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The latest news on Obamacare from Business Insider

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    Carter Phillips

    It's impossible to predict how the famously leak-proof Supreme Court will rule on any case, but that doesn't stop court-watchers from speculating on the biggest cases of the day.

    With less than a week left in its current session, the Supreme Court still has to rule on two major cases. One will determine whether same-sex marriage bans are constitutional, and the other will determine the fate of a key provision of the Affordable Care Act, colloquially known as Obamacare.

    We reached out to Carter Phillips, a partner at Sidley Austin, to get his insights on how the court might rule. Carter has argued 80 cases before the high court — more than any other lawyer in private practice, according to his firm bio

    "If my experience could help me predict accurately where the Court will come down, then I would get out of practice and go make some real money," Phillips joked in an email. "But I will tell you what I think will happen."

    supreme court justicesPhillips predicted a win for gay marriage supporters and a toss-up on Obamacare.

    The first case he commented on centers on the constitutionality of same-sex marriage bans in Kentucky, Michigan, Ohio, and Tennessee, and it will consider these two questions:

    1) Does the Fourteenth Amendment require a state to license a marriage between two people of the same sex?

    2) Does the Fourteenth Amendment require a state to recognize a marriage between two people of the same sex when their marriage was lawfully licensed and performed out of state?

    Phillips said he thinks the court will strike down same-sex marriage bans, and he believes conservative justices may end up joining that majority decision.

    "I think it could be more than 5-4 because I think the justices will figure out the way the winds of history are blowing and will not be keen on seeing their individual legacies tarnished by having hopelessly attempted to block the protection of rights," Phillips wrote, "and I think the conservatives who go that way will say there is something unique about marriage and the need to protect an individual's legitimate desire to have the stability and benefit of those bonds." 

    Gay marriage lesbian coupleThe other case he commented on, King v. Burwell, centers on whether the US government can keep subsidizing insurance in the roughly three dozen states that have not set up their own insurance marketplaces.

    The health law laid out a plan in which states set up their own exchanges but said the federal government could step in and set up the exchanges for the states if they could not do it on their own.

    Opponents of the law point to a part of the statute that they say suggests people can't receive subsidies unless the state set up their insurance marketplace. That part of the law says that subsidies should be issued to plans through an exchange "established by the state."

    If the Supreme Court sides with the law's challengers, millions of people will lose their health insurance because the federal government will no longer be able to subsidize it.

    obamacareIn his email to Business Insider, Phillips said he seemed troubled by the fact that President Barack Obama has publicly defended his signature healthcare law while the decision on its fate is still pending.

    "If I thought I were about to win an important case, I would say nothing for fear of tipping the scales. But if someone at the Court leaked the outcome to the White House, then I might very well do whatever I could to create as much political pressure as I could to convince a fifth vote to take the pragmatic approach rather than the ideological one," Phillips wrote. "But that assumes the President is being calculating based on inside information here rather than merely speaking off the cuff."

    Carter added, "I don't like conspiracy theories."

    Despite Obama's comments, Phillips said the oral arguments suggested one of the court's conservative justices — Chief Justice John Roberts or Justice Anthony Kennedy — might be swayed to save Obamacare.

    "The four liberals were very aggressive at the oral argument and only three of the conservatives were," Phillips said. "So if Obama could pick off either the Chief or Kennedy, he would win." 

    SEE ALSO: This comment from Justice Kennedy could signal the fate of Obamacare

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    obama smile happy

    The uninsured rate in the US declined by nearly one-fifth with the Affordable Care Act implemented for a full year, according to data released Tuesday by the Centers for Disease Control and Prevention.

    The CDC's National Health Interview Survey, considered the most reliable government estimate of the country's uninsured population, found the uninsured rate for adults under the age of 65 dipped from 20.4% in 2013 to 16.3% in 2014. Americans could start buying insurance through marketplaces set up by the Affordable Care Act beginning in October 2013.

    It's the largest one-year drop in uninsured since the CDC began conducting the National Health Interview Survey in 1997. And it confirms other private studies that have suggested the law is succeeding at its central goal of insuring more Americans. Gallup, for example, found the uninsured rate plummeting to its lowest level ever tracked in the first quarter of 2015.

    The survey comes just days before the Supreme Court is set to rule in the caseKing v. Burwell. If the court decides to strike down a key provision of the law that allows the federal government to provide subsidies for about 6.4 million low-income people to buy insurance, experts predict a large chunk of those people would no longer be able to afford coverage.

    Here's a chart from the CDC study that shows the sharp drop:

    Screen Shot 2015 06 23 at 4.53.33 PM

    Obamacare's effects were more pronounced in states that had adopted the expansion of the federal Medicaid program. States that expanded Medicaid saw more than a 5% drop in its uninsured population (from 18.4% to 13.3%). Those that did not expand the program experienced a decline from about 22.7% to 19.6%. 

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    Marijuana pot woman joint Colorado blunt

    CHICAGO (AP) — Medical marijuana has not been proven to work for many illnesses that state laws have approved it for, according to the first comprehensive analysis of research on its potential benefits.

    The strongest evidence is for chronic pain and for muscle stiffness in multiple sclerosis, according to the review, which evaluated 79 studies involving more than 6,000 patients.

    Evidence was weak for many other conditions, including anxiety, sleep disorders, and Tourette's syndrome and the authors recommend more research.

    The analysis is among several medical marijuana articles published Tuesday in the Journal of the American Medical Association. They include a small study suggesting that many brand labels for edible marijuana products list inaccurate amounts of active ingredients. More than half of brands tested had much lower amounts than labeled, meaning users might get no effect.

    Highlights from the journal:

    The analysis

    The researchers pooled results from studies that tested marijuana against placebos, usual care or no treatment. That's the most rigorous kind of research but many studies found no conclusive evidence of any benefit. Side effects were common and included dizziness, dry mouth and sleepiness. A less extensive research review in the journal found similar results.

    It's possible medical marijuana could have widespread benefits, but strong evidence from high-quality studies is lacking, authors of both articles say.

    "It's not a wonder drug but it certainly has some potential," said Dr. Robert Wolff, a co-author and researcher with Kleijnen Systematic Reviews Ltd., a research company in York, England.

    marijuana

    Edible products

    Researchers evaluated 47 brands of medical marijuana products, including candy, baked goods and drinks, bought at dispensaries in Los Angeles, San Francisco and Seattle.

    Independent laboratory testing for THC, marijuana's leading active ingredient, found accurate amounts listed on labels for just 13 of 75 products. Almost 1 in 4 had higher amounts than labeled, which could cause ill effects. Most had lower-than-listed amounts. There were similar findings for another active ingredient. Products were not identified by name.

    Johns Hopkins University researcher Ryan Vandrey, the lead author, said he was surprised so many labels were inaccurate. The researchers note, however, that the results may not be the same in other locations

     

    Marijuana laws

    Twenty-three states and Washington, D.C. have laws permitting medical marijuana use. Approved conditions vary but include Alzheimer's disease, epilepsy, glaucoma, kidney disease, lupus and Parkinson's disease.

    An editorial in the journal says approval in many states has been based on poor quality studies, patients' testimonials or other nonscientific evidence.

    Marijuana is illegal under federal law and some scientists say research has been stymied by government hurdles including a declaration that marijuana is a controlled substance with no accepted medical use.

    But in a notice published Tuesday in the Federal Register, the Department of Health and Human Services made it a little easier for privately funded medical marijuana research to get approved. The department said that a federal Public Health Service review of research proposals is no longer necessary because it duplicates a required review by the Food and Drug Administration.

    marijuana colorado

    The future

    Colorado, one of a few states where recreational marijuana use is legal, has pledged more than $8 million in state funds for several studies on the drug's potential medical benefits, including whether it can reduce veterans' symptoms of post-traumatic stress disorder. That study may begin recruiting participants later this year, said Vandrey, one of that study's leaders.

    Vandrey said there's a feeling of optimism in the research community that "we'll start to get a good science base" for the potential medical uses of marijuana. 

    The recommendations

    The editorial by two Yale University psychiatrists suggests enthusiasm for medical marijuana has outpaced rigorous research and says widespread use should wait for better evidence. Federal and state governments should support and encourage such research, the editorial says.

    "Perhaps it is time to place the horse back in front of the cart," Drs. Deepak Cyril D'Souza and Mohini Ranganathan wrote in the editorial.

    They note that repeated recreational marijuana use can be addictive and say unanswered questions include what are the long-term health effects of medical marijuana use and whether its use is justified in children whose developing brains may be more vulnerable to its effects.

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    medicare doctor old woman patient

    WASHINGTON (AP) — The House voted Tuesday to kill a federal panel that is supposed to find ways to curb Medicare spending, as Republicans ignored a veto threat and leveled their latest blow at President Barack Obama's health care overhaul.

    Members of the Independent Payment Advisory Board have never been appointed, and the panel has never recommended savings from Medicare, the $600-billion-a-year health care program for the elderly.

    Republicans have long targeted the board anyway, saying it would ration care and has too much power. When the health care law began working its way through Congress in 2009, defeated GOP vice presidential candidate Sarah Palin said the law would create "death panels" that could decide the care seniors would receive.

    Democrats argue that the statute specifically forbids the board from rationing care, increasing recipients' premiums or reducing their coverage. That means its recommendations would fall largely on providers, such as doctors and nursing homes.

    The White House has threatened to veto the bill, saying repeal would eliminate a way to "help reduce the rate of Medicare growth responsibly."

    Tuesday's vote was a mostly party-line 244-154. The Senate has yet to consider similar legislation.

    Most Democrats consider the Republican repeal effort an attempt to weaken the health care law.

    Some Democrats agree that the board is too powerful, since its recommended savings automatically take effect unless Congress votes to change or block them.

    obamacare protest supreme court

    But much Democratic support for repealing the board evaporated when Republicans decided to pay the $7 billion, 10-year cost of eliminating it by cutting $8 billion from the health care law's prevention and public health fund, which the GOP says wastes money. Democrats call the prevention program a valuable part of that law.

    The board can only propose savings when the rate of Medicare spending growth hits specified levels that haven't been reached — and are not expected to be reached — for years.

    Last week, the House voted to repeal another piece of the health care law taxing many medical devices.

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    Senate Minority Leader Harry Reid (D-NV) (C) listens to questions from the media after their party's caucus luncheons on Capitol Hill in Washington June 23, 2015.    REUTERS/Gary Cameron

    WASHINGTON (Reuters) - Democrats were prepared to quickly come up with a legislative solution should the U.S. Supreme Court rule in the next few days to invalidate a central part of President Barack Obama's signature healthcare law, party leaders in the Senate said on Tuesday.

    The high court is expected to rule by the end of June in a case that challenges tax subsidies that are helping millions of Americans afford health insurance premiums under the 2010 Affordable Care Act, known as Obamacare.

    The plaintiffs in the case argue that the law's language restricts these subsidies to states that have established their own health insurance exchanges under the law.

    A ruling in the plaintiffs' favor could mean that 6.4 million low- and middle-income Americans in the 34 states that use the federal health insurance exchange will lose their tax subsidies and possibly their insurance.

    "The Supreme Court, I'm hopeful and confident, will rule the right way. If they don't, we're ready to move on it quickly," Senate Democratic Leader Harry Reid told reporters.

    Reid did not elaborate. But No. 2 Senate Democrat Dick Durbin said that if the administration loses the case, Democrats would offer a short piece of legislation clearly saying the tax subsidies are also available to people on the federal exchange.

    "It's one sentence and it's already been written," Durbin said in a Capitol hallway. "I hope we don't need it," Durbin added.

    Democrats generally have been reluctant to talk about the possibility that the administration might lose the case.

    "Leader Pelosi is confident that the court will not act to kick more than six million Americans off their health insurance," Drew Hamill, spokesman for House Democratic Leader Nancy Pelosi, said Tuesday.

    Leading Republicans, who have opposed Obamacare from its inception, say they will have a legislative plan of action if the court throws out the subsidies. But they have not provided many specifics, saying they will do so after the court rules.

    In both the House and Senate, some Republicans say they would favor extending the subsidies for up to two years while working on other changes to the law. Those changes could include letting states opt out of Obamacare to set up their own insurance systems.

    (Editing by Kevin Drawbaugh and Grant McCool)

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    RTX1GXWV

    Any day now, the Supreme Court is set to hand down a decision in King v. Burwell, a case that centers on a key provision of the Affordable Care Act that helps provide subsidies to millions of low-income people.

    It's the third major Obamacare-related case before the court in the past four terms. But if the high court rules against the Obama administration in the coming days, it could potentially deliver a much more fatal blow to President Barack Obama's signature healthcare law than it could have with previous cases.

    "If the court sides with the challengers, chaos ensues, not only in insurance markets but in the political realm as well. The law could survive, but in a very weakened form," Larry Levitt, a senior vice president at the Kaiser Family Foundation, told Business Insider.

    Last year, the court ruled against the administration in a case involving a relatively small provision of the law — its contraception mandate. The court ruled that family-owned corporations shouldn't have to pay for insurance that covers birth control.

    In 2012, the court somewhat surprisingly sided with the administration, when it upheld the heart of the law — its mandate that individuals buy health insurance or pay a penalty.

    But there's a key difference between this case and the 2012 version: Most of the law has been fully implemented for almost two years, and a decision against the government could have real effects.

    A decision in favor of the challengers in the case could, depending on your viewpoint, take away health insurance from millions of people or free them from government-subsidized insurance to potentially more affordable options.

    What's not debatable is that more than 6 million people could have their lives thrown into chaos because of a disruption in their health insurance. The key question in the case centers on whether the government can keep providing subsidies to help low-income people through the federal insurance marketplace.

    obamacare map

    The challengers argue the way the law was written does not allow for subsidized insurance in states where the federal government had set up insurance exchanges. Instead, the challengers argue, insurance subsidies are allowed only in states that have set up their own exchanges. They point to a clause that reads exchanges should be "established by the state," but members of Congress who were involved in writing the law have disputed this characterization. Thirty-four states currently rely on the federal marketplace.

    A win for the challengers could lead to significant ramifications, and it would become a dominant theme on the 2016 campaign trail.

    Michael Cannon, the Cato Institute's director of health policy and a key architect of the current challenge before the court, told Business Insider it could be an opportunity for Republicans to provide Obamacare with something of a death knell if they can propose a new law that would further unravel the president's signature healthcare law.

    Rep. Paul Gosar (R-Arizona) has introduced legislation that would exempt plans in states affected by the King v. Burwell ruling from some regulations imposed by the Affordable Care Act. Cannon noted that the legislation could offer Republicans a vehicle to offer temporary relief to those affected by subsidy cancellations without expanding the law.

    "Republicans should realize that they would not need to expand Obamacare to solve the problem," Cannon said.

    Others, like Levitt, say the response to a potential win for the challengers would depend on several factors — chief among them being how those affected and the general public respond to the likely swift loss of subsidies. It would be crucial to find a way to pay for insurance before people started getting rid of their coverage. 

    "Like Humpty Dumpty, the individual insurance market would be hard to put back together if people lose subsidies and start dropping coverage," he said.

    Correction (2:22 p.m. ET): An earlier version of this post said that Michael Cannon "favors" legislation proposed by Rep. Paul Gosar. He did not take a position on the legislation.

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    Elena Kagan

    The Supreme Court is expected to issue a decision any day now in a case that could severely damage healthcare reform in America, in a challenge that famously focuses on four words in the law.

    During oral arguments in March, Justice Elena Kagan asked a clever question, which drew laughter, in an apparent attempt to explain why four words in one section of the law shouldn't be read literally.

    The case will determine whether the US can keep subsidizing health insurance for people in the roughly three dozen states where insurance exchanges are run by the federal government.

    One part of the law specifically says the federal government can establish insurance exchanges on behalf of the state, but another section says people buying insurance through exchanges "established by the state" get subsidies. The law's opponents contend this means that those buying insurance through exchanges set up by the federal government don't get subsidies.

    Kagan's question, however, seemed to suggest those four words should be read in context of the entire law, which clearly aims to provide insurance subsidies for people who need them. From the transcript:

    So I have three clerks, Mr. Carvin [the lawyer for the challengers]. Their names are Will and Elizabeth and Amanda. Okay? So my first clerk, I say, Will, I'd like you to write me a memo. And I say, Elizabeth, I want you to edit Will's memo once he's done. And then I say, Amanda, listen, if Will is too busy to write the memo, I want you to write such memo.

    Now, my question is:  If Will is too busy to write the memo and Amanda has to write such memo, should Elizabeth edit the memo? [Laughter]

    Kagan's question seems to imply the answer is yes, Elizabeth should edit the memo.

    ObamacareHere's Kagan's point: The ACA asked states (in her example, her clerk Will) to set up health exchanges that would get federal subsidies ("edits" by Elizabeth the clerk).

    But the law also specified that the federal government (equivalent to Amanda) could step in and set up the marketplaces if the states couldn't. Those marketplaces still need the subsidies to operate in the same way the memo needed Elizabeth's edits.

    Kagan was not the only justice who had tough questions for the lawyer opposing Obamacare. Justice Anthony Kennedy, a key swing vote on the court, said during oral arguments he saw a "serious Constitutional" issue with the position taken by the latest opponents of the ACA.

    Here's Kennedy's problem: Under the interpretation put forth by the law's opponents, states will effectively be coerced into setting up their own exchanges if they want their citizens to have insurance.

    "If that's Kennedy's view of the case, there's almost no chance that the challengers can win," UCLA constitutional law professor Adam Winkler told Business Insider.

    A decision in this case is expected as soon as Thursday.

    SEE ALSO: This comment from Justice Kennedy could signal a win for Obamacare

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    Anthony Kennedy

    The Supreme Court is preparing to hand down a decision in the all-important King v. Burwell case, and Justice Anthony Kennedy could again play a key role in deciding the fate of healthcare reform.

    Kennedy made a comment during the case's oral arguments that led some observers to speculate that he was leaning toward siding with the Obama administration in the case, which centers on a key provision of the Affordable Care Act.

    But Michael Cannon, the Cato Institute's director of health policy and a key architect of the current challenge before the court, said that even if Kennedy sides with the administration in this case, it could end up being a long-term loss for the federal government.

    Kennedy, the court's traditional swing voter, said during the case's oral arguments that he saw a "serious constitutional question" with the challengers' interpretation of the Affordable Care Act.

    The case revolves around the question of whether the federal government can hand out subsidies for health insurance in 34 states that have not set up their own insurance marketplaces. The challengers in King v. Burwell point to a part of the law that they say means Americans shouldn't be able to receive subsidies unless individual states have set up marketplaces. The part of the law in question is four words specifying that subsidies should be issued to plans through an exchange "established by the state."

    But Kennedy expressed concern at invalidating that part of the law, for fear it would unfairly coerce states into setting up exchanges at the behest of the federal government. Here's what he told the challengers' lawyer, via the transcript:

    "I fully understand that, but I think the Court and the counsel for both sides should confront the proposition that your argument raises a serious constitutional question. Now, I'm not sure that the government would agree with that, but it is in the background of how we interpret this statute."

    If Kennedy does side with the government on those grounds, it would be a win for the administration in the case. But it could open a new can of worms for a slew of laws that require federal-state cooperation.

    "If Kennedy says the exchange deal is coercive, then he will be signaling — and anyone who signs on to a concurring opinion will be signaling — that they are interested in lowering the bar for proving that a co-operative federal program is unconstitutionally coercive," Cannon told Business Insider.

    "And that means that all sorts of federal/state programs could be vulnerable to be challenged as unconstitutional," he added.

    AP899359620415Some of those programs that he predicts would become newly vulnerable: the Clean Air Act, No Child Left Behind, and more. Some federal gun and immigration laws could also theoretically be challenged.

    That kind of decision could end up benefiting any state that doesn't want to participate in a joint federal program.

    "If that happens, that’s a short-term win for the government but a long-term loss, if states can challenge all kinds of programs as unconstitutional," Cannon said.

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    man in nursing home

    A recent Congressional Budget Office report, "The 2015 Long-Term Budget Outlook," reminds us that the federal government is slowly becoming an agency for taking care of the elderly. Almost everything else is being crowded out.

    We ignored that during the Obama presidency, and now it seems that the fledgling presidential campaign may do likewise. Hillary Clinton and other Democrats plug fairer economic growth. Jeb Bush and other Republicans are more forthcoming (they talk about raising Social Security's eligibility age) but concentrate their rhetoric on creating faster economic growth.

    Government's central reality has gone missing. There's a bipartisan triumph of political expedience over professed beliefs. Liberals shrink many domestic programs, because they won't acknowledge that unchecked spending on the elderly is partially financed by curbing other activities — from food stamps to highway repairs. Conservatives weaken defense, because they won't concede that, even with cuts to domestic spending (including the elderly), an adequate military cannot be financed without additional taxes.

    The irony is that, on paper at least, presidents and other political leaders can regulate the size and role of government through laws and budgets, but their control over the economy is (at most) indirect and incomplete. So what do they do? They make promises on the economy that they cannot easily keep, while dodging unpopular budget decisions that might actually improve government's performance. Both parties tell supporters what they want to hear.

    What encourages the deception is the glacial speed of change. Over long stretches, government is being remade, but in any one year, the shift is tiny and virtually invisible. Look at what has happened since 1990 — and what lies ahead.

    george h.w. bush, oval office, white house

    In 1990, federal spending equaled about 21 percent of the economy, gross domestic product (GDP). Social Security and major health programs (mainly Medicare and Medicaid) represented a little less than one-third of all spending. The rest was defense, domestic "discretionary" programs (homeland security, environment regulation, law enforcement and the like) and non-elderly "entitlements" (unemployment insurance, welfare). In 2015, the federal government is still spending 21 percent of GDP, but now Social Security and major health programs consume about half the budget, according to the CBO report. Most health spending goes to the elderly.

    As the CBO makes clear, an aging population and high health costs will perpetuate this trend for years. Under current law, Social Security and health programs will account for two-thirds of today's budget levels (measured by GDP) by 2040, estimates the CBO. What's left for the rest?

    Not much. The remaining amounts are "the lowest . . . relative to the size of the economy since the 1930s," says the CBO. Either the rest of government will shrink dramatically, or Congress will expand government spending sharply. The latter, of course, would require higher taxes or bigger deficits.

    health care spending

    But budget deficits are not the problem. They are simply the consequences of the problem, which is that the combination of an aging society and expensive health care threatens many vital government functions. Whatever the economic costs of endless deficits — a controversial subject — the political effects seem straightforward. The young are being forced to subsidize the old through higher taxes and reduced public services. Some essential public services, starting with defense, are being sacrificed to avoid antagonizing the elderly.

    The proper response is to spread the pain. Some benefits for the elderly should be cut through higher eligibility ages, lower payments and higher Medicare premiums. Some unneeded government programs (say, farm subsidies) should be ended. And some taxes should be raised. But it's hard to develop a consensus if the nation's leaders won't discuss the choices candidly. The Obama years testify to the futility of that approach. Judging from the evidence so far, the presidential campaign won't much improve matters.

    SEE ALSO: Justice Kennedy could save Obamacare and screw the federal government at the same time

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    obama

    President Barack Obama's legacy is facing perhaps its most defining week in his second term as he seeks to close two major foreign-policy goals and preserve his signature domestic achievement.

    Three events over the next handful of days will help shape the Obama legacy long after he leaves office:

    • After a brutal fight in Congress that he — and, curiously, Republican leaders — ended up winning, Obama is set to sign a bill that will give him so-called "fast-track" negotiating power on trade deals. His administration is in the process of negotiating the Trans-Pacific Partnership, a cornerstone of his "pivot" to Asia.
    • The Supreme Court is set to rule on a case involving a key provision of the Affordable Care Act that allows the federal government to provide subsidies for health insurance to millions of low-income Americans. A ruling against the administration could throw the future of the law as Obama envisioned it into doubt.
    • The Obama administration and its European allies are lurching toward a permanent deal with Iran to curb its nuclear program. 

    By next Tuesday — the deadline for the Iran deal — it'll be much clearer where Obama's major domestic and foreign-policy goals stand. Ian Bremmer, the president of Eurasia Group, told Business Insider that the Trans-Pacific Partnership is the "most important piece" of Obama's foreign-policy legacy. 

    "It's strengthening trade ties for 40% of the world's GDP; it's making good on US commitments to allies that are most interested in improving their relations with America; it's a net economic benefit for the US long term, and, by far most importantly, it's strategically important in countering China's efforts to build trade and financial architecture that completes with US-led global standards," Bremmer said.

    "A failure on this front would have been a huge blow to the US in the most important part of the world for long-term American national interests."

    A 'challenging sell'

    Iran is an "important, but a very distant" No. 2, Bremmer said. Still, the deal has the potential to both radically reshape Iran's role in the Middle East and its relationship with the West, including the US. Potential cooperation with Iran looms on issues like fighting the Islamic State, but closer ties with Iran would also lead to complications with key US allies.

    With just days before the end of the month, another deadline could come and go — the fourth such time it could happen in the talks. And even the run-up to a potential deal has run into opposition from everyone from Republican members of Congress to former members of the Obama administration, who wrote a letter to the president outlining their concerns on Thursday as the US delegation heads to Vienna for perhaps a final round of talks. 

    kerry zarif

    If a deal with Iran is ultimately struck, it'll be a big part of Obama's legacy — but one Bremmer said will be tough for the president to sell as positive.

    It "will be extremely controversial in Congress and among key US allies in the region (Saudi Arabia and Israel have good reason to hate it). So I think it will be challenging for Obama to sell that as effectively as positive for his legacy," Bremmer said.

    'Instrumental to the future of Obamacare'

    The Supreme Court case could well end up being the most important event of the next few days — especially if the court ends up ruling against the Obama administration.

    This challenge, King v. Burwell, has the potential to cripple the law and throw its future into highly uncertain territory in the nearly three dozen states in which the federal government provides subsidies for low-income people to buy health insurance. Challengers argue that only states can hand out subsidies, pointing to four words in the law that say exchanges are to be "established by the state." 

    If the court invalidates that portion of the law, Obama and Congress would have to scramble as more than 6 million people could lose their subsidies — and potentially their coverage. It would be left to congressional Republicans to come up with either a quick fix or to use the ruling as an opportunity to start moving away from the law known as Obamacare.

    obamacare map

    The high court could also uphold that part of the law. In that case, more people would continue to enroll and be covered, and Obamacare would be viewed as the president's crowning domestic achievement long into the future.

    "It’s hard not to see the King case as instrumental to the future of Obamacare," said Larry Levitt, senior vice president at the Kaiser Family Foundation.

    "If the Court sides with the government, more people will continue to enroll and the ACA will likely ultimately be seen as a signature domestic achievement of historic proportions. Obamacare will remain controversial and no doubt feature in the election, but it’s hard to see it getting repealed outright at this point."

    On the other hand, Levitt added: "If the Court sides with the challengers, chaos ensues, not only in insurance markets but in the political realm as well.

    "The law could survive, but in a very weakened form. We would likely see intense debate over the future of Obamacare in the election and beyond, with the outcome of that debate clouded in uncertainty."

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    The Supreme Court has saved Obamacare and now healthcare stocks are ripping higher. 

    On Thursday, the Supreme Court ruled 6-3 to uphold a key provision of the Affordable Care Act, the Obama administration's major legislative accomplishment. 

    Following the news, shares of healthcare companies, including Tenet Healthcare, Community Health, Universal Health, and HCA Holdings, were surging. 

    Tenet shares were up as much as 9%, while Community and HCA both saw shares rise as much as 10%. Universal stock was up 6% following the ruling. 

    Here's the quick pop in these stocks in early trade on Thursday. 

    Screen Shot 2015 06 25 at 10.16.10 AM

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    Antonin Scalia

    Conservative Justice Antonin Scalia is not happy about the Supreme Court's decision to save President Obama's signature healthcare law.

    In a fiery dissent Scalia lashed out at Chief Justice John Roberts for his key vote to save a provision of the Affordable Care Act that allowed the federal government to provide healthcare subsidies to Americans in 34 states that did not set up their own healthcare exchanges.

    "We should start calling this law SCOTUScare," Scalia wrote in the dissent.

    This is the second time that Roberts has played a major role upholding Obama's healthcare law. In a high-profile constitutional challenge to Obamacare in 2012, Roberts was the crucial vote that helped save the majority of the Affordable Care Act.

    This comment amused Chief Justice John Roberts, who again wrote the opinion for the majority. According to Politico reporter Josh Gerstein, Roberts smiled and laughed during parts of Scalia's dissent.

    The case revolved around the interpretation of a phrase that stated that healthcare exchanges must be "established by the State" in order to receive tax credits. Scalia said that he was baffled that the majority of the justices could interpret this to mean that the federal government could give tax credits in states where exchanges weren't established by the state.

    "Words no longer have meaning if an Exchange that is not established by a State is 'established by the State.' It is hard to come up with a clearer way to limit tax credits to state Exchanges than to use the words 'established by the State,'” Scalia said.

    supreme court justices john roberts antonin scalia

    The conservative justice called the logic behind the ruling "interpretive jiggery-pokery," and remarked that the Court was simply looking over the law's errors in order to save Obamacare.

    "Normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved," Scalia said.

    Although Scalia has been one of the most outspoken critics of the law on the Supreme Court, there's at least one area that Scalia agrees with the Obama administration — the second challenge to Obamacare shouldn't have reached the court at all.

    "This case requires us to decide whether someone who buys insurance on an Exchange established by the Secretary gets tax credits. You would think the answer would be obvious—so obvious there would hardly be a need for the Supreme Court to hear a case about it," Scalia said.

    Some court-watchers also noted that Scalia ended his dissent on an unfriendly note.

    SEE ALSO: The Supreme Court just saved Obamacare

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    Republican presidential candidate and former Arkansas governor Mike Huckabee slammed the Supreme Court on Thursday after it delivered a huge victory for the White House by saving a crucial component of Obamacare in a 6-to-3 vote.

    In a fierce statement, Huckabee said the decision was "an out-of-control act of judicial tyranny."

    The US' highest court ruled that President Barack Obama's signature healthcare law could provide subsidies to millions of people who were insured through federal exchanges. The dissenting justices argued that the language of the Affordable Care Act indicated that only people insured through state-based exchanges should be eligible for the subsidies.

    Huckabee clearly agreed with the dissent.

    "Our Founding Fathers didn't create a 'do-over' provision in our Constitution that allows unelected, Supreme Court justices the power to circumvent Congress and rewrite bad laws," his statement continued. "The Supreme Court cannot legislate from the bench, ignore the Constitution, and pass a multitrillion-dollar 'fix' to Obamacare simply because Congress misread what the states would actually do."

    He added: "The architects and authors of Obamacare were intentional in the way they wrote the law. The courts have no constitutional authority to rescue Congress from creating bad law."

    Huckabee has long been critical of what he describes as the Supreme Court's overreaching its legal authority. When discussing the court potentially ruling in favor of same-sex marriage, for example, he has argued "the court cannot change what God has created."

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    John Roberts

    For the second time in four Supreme Court terms, Chief Justice John Roberts has broken with conservatives and rescued the Affordable Care Act from potential oblivion.

    Roberts, an unlikely hero of sorts for the law, wrote the majority opinion on Thursday upholding a key provision of Obamacare that helps provide health-insurance subsidies to more than 6 million Americans.

    "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in his opinion Thursday.

    He was joined by the court's four liberals — and, this time, traditional swing Justice Anthony Kennedy. It prompted a scathing dissent from fellow conservative Justice Antonin Scalia, who took a shot at Roberts.

    This case, King v. Burwell, was long considered by observers to be a chance for Roberts to redeem himself with conservatives, who felt slighted by his decision to break with the court's right-leaning members in 2012.

    He reportedly changed his vote at the last minute, delivering the majority opinion that upheld the heart of the Affordable Care Act — its mandate that individuals buy insurance or pay a penalty. Roberts said the penalty was constitutional because it was the same thing as a tax.

    The key question in this case centered on whether the federal government had the ability to provide subsidies to help low-income Americans buy health insurance.

    The challengers in the case argued that the way the law was written does not allow for subsidized insurance in states where the federal government had set up insurance exchanges. Instead, the challengers argued, insurance subsidies are allowed only in states that have set up their own exchanges. They pointed to a clause that they argued meant exchanges should be "established by the state," but members of Congress who were involved in writing the law disputed that characterization. Thirty-four states currently rely on the federal marketplace.

    Roberts' opinion suggested he viewed the wording of the law as ambiguous but thought the intent of Congress was clear. Congress, he wrote, always had the intention of subsidies being provided nationwide.

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    "Had Congress meant to limit tax credits to State Exchanges, it likely would have done so in the definition of 'applicable taxpayer' or in some other prominent manner," Roberts wrote. "It would not have used such a winding path of connect-the-dots provisions about the amount of the credit."

    Supreme Court observers couldn't figure out which way Roberts was leaning ahead of the decision, as he made only two substantive comments during the case's oral arguments. That was as often as the number of times he opened his mouth to crack a joke at one of the lawyers involved in the case.

    On one hand, observers said, he upheld the law last time. On the other hand, he's viewed as generally pro-business in his decisions, and multiple businesses and organizations have issued briefs on the side of the administration in this case.

    Roberts' decision made clear that he subscribed to Solicitor General Donald Verrilli's argument that getting rid of the subsidies might have led to a "death spiral" for states' insurance markets.

    "The combination of no tax credits and an ineffective coverage requirement could well push a State's individual insurance market into a death spiral," Roberts wrote, citing studies that predicted premiums could rise by as much as 47% while enrollment could decline by 70%.

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    Former Secretary of State Hillary Clinton had an ecstatic reaction to Thursday's Supreme Court ruling that saved a critical component of Obamacare.

    The Democratic presidential front-runner exclaimed "Yes!" in a Twitter post: 

    In a second post, she included a photo of her hugging President Barack Obama, in whose administration she used to serve. The photo is the same one she posted earlier this year to celebrate the Affordable Care Act's fifth anniversary: 

    Updated (11:29 a.m.): Clinton released a much lengthier statement as well:

    I applaud the Supreme Court’s decision to affirm what the authors of the Affordable Care Act clearly intended and wrote into law: that health insurance should be affordable and available in every state across the country. 

    Republicans in Congress have waged a sustained attack against this promise.  They’ve voted more than 50 times to repeal or dismantle the law, roll back coverage for millions of Americans, and let insurers write their own rules again – all without proposing any viable alternatives.  Now that the Supreme Court has once again re-affirmed the ACA as the law of the land, it’s time for the Republican attacks to end.  It’s time to move on. 

    The Affordable Care Act isn’t perfect, but the evidence is clear: it’s working. Sixteen million Americans have gained coverage.  Millions of young people are able to stay on their parents’ plans.  Insurance companies can no longer discriminate against people with preexisting conditions or charge women higher rates just because of their gender.  

    Republicans should stop trying to tear down the law and start working across party lines to build on these successes.

    I’ve fought for the promise of quality, affordable health care for every American for decades.  And I’m not going to stop now.  Anyone seeking to lead our country should stand up and support this decision. 

    SEE ALSO: Mike Huckabee: The Supreme Court just issued 'an out-of-control act of judicial tyranny'

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    Barack Obama

    President Barack Obama hailed the Supreme Court's decision to uphold a key provision of the Affordable Care Act on Thursday, calling it a "victory for hard-working Americans."

    "After multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay. This morning, the court held up a critical part of this law," Obama said of the decision, which provided the administration with a significant victory.

    Obama repeatedly said the "law is working," calling on Republicans to work to improve a law that he said has now been "woven into the fabric of America."

    "What we're not going to do is unravel what has been woven into the fabric of America," he said.

    It's the second time in four terms the court has prevented the law from a major obstruction that would threaten its existence. The Affordable Care Act will again survive intact as the largest expansion of healthcare in half a century.

    "The point is this is not an abstract thing anymore," Obama said. "This is not a set of political talking points. This is reality. We can see how it is working. This law is working exactly as it's supposed to. In many ways, this law is working better than we expected it to."

    He added: "This is healthcare in America. And unlike Social Security or Medicare, a lot of Americans don't know what Obamacare is beyond all the political noise in Washington."

    The key question in the case, King v. Burwell, centered on whether the federal government had the ability to provide subsidies to help low-income Americans buy health insurance.

    The challengers in the case argued the way the law was written does not allow for subsidized insurance in states where the federal government had set up insurance exchanges. Instead, the challengers argued, insurance subsidies are allowed only in states that have set up their own exchanges. They pointed to a clause that they argued meant exchanges should be "established by the state," but members of Congress who were involved in writing the law disputed characterization. Thirty-four states currently rely on the federal marketplace.

    Obama touted the law's provisions in his Rose Garden speech and called Thursday a "good day for America."

    "That's when America soars. When we look out for one another. When we take care of each other. When we root for one another's success. When we strive to do better and be better than the generation that came before us and try to build something better for generations to come," Obama said.

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    Republicans were swift to denounce the Supreme Court's decision to uphold a key part of President Barack Obama's signature healthcare law on Thursday.

    In a 6-3 decision, the Supreme Court upheld a provision that allows the federal government to issue subsidies to help low-income Americans buy health insurance. Within minutes, almost every Republican presidential candidate swiftly condemned the decision.

    Here's how the candidates reacted.

    Former Florida Gov. Jeb Bush (R)

    "This decision is not the end of the fight against Obamacare," Bush said in a statement.

    "This fatally-flawed law imposes job-killing mandates, causes spending in Washington to skyrocket by $1.7 trillion, raises taxes by $1 trillion and drives up health care costs. Instead of fixing our health care system, it made the problems worse.

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    Sen. Marco Rubio (R-Florida)

    In a brief statement, Rubio touted the Obamacare alternative that he rolled out earlier this year.

    “Despite the Court’s decision, ObamaCare is still a bad law that is having a negative impact on our country and on millions of Americans," he said. I remain committed to repealing this bad law and replacing it with my consumer-centered plan that puts patients and families back in control of their health care decisions.

    Marco Rubio

    Wisconsin Gov. Scott Walker

    Keeping with his message that Obama's policies hurt working class Americans, Gov. Walker emphasized the the Court's ruling could hurt middle class Americans.

    "Workers have lost hours because of new costs faced by their employers, people have lost their insurance and cannot afford the dramatic premium and fee increases, and many can no longer see their preferred doctors," Walker said.

    Walker also called on congressional Republicans to "redouble" their efforts to repeal the law.

    WAUKEE, IA - APRIL 25: Wisconsin Governor Scott Walker speaks to guests gathered at the Point of Grace Church for the Iowa Faith and Freedom Coalition 2015 Spring Kickoff on April 25, 2015 in Waukee, Iowa. The Iowa Faith & Freedom Coalition, a conservative Christian organization, hosted 9 potential contenders for the 2016 Republican presidential nominations at the event.

    Sen. Rand Paul (R-Kentucky)

    In a statement, Paul said that he knew the best way to reform Obamacare due to his experience as an ophthalmologist.

    "This decision turns both the rule of law and common sense on its head. Obamacare raises taxes, harms patients and doctors, and is the wrong fix for America's health care system," Paul said.

    "As a physician, I know Americans need a healthcare system that reconnects patients, families, and doctors, rather than growing government bureaucracy," he added.

    rand paul, sv100 2015

    Former Arkansas Gov. Mike Huckabee (R)

    Immediately following the decision, Huckabee released a strongly-worded statement condemning the Court's interpretation.

    "Our Founding Fathers didn't create a 'do-over' provision in our Constitution that allows unelected, Supreme Court justices the power to circumvent Congress and rewrite bad laws,"Huckabee said. "The Supreme Court cannot legislate from the bench, ignore the Constitution, and pass a multitrillion-dollar 'fix' to Obamacare simply because Congress misread what the states would actually do."

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    Sen. Ted Cruz (R-Texas)

    Cruz, who has argued several cases in front of the Supreme Court, directed most of his outrage at the Justices themselves.

    "Today’s decision in King v. Burwell is judicial activism, plain and simple," Cruz said. "For the second time in just a few years, a handful of unelected judges has rewritten the text of Obamacare in order to impose this failed law on millions of Americans. The first time, the Court ignored federal law and magically transformed a statutory ‘penalty’ into a ‘tax.’ Today, these robed Houdinis transmogrified a ‘federal exchange’ into an exchange ‘established by the State.'"

    Former Sen. Rick Santorum (R-Pennsylvania)

    In a statement, Santorum focused his attention on Hillary Clinton and touted his record opposing former President Bill Clinton's unsuccessful healthcare reform push.

    "I am the one candidate in this race who has taken on the Clinton Machine on the issue of healthcare and won," he said.

    "In my first race for the United States Senate, I defeated the author of HillaryCare in a campaign that was led by Paul Begala and James Carville. I am not afraid to debate Hillary Clinton on the issue of healthcare because I know that when the American people are given the choice, they will choose freedom and opportunity over a government-knows-best approach to the most personal decision in their lives."

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    Sen. Lindsey Graham (R-S.C.)

    Following the ruling, Graham slammed Congress for failing to proofread Obamacare before passing it.

    "This case was brought before the Supreme Court because President Obama and his Democratic allies in Congress rammed through their hastily and deeply flawed legislation to create Obamacare, apparently without even proofreading their own bill.  The result has been a disaster from day one," Graham said.

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    Carly Fiorina

    "It is outrageous that the Supreme Court once again rewrote ObamaCare to save this deeply flawed law despite the plain text and in the face of overwhelming evidence that the law is not working for the majority of Americans," the former Hewlett-Packard CEO wrote in a message on her Facebook page.

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    Ben Carson

    "Obamacare fundamentally increases the power of the government over the people and healthcare providers.  While I resent what the court has done, it only causes me to work even harder to make sure the next President will repeal and replace Obamacare with sensible consumer empowering solutions that remove the government from the patient/doctor relationship," the retired neurosurgeon Carson said in a statement.

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    Former Texas Gov. Rick Perry (R)

    "The Obama Administration has ignored the text of the Affordable Care Act time and again, and today’s ruling allows them to continue to disregard the letter of the law. While I disagree with the ruling, it was never up to the Supreme Court to save us from Obamacare," the former Texas governor said in a statement.

    "We need leadership in the White House that recognizes the folly of having to pass a bill to know what’s in it. We need leadership that understands a heavy-handed, one-size-fits-all policy does nothing to help health outcomes for Americans."

    rick perry

    Former New York Gov. George Pataki

    "While I'm disappointed the Supreme Court has again stretched to find a way to save Obamacare, the decision simply makes plain the need to repeal it and it's broken promises and replace it with a patient-centric, market-based system like we did when I was Governor of New York," Pataki said.

    Pataki screenshot

    Louisiana Gov. Bobby Jindal (R)

    "Republicans must outline a clear and coherent vision for health care to win the trust of the American people to repeal Obamacare. And right now, I am the only candidate to put forward a comprehensive plan," Jindal said.

    bobby jindal

    New Jersey Gov. Chris Christie (R)

    On the heels of news that he'll likely launch his presidential campaign next week, New Jersey Gov. Chris Christie slammed the court's logic in the case.

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    For the second time under Chief Justice John Roberts, the Supreme Court delivered President Barack Obama a legacy-saving ruling on Thursday.

    In fact, the Supreme Court has done so much to protect Obamacare that conservative Justice Antonin Scalia snarkily suggested it should be renamed "SCOTUScare" in his dissent. 

    But Obama and Roberts weren't always on the same page: As a US senator, Obama was one of just 22 Democrats who opposed his 2005 confirmation.

    In a floor speech explaining his vote at the time, Obama reportedly praised Roberts' intellect but said he "far more often used his formidable skills on behalf of the strong in opposition to the weak."

    "He seemed to have consistently sided with those who were dismissive of efforts to eradicate the remnants of racial discrimination in our political process," Obama said, according to ABC News. "In these same positions, he seemed dismissive of the concerns that it is harder to make it in this world and in this economy when you are a woman rather than a man."

    On Thursday, the Supreme Court ruled by a 6-3 count that the Affordable Care Act could provide subsidies to millions of people who were insured through federal exchanges — a critical component to the overall law. In a 2012 ruling, the court decided by a 5-4 margin to uphold another crucial piece: the individual healthcare insurance mandate. Roberts wrote the majority opinion in both cases.

    SEE ALSO: Obama just took a victory lap on Obamacare

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    John Roberts

    Chief Justice John Roberts broke with his three conservative colleagues on the Supreme Court and voted to uphold a key provision of the Affordable Care Act on Thursday.

    Roberts wrote the majority opinion, and in it he rejected the challengers' argument that Congress intended to use the provision of Obamacare in question as a weapon of coercion against states.

    And in proving his point, he used words from his dissenting colleagues — one of whom took a shot at Roberts on Thursday — from a separate Obamacare-related case three years ago.

    The key question in the case centered on whether the federal government had the ability to provide subsidies to help low-income Americans buy health insurance.

    The challengers in the case argued the way the law was written does not allow for subsidized insurance in states where the federal government had set up insurance exchanges.

    Instead, the challengers argued, insurance subsidies are allowed only in states that have set up their own exchanges. They pointed to a clause that they argued meant exchanges should be "established by the state." Thirty-four states currently rely on the federal marketplace.

    In the opinion of the court, Roberts wrote that their challenge was plausible — but that their underlying theory was not. As evidence, he cited the dissent from Justices Antonin Scalia, Clarence Thomas, Anthony Kennedy, and Samuel Alito in the 2012 case that upheld Obamacare's mandate for individuals to purchase health insurance or else pay a penalty.

    Here's what Roberts wrote in Thursday's opinion (emphasis added):

    It is implausible that Congress meant the Act to operate in this manner. See National Federation of Independent Business v. Sebelius, 567 U. S. ___, ___ (2012) (SCALIA, KENNEDY, THOMAS, and ALITO, JJ., dissenting) (slip op., at 60) (“Without the federal subsidies . . . the exchanges would not operate as Congress intended and may not operate at all.”). Congress made the guaranteed issue and community rating requirements applicable in every State in the Nation. But those requirements only work when combined with the coverage requirement and the tax credits. So it stands to reason that Congress meant for those provisions to apply in every State as well."

    supreme court justices john roberts antonin scaliaRoberts' opinion suggested he viewed the wording of the law as ambiguous but thought the intent of Congress was clear. Congress, he wrote, always had the intention of subsidies being provided nationwide.

    "Had Congress meant to limit tax credits to State Exchanges, it likely would have done so in the definition of 'applicable taxpayer' or in some other prominent manner," Roberts wrote. "It would not have used such a winding path of connect-the-dots provisions about the amount of the credit."

    He's basically telling his colleagues: I'm right, and your words prove it. 

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    (Reuters) - The U.S. Supreme Court on Thursday upheld tax subsidies crucial to President Barack Obama's healthcare law, but several other challenges to the 2010 statute are making their way up through the courts.

    Here is a look at some of the major cases and the grounds on which they have been brought.

    U.S. House of Representatives v. Burwell

    Filed last November by House Republicans, the lawsuit challenges the Obama administration's implementation of the Affordable Care Act, widely known as Obamacare. The lawsuit claims some of the administration's actions to put the law into effect required, but did not receive, congressional authorization. Those actions included delaying implementation of a mandate that certain employers buy insurance for their employees and authorizing the Treasury to make payments to health insurers without getting funding from Congress. The administration's motion to dismiss the case is pending before the U.S. District Court for the District of Columbia.

    Sissel v. U.S. Department of Health and Human Services (HHS), Hotze v. Burwell

    These lawsuits assert that the law, which originated in the Senate, violates the Constitution's "origination clause," which requires a bill raising revenue to originate in the House. In 2012, the Supreme Court said the penalty on individuals for failing to buy health insurance could be regarded as a tax. The Sissel lawsuit was rejected last July by the D.C. Circuit Court of Appeals, which found the "origination clause" did not apply because raising revenue was incidental to the main purpose of the law. The plaintiff, an artist who sells his work out of his studio, is asking for a rehearing. The other case, Hotze v. Burwell, was dismissed by the 5th Circuit Court of Appeals in April for lack of standing. The plaintiff, a Texas doctor, is also seeking a rehearing.

    Michigan Catholic Conference v. Burwell and other lawsuits challenging the contraception mandate and related waiver

    In a series of cases, non-profit employers have objected to the process for opting out on religious grounds of the law's requirement to buy contraception coverage for their employees. Such employers must provide a form to their insurers, which then separately must provide contraception coverage for employees. Numerous employers have claimed in lawsuits that submitting the form goes against their religious objections. One of the most closely watched is Michigan Catholic Conference v. Burwell, which was dismissed by the 6th Circuit U.S. Court of Appeals last June. The plaintiffs, a group of Catholic employers, are asking the Supreme Court to take the case. Another is Zubik v. HHS, which was brought by Pittsburgh Catholic bishop David Zubik. Though the 3rd Circuit U.S. Court of Appeals dismissed Zubik's case in 2013, Supreme Court Justice Samuel Alito put that decision on hold in April pending further review.

    (Compiled by Brendan Pierson; Editing by Will Dunham)

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