “Thirty million Americans without health care will now have it. Over 5 million people on Medicare save more than $3.7 billion on their medications. Over 3 million young adults get coverage through their parents’ health plans.”
More who were previously blocked from coverage because of pre-existing conditions will get it, he said.
1:15 p.m.: The Greater Boston Tea Party said in a press release that the group is “extremely disappointed” in the court’s decision. The law is an “egregious affront to liberty,” the group said.
“We will redouble our efforts to educate and inform political activists of the threat to individual liberty this policy represents,” said President Christine Morabito. “We were told repeatedly this is not a tax. We expect Congress to act immediately to block seizing funds from American citizens to pay for a political whim.”
1:10 p.m.: Veronica Turner, executive vice president of 1199SEIU, the largest union representing health care workers in the state, said expanding insurance coverage saves lives.
“Our mission as healthcare workers is to ensure quality, affordable access to healthcare for our patients and today is a significant step forward towards that goal and vision,” Turner said in a press release.
1:05 p.m.: Amy Whitcomb Slemmer, executive director of Health Care for All, a Boston-based consumer group that lobbied in favor of Massachusetts’ landmark 2006 health law, said thousands more Massachusetts residents will be able to afford health insurance.
The Massachusetts law, on which the federal law is modeled, extended subsidized insurance to people making up to three times the federal poverty level, or $33,500 for an individual this year. Under the federal law, that will be extended in 2014 to those earning up to four times the poverty level, or $44,680.
“These are folks who are trying to maintain their health care coverage and have been affected by the economic downturn, and are struggling to meet their monthly bills,” said Slemmer, whose organization runs a hotline to help connect consumers with health insurance.
Slemmer said today’s Supreme Court decision means Massachusetts and the rest of the country can focus on the next big hurdle in health care --- containing the soaring costs. Massachusetts lawmakers are now considering legislation to tackle that issue.
“The next frontier is addressing the cost of health care,” Slemmer said. “We look forward to helping other states who are looking for our expertise in implementing the law and with costs.”
-- Kay Lazar, Globe staff
1:00 p.m.: The Massachusetts Hospital Association e-mailed a statement saying the group applauds the decision:
“Since 2006, Massachusetts has led the nation to implement groundbreaking healthcare reforms – first with a successful universal coverage law and then subsequent steps to increase transparency and enhance the quality and affordability of care provided to all. With these deep roots and a firm belief in the benefits of reform, Bay State hospitals have supported the Patient Protection and Affordable Care Act since its inception for one simple reason – it is the right thing to do for Massachusetts and the nation.”
12:52 p.m.: Sen. Richard Moore, who was involved in drafting the 2006 law and is leading the Senate’s efforts on cost containment, said the ruling gives a boost to efforts to pass legislation to control health care costs. “There was a big ‘if’ hanging over the discussions on cost containment,” he said. “This adds a degree of certainty. And it certainly helps us financially because the federal law will pick up some folks we are now covering (as part of Medicaid.) That’s a big help.”
-- Liz Kowalczyk, Globe staff
12:40 p.m.: Robert Huckman, professor of business administration and faculty co-chair in the Healthcare Initiative at Harvard Business School, said he does not see the court’s decision as clear vindication for the policy laid out in Massachusetts.
“Ultimately, what’s going to need to happen is the state is going to have to show what happens to outcomes and costs over the longterm,” he told Globe reporter Liz Kowalczyk. “That would be the ultimate vindication for the model, to show it can reduce costs or improve quality and do those in a combination.”
12:33 p.m.: Massachusetts Senator Edward M. Kennedy once called health care “the cause of my life.” He died before the Affordable Care Act was passed.
A statement from his widow, Vicki Kennedy: “I applaud the decision by the United States Supreme Court this morning, upholding the constitutionality of the Affordable Care Act. We still have much work to do to implement the law, and I hope we can all come together now to complete that work. The stakes are too high for us to do otherwise. As my late husband Senator Edward Kennedy said: ‘What we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.’ ”
Poltico reports that House Minority Leader Nancy Pelosi called Vicki Kennedy after the decision was released and told her, “Now, Teddy can rest.”
12:20 p.m.: Dr. Stephen Boswell, chief executive of Fenway Health said the law, and the court’s decision, is important for people living with HIV/AIDS and for people who are lesbian, gay, bisexual, or transgender.
“The Affordable Care Act provides the LGBT community in parts of the country that don’t recognize same-sex relationships with more affordable insurance options and provides support for preventative care and HIV testing, treatment and prevention services,” Boswell said in an e-mailed statement. “It also prohibits insurance companies from canceling coverage for pre-existing medical conditions, including for people living with HIV. The Affordable Care Act also provides resources to expand community-based care to help meet our country’s growing healthcare needs and to provide more access to primary care providers in the hopes of keeping people healthier and cutting down on expensive emergency room visits and hospitalizations.”
12:06 p.m.: More than 62,000 seniors and people with disabilities in Massachusetts will continue to see significant savings on their prescription drugs because the law was upheld.
A provision in the law helps people on Medicare with the costs of their prescription drugs when they reach the so-called “donut hole” coverage gap.
The donut hole refers to a gap in prescription drug coverage through the Medicare Part D program. That gap kicks in when a Medicare beneficiary this year reaches $2,930 in prescription drug costs. The gap ends when a person’s total out-of-pocket costs reach $4,700.
Among those who have been helped is Pat Liberti, a 62-year-old disabled former nurse who takes 18 daily medications for heart disease, diabetes and a constellation of other health problems. A 60-day supply of just one of her heart medications costs $400, and the law eased that by covering half of the price.
The Salem resident said that if the law had been overturned, she and her husband would have faced some tough choices.
“We might have had to sell our home to use the equity in that,” Liberti said.
As it is, Liberti said, most of her monthly Social Security check goes to paying for medications.
Massachusetts seniors and those with disabilities who are covered by Medicare have saved, on average, $648 so far this year, according to the Obama administration. Since 2010, the savings in Massachusetts have totaled more than $64.2 million on prescription drugs bought by people who had reached the donut hole gap, the administration said.
-- Kay Lazar, Globe staff
11:57 a.m.: Robert Friel, chief executive of life sciences tool manufacturer PerkinElmer in Waltham, said the court decision provides certainty for the business community.
Friel told Globe reporter Robert Weisman that a medical device tax that will help pay for the law will cost his company about $5 million a year, a relatively small sum.
“For some (other) medical device companies, the tax is going to put pressure on their costs, and they might have to cut back on R&D,” he said. “So it could have the potential to impact innovation negatively.”
Among those more affected is Abiomed Inc., a maker of heart pumps and artificial hearts in Danvers. Chief Executive Michael R. Minogue said the tax will cost the industry $29 billion over 10 years.
“The device tax in our mind is really not part of health care reform,” he told Weisman. “It’s a policy decision, and we think it’s bad policy because it’s going to have a negative impact on jobs. It’s about 15 percent of our research budget. It’s about 10 percent of our heads. We are not going to add as many jobs as quickly as we would have, and we’re not going to be able to fund research and development as quickly as we would have.”
11:55 a.m.: A statement from Senator John Kerry: “This is an important day for the Supreme Court and an important day for Americans who need affordable health care coverage. But I hope this will also be an important day for our politics and our discourse. For the past three years, opponents of health reform did everything they could to distort and deceive. They tried to scare the American public with outright lies about ‘death panels’ and ‘socialized medicine.’ When that didn’t work, they came up with a new strategy: claim that the individual mandate the Republican Party itself had invented was unconstitutional. Today, the conservative Roberts Court put an end to that debate. Those who have sought to demonize health reform need to put an end to their scare tactics. This needs to begin a new day, where the test is not what you can oppose but what you can propose. Enough time has been wasted in the United States Congress on pointless repeal votes designed to score political points. Too much time has been wasted on a legislative temper tantrum. We need to get back to the business of implementing a constitutional law that will lower health care costs for everyone and give 33 million Americans the health coverage they deserve.”
11:40 a.m.: Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts, called the decision “an extraordinary moment.”
“There’s a sense of vindication today,” he told Globe reporter Robert Weisman. “To us, this validates all the work we did here in Massachusetts over decades to expand health care to all citizens. So now all Americans will have the same health care protection and benefits that Massachusetts citizens have had for years.”
11:35 a.m.: Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center and a leader in health information technology, said in an e-mail that overhauling health care as outlined by the Affordable Care Act requires universal adoption of electronic health records, sharing of information between organization, and advancements in tools to analyze data to improve quality and track costs.
The court’s decision “ensures that these components will still have urgency, since every provider organization will be motivated to implement them in order thrive in the healthcare marketplace of the future,” he wrote.
11:23 a.m.: John McDonough, director of the Center for Public Health Leadership at Harvard School of Public Health who had a hand in drafting the Affordable Care Act, has posted his early reaction on the Health Stew blog. He was “prepared for the worst,” he said.
11:05 a.m.: It seems the big story is Chief Justice Roberts. How did he come to this decision? How will history read this opinion?
From the SCOTUSblog: “Amy Howe: Yes, a commenter notes that the Chief Justice’s opinion starts with a mini-civics lesson -- definitely an awareness that this is one for the ages. Reminded me of his opinion in Snyder v. Phelps, the funeral protesters’ case last Term.”
10:56 a.m.: The state’s network of more than 280 community health center sites, which already received more than $80 million for expansion of operations and construction, stood to lose millions more if the law was struck down. At least 12 Massachusetts health centers had put together applications, counting on the federal funding, to start new health center sites in areas of the state that lack adequate primary care access.
And 46 new clinicians had been hired for the centers, paid for by money from the new law. They were hired under the provision know as the National Health Service Corps, a program of loan repayment for clinicians who choose to work in medically underserved communities.
James W. Hunt, Jr., president of the Massachusetts League of Community Health Centers, said the ruling is a “big sigh of relief.”
“All Americans will have all the opportunity to have what we have in Massachusetts,” he said. “Health centers will grow. Primary care will grow. People will get the right care in the right place and at the right price.”
The state’s community health centers currently serve one out of every eight residents.
-- Kay Lazar, Globe staff
10:53 a.m.: Mayor Thomas M. Menino, in an e-mailed statement, celebrated the decision:
“This legislation, like the law we passed in Massachusetts, will extend coverage to millions of uninsured Americans, level the playing field between consumers and insurance companies and help us to contain runaway healthcare spending. I am pleased that the benefits we have enjoyed since the law passed remain on firm legal footing and that the Obama Administration is able to continue with implementation of this groundbreaking legislation.”
10:49 a.m.: Dr. Richard Aghababian, president of the Massachusetts Medical Society, in an e-mailed statement, said insurance coverage increases the likelihood that people will get the care they need:
“That’s why is we are so pleased that the ACA was upheld. Universal coverage is a state-federal partnership – no state can do this on its own. We’ve accomplished a great deal since 2006 – and there’s still a lot of work to do. Affordability is still a big challenge. We promise to work with the Governor, legislators, and the leaders of the health care community to ensure that the noble vision of our health reform law is fulfilled for many years to come.”
10:42 a.m.: Here’s a link to the Supreme Court decision. In the summary, called the syllabus:
“CHIEF JUSTICE ROBERTS delivered the opinion of the Court with respect to Part III–C, concluding that the individual mandate may be upheld as within Congress’s power under the Taxing Clause.”
10:40 a.m.: Globe reporter Tracy Jan has an early story on the Supreme Court’s decision, calling it a victory for the Obama administration. She writes:
The ruling reaffirms the most ambitious and controversial undertaking of Obama’s first term: attempting to guarantee that most of the 45 million Americans without insurance will get better access to medical care.
By maintaining the status quo, the Supreme Court has given Republicans in Congress a fresh rallying point, as they have vowed to continue their fight to legislatively repeal the sweeping law. But with the conservative-leaning court affirming the government’s power to intervene aggressively in the national healthcare market, the GOP faces a difficult path.
Obama and his Democratic allies have said they will continue seeking to persuade voters of the virtues of the law during the election season, including popular provisions that bar insurance companies from denying coverage for pre-existing conditions and that require insurers to cover children in family plans until they are 26 years old. The law also includes a massive expansion of the federal Medicaid program, which is expected to add 17 million new people to government-sponsored coverage by 2016, also remains intact.
10:31 a.m.: The decision to uphold was 5-4. SCOTUSblog is reporting that dissenters would have invalidated the entire law.
10:15 a.m.: SCOTUSblog is reporting that Chief Justice Roberts joined the left of the court. Here’s this, from Tom Goldstein on the blog: “The bottom line: the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.”
10:09 a.m.: First word on Twitter was that mandate was struck down. SCOTUSblog is reporting that the mandate survives as a tax.
10:00 a.m.: Feeling anxious?
9:52 a.m.: The Globe’s Bobby Caina Calvan is at the Supreme Court and describes the scene on Political Intelligence. He writes:
Karen Higgins, a nurse at Boston Medical Center’s intensive care unit, took an early flight to join Washington area nurses to weigh in. “It was important for me to be here,” said Higgins, a co-president of National Nurses United.
“No matter what the justices do, it will open the door for more discussion in this country.”
9:45 a.m.: Massachusetts is in a unique position today. In some ways it shares part of the spotlight on the Affordable Care Act. The state’s 2006 health care law, signed by Governor Mitt Romney, served as a model for the national law. But, because of that state law and others, a decision to overturn the Affordable Care Act would mean fewer changes for people in Massachusetts than in other states.
The mandate requiring most people in Massachusetts to have health insurance would stand. About 98 percent of people in the state have coverage. The question before the court is, in part, whether the federal government can require people to purchase a product. The ability of states to do so was not in dispute.
State law already protects coverage of people with pre-existing conditions, requires insurers to use a large majority of premium dollars for actual medical expenses and cover some young adults. But many of those state provisions do not apply to people who get their insurance from large employers who are self-insured. The federal law extends such coverage requirements to them, as well.
Aside from the direct impacts on consumers, there are hundreds of millions of dollars in new federal funding at stake for Massachusetts.
9:20 a.m.: Governor Deval Patrick said during a regular radio appearance this morning that it would be a “tragedy” for the country if the court overturns the law, but Massachusetts would continue its efforts at overhauling health care. “Millions and millions of people” in the United States could lose their health coverage if the law goes down, he said on WTKK-FM. See more from Globe reporter Michael Levenson on the Political Intelligence blog.