The Obamacare Decision: Reflections on the One Year Anniversary of the Supreme Court Ruling

• On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, more commonly known as Obamacare. This law, along with the Health Care and Education Reconciliation Act, represents the most significant government expansion and regulatory overall of the U.S. healthcare system since Medicare and Medicaid were passed in 1965. This law is momentous because it addresses two large issues: health insurance for all and Medicaid expansion in each state. The constitutionality of this law is the cause of much debate, however, even though Friday, June 28, 2013 marked the one year anniversary of the United States Supreme Court's ruling that it was, in part, constitutional. So what was ruled constitutional and what wasn't?

• The Act's first directive is that each individual must purchase health insurance from a private company. Those who do not comply with this mandate are forced to make a "shared responsibility payment," a fine of $95 or 1 percent of their yearly income, to the federal government through the Internal Revenue Service with the individual's taxes. The Supreme Court ruled that the mandate is more of a "choice" and the penalty is considered a "tax." Thus, if the tax is unpaid, it will be viewed in the same manner as tax penalties. Because of these terms, it was deemed constitutional. 

• The second issue addressed in Obamacare is the expansion of Medicaid, the state administered albeit federal program that provides comprehensive inpatient and outpatient health coverage for low-income individuals and families. According to the Supreme Court's ruling, the Affordable Care Act expands the scope of the Medicaid program and increases the number of individuals the states must cover, along with an increase of federal funding to cover the expansion costs for the states. According to the law, if a state does not comply, it may lose not only the federal funding for those requirements, but all of its federal Medicaid funds. The Supreme Court found this to be unconstitutional and ruled that states may now choose to expand their Medicaid program for additional federal funding or choose not to expand its Medicaid program while still maintaining their current federal funds. In essence, the ruling makes the Medicaid expansion voluntary with no federal retribution on the states' decision.

• Both aspects of the law were determined constitutional which is why the law remains unsettled business and an increasing issue with Americans. A new Gallup report stated that the rate of disapproval has shifted from a 45% to a 52% rate of disapproval in the last year and a Fox News poll showed that "58 percent of voters favor repealing all or some of President Obama's signature legislative achievement." But what is the political reaction? The U.S. House of Representatives has voted thirty-seven times to either edit or completely repeal Obamacare, five bills (that were passed by the House) are currently stagnant in a Democratic Senate, and a growing number of states are declining to expand their Medicaid program. The Heritage Foundation, in an article regarding the Supreme Court's ruling on Obamacare, stated that the hands of the States were strengthened, not weakened, by the ruling. This appears to be true as more people realize that the Affordable Care Act is neither affordable, legal, nor what America wants. 

• What can be done? According to Article 1, Section 9, Clause 7 of the Constitution, "No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law," meaning that no appropriations can lawfully be made without the House of Representatives approving them. House Republicans should refuse to appropriate money to fund Obamacare; Obama cannot take money from the Treasury to implement Obamacare without the approval of the House of Representatives. House Republicans could take steps to defund Obamacare should they choose to do so.