Health Care Ruling: Experts Discuss Outcome of High Court Decision

The Supreme Court upheld the health care reform law on Thursday, ending--at least temporarily--a battle over the controversial act that served as background for most of President Obama’s incumbency. We’ve asked some of our Perspectives contributors, a diverse collection of think tanks, advocates and leaders in their fields, as well as several other experts to tell us what they thought on the ruling.

Here’s what they had to say.

Mee Moua, president and executive director of the AAJC, said in a statement that she applauded the ruling, calling it “critical in ensuring that communities of color have access to health care and key preventative services.”

“Our task at hand is to spearhead and move forward with implementing this law, so that the 2.5 million Asian Americans, Native Hawaiians and Pacific Islanders will have affordable health insurance, eliminating the current health disparities that plague our communities.”

“While we welcome today's decision that brings us one step closer to health equity in this country, we cannot forget the Supreme Court's ruling, just three days ago, in the Arizona anti-immigrant law, which will likely lead to discrimination against communities of color. These important debates reinforce the need for our communities to act and make our voices heard, loud and clear."

Kathy Lim Ko, president and CEO of the APIAHF, said the Supreme Court’s decision “validated a landmark civil rights law.” The APIAHF is an advocacy organization promoting policy and community programs that benefit the health of Asian-Americans and Pacific Islanders.

“The ACA will improve access to quality health care for millions of Asian Americans, Native Hawaiians and Pacific Islanders, protect our communities from unfair insurance company practices and make substantial investments in our nation’s public health infrastructure,” she said in a statement.

“We know that the work ahead is still significant and we must continue to fight to ensure that all people--including our nation’s immigrants--have the right to health and health care. We will continue to analyze today’s decision in more detail and work to defend the ACA against continued attempts to repeal the advances that have been made.”

Neera Tandeen, president of educational institute and think tank Center for American Progress, called the ruling a “victory for millions of Americans who are already benefiting from the health reform law.”

“It’s not about Democrats or Republicans winning or losing, it's about people’s lives. All of us—Democrats and Republicans—must move forward with making health care work for every American and that means stopping the political games and implementing the law,” she said in a statement.

Tandeen called for an end to the bipartisan battle over the act, adding in her statement, “But will Republicans stop their politics-at-all-costs campaign long enough to make sure America’s health care system works for every American?”

“No more slash-and-burn politics. No more delay tactics. Republican attorney generals have wasted millions of dollars using the courts to achieve their political ends. Today the court affirmed its role as the neutral arbiter of the law for all Americans.”

The GOProud, a gay and straight alliance promoting conservative ideals, criticized the Court’s ruling, saying the decision gives the federal government “unchecked power.”

“Today is a good day for big government and a bad day for individual liberty,” said Jimmy LaSalvia, executive director of GOProud, in a statement.

He continued: “This decision reminds us of how important it is to elect conservatives to the House, Senate and the White House that will protect our individual liberties, because it is clear that the Supreme Court is unwilling to do so.”

“Free market healthcare reform would expand access to domestic partner benefits and put gay people in charge of their healthcare decisions. By upholding Obamacare, the Supreme Court has upheld legislation that hurts all Americans, but especially hurts gay and lesbian families.”

The Hispanic Leadership Network, an initiative by the American Action Network to engage the Hispanic community on center-right issues, issued the following statement from Executive Director Jennifer Korn.

Korn maintained that the Supreme Court’s decision would ultimately hurt Latinos and the American public, especially in light of the faltering economy. She called on Congress to work on a bipartisan solution that would replace the key provisions of the health care act that would create “quality and affordable healthcare while protecting future generations from a mountain of debt.”

“In its opinion, the Court shed light on the truth--that Obamacare is, in fact, a one trillion dollar tax-hike imposed on the American people,” she said. "A federal mandate is not what the American people need or want to improve our health care system. Simply because something is deemed constitutional, it doesn’t mean it is good policy.”

“This law endangers quality private coverage for families, while robbing $500 billion from seniors to help pay for it. As it stands, this law puts the financial security of countless Hispanic families at risk and irresponsibly places the burden of debt on our children and grandchildren--jeopardizing the American dream.”

The HRC, a civil rights advocacy organization for LGBTs, said the ruling “paved the way for important new protections for and investments in the health.”

“The Affordable Care Act addresses a number of the barriers LGBT people face in obtaining health insurance, from financial barriers to obtaining affordable coverage to discrimination by insurance carriers and healthcare providers,” said HRC President Chad Griffin.

“While there is a great deal more that must be done to ensure that the health needs of all LGBT people are fully met throughout the healthcare system, today’s decision is an important victory in the fight for healthcare equality.”   

NAACP Chairman Roslyn M. Brock released a statement saying she applauded the decision to uphold the health care act.

“Access to quality, affordable health care is a civil and human right that should not be reserved for the wealthy or the few. The 32 million American men, women and children covered under this law can now breathe easier,” she said in a statement.
“Many serious health issues are preventable,” Brock said. “But far too often, patients who lack health insurance--especially patients of color--enter medical facilities late in the progression of their diagnosis. This sad reality is costing lives and costing American taxpayers hundreds of millions of dollars in unnecessary health care bills. States can now move forward in implementing health care reform with the knowledge that the Affordable Care Act is not going anywhere anytime soon.”

The conservative organization dedicated to closing the gap between the Republican party and America’s Hispanic population expressed its dissatisfication with the Supreme Court’s decision.

“President Obama and the Democrats in Congress forced Obamacare on America without one Republican vote of support and against the sentiment of the American people,” said RHNA chairman Alci Maldonado in a statement.

“We Americans must repeal and replace Obamacare with a more common sense reform to our health care system, currently the best in the world, although all would agree that it does need reasonable reform.”

The RHNA sided with Sen. Marco Rubio, R-Fla., and Gov. Mitt Romney in their assertion that the health care act would only increase taxes on all Americans, affecting the middle class most severely.

Perspectives regularly features guest commentary, analysis and insights from a diverse field of thought leaders, think tanks, research institutes and more. The Next America is always looking for input from all sides of the story. If you or your organization is interested in participating in this conversation, please e-mail The Next America team.

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2008 Obama: Health Care Should "Never Be Purchased With Tax Increases On Middle Class Families."

At a Campaign rally in 2008, Obama said that health care should not purchased with a tax increase (October 4, 2008).

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Health Care ruling clears path for Colo. exchanges

DENVER (AP) — Colorado Republicans who decried Thursday's health care ruling said the state did the right thing by beginning to create insurance exchanges required under the law, rather than waiting for the federal government to create one.

Democrats said that the decision clears the path for Colorado's health plans and that Colorado more than other states would have been tripped up if the health law had been axed.

State lawmakers last year created the Colorado Health Benefit Exchange, which forms a virtual marketplace to allow individuals and groups the ability to purchase health insurance at discounts like those in larger risk pools. About 13 percent of the state, or 656,000 state residents, had no health insurance as of 2011, according to U.S. Census estimates.

Colorado's exchanges are expected to launch October 2013. The U.S. Supreme Court's ruling gave clarity to the implementation of the exchanges, which could have been thrown in disarray if the federal law was struck down in its entirety.

"It affirms what we have been doing all along in moving forward with the exchange," said Democratic Sen. Betty Boyd, one of the architects of Colorado's exchange.

Gov. John Hickenlooper said the ruling "simply keeps Colorado on the path toward reform we've been on."

Ten states and the District of Columbia have passed insurance exchange laws to establish exchanges, according to the National Conference of State Legislatures. The idea of creating something similar to an exchange was broached in Colorado in 2008 by a panel studying health care reform, long before Congress passed a law.

Republican Attorney General John Suthers, who was among the attorneys general challenging the health care law, called the ruling "extraordinary and unexpected."

Justices in the 5-4 ruling upheld virtually all of the law's provisions, including the divisive individual mandate, saying it can be construed as a tax allowed under the Constitution.

"I think this bill would've never passed if they had said, 'Oh we're going to tax everybody who doesn't buy health insurance. It's just the nature of politics in America," Suthers said.

Suthers said the debate now moves to the "political arena," where he believes it will become more volatile in the presidential election.

Republican Rep. Bob Gardner, the chair of the legislative panel overseeing implementation of the exchange, agreed with Suthers that Colorado was wise to implement the insurance exchange.

"I think that Colorado did the right thing by having a mechanism to do its best to impose a Colorado solution," he said. But Gardner said he was outraged by the ruling that the individual mandate can be interpreted as a tax.

"They have hoodwinked the American people," he said.

Republicans saw a bright spot in the ruling regarding Medicaid expansion, where the court ruled the federal government can't withhold states' entire Medicaid allotment if they don't take part in the law's extension. Colorado's GOP has criticized fast-growing Medicaid spending and called for Colorado to buck the federal government to trim costs.

Hickenlooper said Thursday that it was too soon to say whether Colorado would raise income caps for adults without children who receive Medicaid.

"We're certainly looking at it and trying to figure out a way to do that and still live within our means," he said.

Health care activists who backed the health care law said Colorado is in better shape because it was upheld.

Dede de Percin, executive director of the Colorado Consumer Health Initiative, said Colorado was ahead of the federal government on many of the new law's provisions, not just the exchange and expanded Medcaid eligibility but also on laws about preventive screenings and new guidelines for medical underwriting.

"There's been a lot of debate about the law, and I think now it's time for us to get together and move forward," de Percin said.

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Health care, bank stocks lead stock market lower

NEW YORK (AP) — Health care stocks tumbled Thursday after the Supreme Court upheld most of President Barack Obama's health care overhaul, falling along with major banks as Wall Street worried about the European debt crisis and the sluggish U.S. economy.

It had already been a bad morning for the market, which was dragged down sharply by news about regulatory investigations at Barclays, JPMorgan Chase, Citigroup and others.

Then, the high court upheld a key provision of the health care law, and the losses accelerated.

Although health care and finance dominated the headlines, the market's concerns were more widespread, stretching to numerous types of companies and economic data.

The Commerce Department said the American economy expanded at a 1.9 percent annual rate in the first quarter, a weak pace that isn't expected to pick up. The government also reported that unemployment applications fell last week, but only slightly, and analysts worried that the claims are still too high to indicate a recovery.

News Corp, parent of the Wall Street Journal and the 20th Century Fox movie studio, fell after it said it planned to split into two companies. Family Dollar declined after reporting that it missed analysts' estimates for revenue and profits.

Major indexes in France, Britain, Germany and Greece were down as the European Union met in Brussels. Leaders are trying to hammer out how to deal with the weakest countries, like Greece and Spain, but many of the previous meetings have failed to produce concrete plans.

"The first one thousand summits, I was pretty excited," deadpanned Jeff Sica, president and chief investment officer of SICA Wealth Management in Morristown, N.J.

David Lefkowitz, senior equity strategist at UBS wealth management research in New York, was also watching Europe more than the health care ruling or the bank probes. Health insurance companies make up only about 1 percent of the Standard & Poor's 500, he said.

And even concerns about the indirect effects of the health care law — like whether it will cause small businesses to curb hiring — can get overblown, he said. The much bigger cost of hiring is still salaries.

In the U.S., the Dow Jones industrial average fell throughout the morning. It was already down about 100 points by 10 a.m., 30 minutes into trading and just before the Supreme Court released its decision. It fell as much as 165 points later in the morning, then recovered some of those losses.

By 1 p.m., it was down 128 points, or about 1 percent, to 12,499. Thursday could be the Dow's second triple-digit loss this week.

The S&P 500 fell 13 points to 1,318. The Nasdaq composite index fell 43 points to 2,833.

JPMorgan was down 4.5 percent, more than any other company in the Dow index of 30 stocks. The New York Times reported early Thursday that a trading loss there, previously estimated at about $2 billion, could top $9 billion. JPMorgan's stock has lost 14 percent since then, compared to 3 percent for the Dow.

The U.S.-listed shares of Barclays plunged 15 percent. Regulators in the U.S. and the U.K. on Wednesday announced that the British bank would settle accusations that it had manipulated international interest rates, which are important because they affect how much consumers pay on mortgages and other loans.

On Thursday, banking stocks got another dose of unwelcome news when British regulators announced that their investigation had expanded to Citigroup, Britain's HSBC, Switzerland's UBS and the Royal Bank of Scotland'.

Financial stocks fell more than any of the other nine industry groups on the S&P 500, losing 1.7 percent in the afternoon.

Health care stocks fell 1 percent, led by sharp declines in insurers like UnitedHealth Group, WellPoint and Aetna.

But hospitals had the opposite reaction, with stocks rising notably at Hospital Corp. of America and Community Health Systems.

The reasons for the disparity weren't clear cut.

The health care law will require all Americans to carry insurance. So for hospitals and related industries, like companies that make surgical instruments or lab equipment, that can mean more customers.

It also means more customers for insurance companies. But some of those customers won't be as profitable as the companies might like, such as those who are already sick.

Even with the ruling in hand, there's plenty of uncertainty overhanging the issue. Small businesses aren't sure how much money to set aside now that more of them will be required to insure their employees. The health care law also doesn't address the overhanging problem of looming deficits in Medicare.

"It's not like we're at the end of the road here," said Gerard Wedig, a health care economist at the University of Rochester, "where our health care problems are solved."

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Iowa lawmaker assembling summit on health care

DES MOINES, Iowa (AP) — A leading health care advocate in the Iowa Legislature said Thursday he's working to organize a nonpartisan health care summit to determine how Iowa moves ahead with the federal overhaul largely upheld by the U.S. Supreme Court.

Sen. Jack Hatch, a Des Moines Democrat, said he's been talking with Republican Gov. Terry Branstad's chief of staff Jeff Boeyink, who has expressed willingness to assemble a summit organized by nonpartisan third parties.

Branstad's spokesman, Tim Albrecht, said the governor's office is interested in discussing such issues "but it would be premature to commit to any specific event until the decision had been rendered and we had adequate time to review its implications for Iowa."

Branstad, meanwhile, released a statement calling the court's ruling "a disastrous decision to uphold President Obama's destructive health care law" and is seeking to have it repealed. Republican legislative leaders claimed the law could lead to increased taxes as health insurance is offered to more people.

About 366,000 Iowans — roughly 12 percent of the population — are uninsured, according to U.S. Census Bureau data from 2011.

"Iowans are perfectly capable of making health care decisions on their own; they don't need Washington, D.C. telling them what to do," said Republican House Majority Leader Linda Upmeyer.

Iowa does not have a law establishing the new online health insurance markets required under the law. Called exchanges, the new markets are supposed to be up and running on Jan. 1, 2014. People buying coverage individually, as well as small businesses, will be able to shop for private coverage from a range of competing insurers.

Hatch said bringing together a variety of individuals and groups dealing with health care in a summit would help Iowa work through the law's complexities and meet the federal requirements. He said state officials have done some preparation and the state has received two federal grants totaling $8 million, one of which was used to help plan the exchange and another that helped the state comply with new electronic record-keeping requirements.

Branstad also signed a measure into law establishing a new licensing requirement for health insurance "navigators," to comply with the federal law. The navigators act like insurance agents to guide customers through the enrollment process.

Upmeyer said the state has enacted several other pieces of the health care law, including a website that helps Iowans buy insurance. But the website doesn't meet all the federal requirements, and Upmeyer said lawmakers would have to approve more legislation to comply.

While upholding most of the law, the court found problems with the expansion of Medicaid, although the majority of justices said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's expansion. The decision means states will not be forced to expand their Medicaid coverage under the law.

Hatch said Iowa Democrats in Iowa will push to expand Medicaid, a low-cost government health care program that covers low-income adults, children, people with disabilities and pregnant women.

"It would be a complete reversal and really a betrayal if Republicans wish to move the needle back," he said. "I assume there will be a lot of chest beating but we're going to proceed with covering as many adults as possible and expanding Medicaid."

About 150,000 additional people would be pulled into Medicaid if Iowa moves ahead with the expansion outlined under the federal law, said Roger Munns, spokesman for the Iowa Department of Human Services. Iowa currently enrolls about 400,000 people in Medicaid.

The federal overhaul allows adults with an income of less than 133 percent of the federal poverty level to be eligible for Medicaid. That means a single person making less than $14,856 would be eligible. Iowa currently enrolls children under age 18 with household income of less than 300 percent of poverty. That means a family of four making less than $30,657 would qualify.

Republican House Speaker Kraig Paulsen said he opposes government-run health care and said any talk of adding more people to Iowa's Medicaid roles is premature.

"I think right now what we're trying to do is make sure we have our arms around what we already do and make sure what we have is operating correctly and efficiently because I'm not 100 percent convinced that it is," he said.

He believes voters will express displeasure in the November election by electing Republicans to Congress and Mitt Romney to the White House. He suggested the law could then be overturned.

"I think the next step is we've got an intervening election," he said. "If it becomes part of the dialogue which I think it's going to, you know the electorate has a way of letting us know which way they want us to go."

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President Obama Speaks on Health Reform

The Supreme Court's decision to uphold the Affordable Care Act ensures hard-working, middle class families will get the security they deserve and protects every American from the worst insurance company abuses. June 28, 2012.

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Is Court's Health-Care Ruling a Wise Decision? It Depends...

THURSDAY, June 28 (HealthDay News) -- Supporters of the Obama administration's health care reform law said Thursday that the U.S. Supreme Court's decision upholding the landmark legislation protects the health of millions of Americans, but critics claim it does so at the expense of key civil liberties and exacts a high economic toll.

The 5-to-4 ruling "means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," Dr. Jeremy Lazarus, president of the American Medical Association, said in a statement.

"This decision protects important improvements, such as ending coverage denials due to preexisting conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies," Lazarus said.

Already, about 54 million Americans are benefiting from expanded preventive and wellness care coverage, Lazarus noted.

But many of those who oppose the legislation fear the federal government is intruding into the lives of private citizens.

"I'm disappointed that the Court is willing to give the federal government the power to tell you what has to be in your health care plan down to your contraceptives and mammograms," said John Goodman, president and founder of the National Center for Policy Analysis. "That's a great deal of power."

Economically, the Affordable Care Act "is one reason economic recovery has been so anemic," he suggested. Although hours worked across the United States are now what they were before the recession, hiring is not at pre-recession levels, he said, attributing that lag to "Obamacare" insurance requirements.

"The mandates come with a big price tag for employers and employees," Goodman said. The cost of family coverage works out to $6 an hour, he added.

Whether for or against the law, experts voiced relief that a decision was reached.

"We're very relieved and eager to move forward from here now that we have some certainty," said Dr. Glen Stream, president of the American Academy of Family Physicians.

The law's comprehensive primary-care initiative ensures funding for important health practices related to the "medical home" approach, he said. Preventive services, such as wellness coaching, dietitians and electronic record-keeping programs, are now accessible to many Americans through public and private payers, he noted.

Another benefit, according to Stream, is the provision for primary care work-force training. "Federally qualified community health centers have the capacity to train family physicians, which is critical," he said.

"Now we can work on other meaningful reforms," he said, mentioning liability reform.

Alison Renner Manson, manager of government affairs and policy for the National Coalition on Health Care, predicted that Congress has some hard work ahead. In some ways, the ruling was only the tip of the iceberg, she noted.

"The decision upholds existing law, so we're not looking at major changes," she said. "A lot of decisions on health care need to be made over the next year that will have a larger impact."

For instance, even with the Affordable Care Act in place, as much as one-third of U.S. health spending benefits no one's health, Manson said.

"It's an ongoing problem we have to deal with one way or another," she said. These issues include unnecessary or duplicated tests and services, excessive administrative costs, and instances of fraud and abuse, she explained. "We want to get more for our health-care dollars, but we don't want people to go without services," she said. And for that to happen, consumers, politicians and policy makers will have to work together, her group believes.

Because the court decision upheld the individual mandate of the Affordable Care Act under a constitutional tax provision, there could be surprise financial implications, some say.

Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said in a statement that she anticipates financial obstacles as a result of the ruling. AHIP is a Washington, D.C.-based trade association representing the health insurance industry.

"The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed," she noted.

"Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition," she said.

Figures reviewed by AHIP indicate that the minimum essential health benefits requirement "will result in less affordable coverage for individuals, families and small employers by forcing them to 'buy up' and purchase more coverage than they may want or need," she added.

More information

To learn more about a medical home, see the American College of Physicians.

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Health care reform: How it impacts your insurance coverage

The Supreme Court's ruling Thursday to uphold health care reform has widespread implications for both insured and uninsured consumers.

Beginning in 2014, uninsured individuals must buy coverage -- either on their own, through an employer's plan or through a health insurance exchange -- or else pay a tax penalty. Meanwhile, insured consumers will continue to enjoy key mandates of the law, such as free preventive care and coverage of adult dependents up to age 26, but at the expense of higher out-of -pocket costs.

In the United States, more than half of the population -- or 160 million people -- gets health insurance directly through their employers, while 50 million people have no insurance, according to the government. Tens of millions more consumers either buy their own private insurance or are covered by government programs, such as Medicaid and Medicare.

Several key mandates of health reform have already gone into effect since the law passed in 2010. Here's a rundown of those provisions and new mandates rolling out over the next two years that will impact almost all of these consumers.

If you have insurance through your employer: Employees will continue to enjoy key benefits mandated by health reform that have already gone into effect.

"For consumers who are insured through their employers, this is good news," said Mike Thompson, principal with PwC's Global Human Resources Services.

Among the main provisions: Employers must provide coverage for adult dependents of workers up to age 26; health plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance; and insurers can't impose a maximum lifetime dollar limit on a customer's medical care.

In 2013, eight additional preventive care services for women, including HIV and HPV (Human Papillomavirus) screening, will be covered under health reform.

Related: Justices say insurance mandate is a tax

But some industry experts also said that employers who offer insurance will now be even more focused on controlling their health care costs, especially since the individual mandate is expected to add more people -- including more high-risk individuals -- to their plans.

This means employees could see further increases in premiums and deductibles.

Also starting in 2013, the health care law will limit employee contributions to flexible spending accounts to a maximum of $2,500 a year. Many employers have their own caps on FSA contributions and the cap for federal employees is $5,000.

"Come open enrollment, it's very important that employees pay careful attention to their benefits packages and take a good look at options and incentives that companies are offering them to lower their out-of-pocket costs," said Tracy Watts, senior health care consultant with benefits consulting firm Mercer.

If you buy your own insurance: About 15 million consumers in the United States buy health insurance directly from private insurers or work for businesses that do so.

Under health reform, insurers must also allow policyholders to add adult dependents up to age 26 to their plan. Also, beginning in 2014, insurers can't drop an individual if they become sick and they cannot refuse coverage for a pre-existing condition. Insurers also can't set annual or lifetime limits on the amount of care.

If you're uninsured: Come 2014, if you don't have health coverage, you will have to pay a penalty.

In 2014, the fee is capped at $285 per family, or 1% of income, whichever is greater. By 2016, it will jump sharply to $2,085 per family, or 2.5% of income, whichever is greater. Individuals will pay penalties of $95 in 2014 that will climb to $625 in 2016.

The law mandates that states set up health insurance exchanges -- an online marketplace where consumers can buy subsidized health plans -- by 2014. These exchanges are geared towards making health insurance affordable to underinsured and uninsured individuals.

Related: 20-somethings celebrate: 'I can pay my rent'

Subsidies are determined by individuals' income levels. Uninsured consumers with incomes between 139% and 400% of poverty will be eligible for tax credits to offset the cost of buying coverage through exchanges.

According to the Congressional Budget Office, the average subsidy per enrollee in the exchange will be $4,780 in 2014, rising to $5,780 in 2018.

If you work for a small business: By 2014, companies with 50 or more full-time employees must start providing health insurance or face penalties.

For most small businesses, that means a new way to shop for less expensive health insurance on the exchanges where they can buy plans for their workers.

But Sandy Ageloff, an analyst with Towers Watson, a leading benefits consulting firm for Fortune 1000 companies, expects several businesses could still opt out of providing health care coverage and instead send workers to exchanges.

"For these businesses who buy insurance coverage directly from private insurers, they often have higher premiums," said Ageloff.

"So they may find it more cost effective. despite the penalties, to eliminate their company insurance benefits and send workers to exchanges," she said.

Related: What small businesses need to know

Mercer's Watts said health insurance exchanges are a welcome provision for early retirees as well.

"There are many individuals who want to retire early but don't because they don't want to lose their health insurance," she said. "These exchanges will allow them to retire and still be able to buy affordable health insurance."

If you're insured through Medicare or Medicaid: For Medicare beneficiaries, health reform mandates that the Part D donut hole -- the gap in drug coverage during which beneficiaries have to pay the cost of prescriptions entirely out of pocket -- will be phased out by 2020.

The government said Medicare recipients have saved $3.7 billion on drug costs as a result of provisions which went into effect after health reform passed in 2010. To help afford their prescriptions, those who have fallen into the donut hole have received a one-time tax rebate and discounts on name-brand and generic drugs.

Those who currently receive Medicaid won't be impacted much by health care reform. It's less certain after Thursday's ruling, however, whether all states will expand the program come 2014.

Initially, health care reform mandated that states expand Medicaid coverage or lose federal funding for the program. The new Medicaid guidelines were to expand coverage to anyone under 65 whose income was up to 133% of the federal poverty level by 2014.

On Thursday, the Supreme Court struck down that provision, saying it should be up to the states to decide whether or not they want to expand the program, without any threat of losing federal funding.

"This is the one piece that impacts some individuals," said Ageloff. "If a state decides not to expand the program, some individuals now may not be able to get Medicaid coverage."

More on health care reform:

What health reform could cost 20-somethings celebrate: 'I can pay my rent'

Exchanges: Health insurance models of the future Health reform: What companies need to know

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Growth in health spending grinding to a halt: OECD

LONDON (Reuters) - Growth in health spending reversed a long-term trend of rapid increase and either slowed or fell in real terms in most OECD countries in 2010, driven by cuts among governments imposing austerity budgets, data showed on Thursday.

Overall health spending grew by nearly 5 percent a year in real terms in the 34 countries of the Organisation for Economic Co-operation and Development (OECD) between 2000-2009, but this was followed by zero growth in 2010.

In its Health Data 2012 report, the OECD also said preliminary figures for a limited number of countries suggest there was little or no growth in health spending in 2011.

"The halt in total health spending in 2010 was driven by a fall of 0.5 percent in public spending for health, following an increase of over 5 percent per year in 2008 and 2009," the report said.

It found that while government health spending tended to be maintained at the start of the economic crisis, cuts really began to bite in 2010.

This was most evident in European countries hardest hit by recession, such as Ireland, Greece and Estonia.

In Ireland, cuts in government spending drove total health spending down by 7.6 percent in 2010, compared with an average yearly growth rate of 8.4 percent between 2000 and 2009.

In Greece, OECD estimates suggest total health spending fell by 6.5 percent in 2010 after a yearly growth rate of more than 6 percent on average since 2000.

In Iceland, health spending fell by 7.5 percent in 2010, and in Estonia it dropped by 7.3 percent, driven by reductions in both public and private spending.

The OECD said most of the health spending cuts in Ireland were made through cuts in wages or fees paid to professionals and pharmaceutical companies, as well as through reductions in the number of health workers.

Estonia cut administrative costs in the ministry of health and also reduced prices of publicly reimbursed health services.

Investment plans have also been put on hold in a number of countries, including Estonia, Ireland, Iceland and the Czech Republic, while other countries have been seeking efficiency gains through mergers of hospitals or ministries, or by accelerating the move from caring for patients in hospitals towards more out-patient care and day surgery.

More generic drugs are also being used by a number of countries, the OECD said, and some other measures have been introduced to make people pay more out of their own pockets.

Outside of Europe, health spending growth slowed in 2010, to about 3 percent in the United States, Canada and New Zealand. Growth remained at more than 8 percent in Korea.

As a result of the zero growth in health spending across OECD countries in 2010, the percentage of GDP devoted to health stabilized or declined slightly in most countries.

Health spending accounted for 9.5 percent of GDP on average across OECD countries in 2010, versus 9.6 percent in 2009.

The United States spent by far the highest proportion of its GDP in health, at 17.6 percent, followed by the Netherlands at 12 percent and France and Germany on 11.6 percent.

The lowest proportions devoted to health were in Mexico, at 6.2 percent and Turkey on 6.1 percent. In Japan, the share of spending allocated to health has increased substantially in recent years to 9.5 percent, up from 7.6 percent in 2000.

The share also increased in Korea to 7.1 percent in 2010, up from 4.5 percent in 2000.

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Weight Loss Bully Diet

http://tinyurl.com/weightlosshelps The Weight Loss Bully System

I'm sure you have actually discovered exactly how troublesome it is usually to see a healthy and balanced good diet for losing weight on the net which is going to be effective. One weight-loss system will tell you that you cannot eat any kinds of bread if you want to lose weight while other programs say that eating bread is fine. It appears as though every program has different rules, and if you switch from one program to another you end up doing a thing that the last program told you to avoid. In this post we're going to be taking a look at The Weight Loss Bully program that assures that you will never need to purchase a another weight-loss system again.

Unlike many internet sites which simply write out what their programs are about, you're going to discover that this program gives you a video that explains the program to you plus delivers the simplest tips to lose belly fat that you may incorporate immediately. Something you're going to learn is the fact that the webpage still has loads of information on it but it is made up completely of testimonials from people who have had great success with this program. You are in addition going to discover that while many sites will simply have testimonials written out, on this website there loads of people who sent in video testimonials thanking the originator of this program. There are in fact people who have lost more than 50 pounds in a matter of 12 weeks by just following what this program describes.

How Can I Lose Weight Fast

Many weight loss diet plans will tell you that losing 5 pounds every week isn't possible, but this program says to you that not only is it possible but it is very practical if you adhere to this program. While good nutrition will obviously be a big portion of this program, another thing you're going to learn is that you're only going to have to exercise 15 minutes each day four times every week to reach your goals. I ought to also mention that you're not going to have to join a gym or purchase any special fitness equipment to be able to do these exercises. While you're going to be exercising less you're going to discover that these exercises will end up burning up more calories than performing cardio or jogging for 45 minutes.

With regards to shedding weight you're going to find a large number of programs available that claim to have the ability to help you accomplish your goals. Having a high metabolism is very important with regards to weight loss and they teach you how to generate meals that will end up doing this. This program was developed with loads of research being done finding methods and tricks that men and women can use to lose weight, and the creator of this program tried all these on himself as he used to be fat as well.

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DIET RECIPE - Healthy Recipe for Breakfast

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Atkins Diet Recipes: Buffalo Wings (IF)

These wings are some of the best reasons to go on the Atkins Diet. They are completely legal for all phases of the diet and absolutely delicious. The Diet Coke is a unique ingredient, but it really does the trick. I think by adding the wings to the simmering sauce, the collagen helps thicken the sauce as well.

Ingredients
3 pounds chicken wings, separated at joints, tips discarded
1 cup Louisiana-style hot sauce (Franks Hot Sauce recommended)
http://www.amazon.com/gp/product/B0005YVOGU?ie=UTF8&tag=atkdiehowtovi-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=B0005YVOGU
1 can Diet Coke with Splenda
1 tsp cayenne pepper, or to taste
1 tsp ground black pepper, or to taste
1/2 tsp Thyme
1/2 tsp Garlic Powder
1 tablespoon soy sauce
1/2 TBS Dried Chopped Onions

Instructions:
* Cut the wings into pieces.
* Mix other ingredients into large pot and start simmering.
* Add wings to pot to give flavor
* Heat Oil to 350-375F degrees
* Add wings to fryer and cook until done (12-14 minutes)
* Add wings back to Buffalo sauce and coat thoroughly

(IF = Induction Friendly)

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Health Care Law: Supreme Court Decision Live Blog

The big day has come for the president's health care law. The Supreme Court hands down it's verdict on the Patient Protection and Affordable Care Act at 10 a.m. ET. We'll be here all day updating with the decision, what's going on outside the court, what it means for politics, the health care industry and your health care coverage.

8 a.m. ET - Prep Work - Here's some things to get you started. Click on the images below for flow charts, infogrpahics, and what the justices have said previously about the legal issues surrounding the ruling.

The Court - Meet the nine Supreme Court justices who will decide whether you have to purchase health care coverage. Here's what they've said about the health care law in the past. Click below:

How could they rule? The Supreme Court has these options by our estimation. They could get creative, but these are the general questions:

Here's how Americans get their health insurance:

Also Read

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Health Care Law Lacks Support - But So Does the Status Quo

Americans are equally dissatisfied with the current health care system and with the federal law intended to improve it - suggesting that the U.S. Supreme Court's decision on that law will by no means end the country's sharp political debate over health care policy.

Just 36 percent in this ABC News/Washington Post poll express a favorable opinion of the health care law under Supreme Court review. But ratings of the health care system as it currently stands are about as weak, 39 percent favorable. That means that while the intended fix is unpopular, so is the status quo - leaving the public still in search of solutions.

See PDF with full results, charts and tables here.

One key challenge is that while Americans are broadly dissatisfied with the system overall, vastly more - 75 percent - rate their own quality of care favorably. The difficulty thus remains where it's been all along: Forging solutions to the current system's problems that don't leave people fearing they'll lose what many see as their own good quality of care now.

[Related: Romney pushed for individual mandate in Mass.]

The high court's ruling on the health care law, the Patient Protection and Affordable Care Act, known as the ACA, is expected Thursday. While the law's popularity is weak, barely more than half, 52 percent, see it unfavorably, including 38 percent who have a "strongly" unfavorable opinion. With key provisions yet to take effect, 12 percent are undecided.

Other polling has indicated that a variety of aspects of the ACA are broadly popular - but that these are outweighed by the unpopularity of the so-called individual mandate, requiring nearly all adults to purchase insurance or pay a fine.

Another difficulty for proponents of the ACA is that dissatisfaction with the health care system now, or with current care, doesn't boost support for the new law. Among people who rate the current system unfavorably, just 35 percent have a favorable opinion of the ACA. And among those who give a negative review to their own care, the ACA's popular with just 32 percent.

[Related: Biggest insurer to keep parts of 'Obamacare,' regardless of ruling]

Still, while the ACA is not popular, an ABC/Post poll in May found weak support for Mitt Romney's call to repeal it - a 40-40 percent division in favorable vs. unfavorable views. And in another measure, in April, just 38 percent said the Supreme Court should reject the law in its entirety. Twenty-five percent wanted it entirely upheld; 29 percent said it should be upheld in part, rejected in part.

POLITICAL LINES - This poll, produced for ABC by Langer Research Associates, finds sharp political differences, with the ACA seen favorably by 59 percent of Democrats, falling sharply to 36 percent of independents and just 14 percent of Republicans. Ideological divisions are similar, with liberals nearly three times more supportive of the law than are conservatives.

[Related: Woman who helped change AIDS stereotype still fighting]

Divisions on the current health care system are more muted. Republicans divide, 47-49 percent, in favorable vs. unfavorable opinions of the system as it is now. Positive views are 10 and 13 percentage points lower among Democrats and independents, respectively.

Among one group - conservative Republicans - favorable views of the current system inch over the halfway point, to 51 percent, while positive ratings of the ACA crater in this group at just 11 percent. Across the spectrum, among liberal Democrats, the current system is less popular by 19 points, while the ACA is more popular by a vast 60-point margin vs. conservative Republicans.

Get more pure politics at ABC News.com/Politics and a lighter take on the news at OTUSNews.com

A difference in intensity of sentiment boosts critics of the health care law: It's seen "strongly" unfavorably by 63 percent of Republicans and 57 percent of conservatives, but strongly favorably by just 30 percent of Democrats and 31 percent of liberals.

OTHERS - Among other groups, views of the ACA are more strongly negative by 15 points among full-time workers vs. those who are employed part time; by 18 points among middle-aged and older adults (40 and up) vs. those who are younger; and by 10 points among people with middle or higher incomes vs. those with household incomes less than $50,000 a year.

Positive ratings of current care, for their part, peak among senior citizens, at 86 percent - perhaps ironically, given their enrollment in the government-run Medicare program. Current care ratings also are higher, by 15 points, among people with $50,000-plus incomes, vs. their lower-income counterparts. And strongly favorable ratings of current care spike, in particular, among people in $100,000-plus households.

[Related: Is the individual mandate a red herring?]

In all, however the Supreme Court rules, views on health care leave most Americans in a long-familiar place: torn between satisfaction with their own quality of care and unhappiness with the current system overall - and dissatisfied with the solutions as yet put forth.

METHODOLOGY - This ABC News/Washington Post poll was conducted by landline and cell phone June 20-24, 2012, among a random national sample of 1,022 adults. Results have a margin of sampling error of 3.5 points. The survey was produced for ABC News by Langer Research Associates of New York, N.Y., with sampling, data collection and tabulation by SSRS/Social Science Research Solutions of Media, Pa.

Also Read

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Health care: Issues roundup

The Supreme Court is expected to rule on the constitutionality of the health care reform law this month.The Supreme Court will rule on the Affordable Care Act this monthNo matter the ruling, most Americans will be affected For more on the Affordable Care Act, check back with CNN.com/health

(CNN) -- While many changes to Americans' health care outlined in the the Patient Protection and Affordable Care Act don't take effect until 2014, a Supreme Court ruling expected this month could stop those changes from coming at all.

The act, often referred to as "Obamacare," is a step toward guaranteeing insurance coverage for all Americans and received enough support to pass in Congress in 2010. However, the Supreme Court agreed to hear arguments on several of its core issues in March. The court may rule on the issues by the end of this month.

Basics: Health care reform issues

No matter the ruling, most Americans will be affected. Here are some of the issues being discussed right now:

Business owners

One hundred and sixty million Americans receive health care from their employers, many of whom set their own rates for their employees. If the court rules against the act, employees might face higher premiums, fewer network providers, higher-deductible plans and more stringent regulations on adding adult dependents.

What is Corporate America's Plan B to safeguard employees and industry if the act is struck down? Here are some insights:

Employers' 'plan B' if health reform is axed

Employers bear brunt of health insurance hikes

Small business owners

If you run your own company, the act has a lot of good in store for you -- that is, if you know how to access it. Many small business owners across the country who do offer health coverage haven't taken advantage of, or didn't even know about, a tax credit that helps offset giving employees insurance.

Why wouldn't small business owners take advantage of this? CNNMoney answers that question and talks about what might happen if only parts of the act are kept:

The health care tax credit few are taking

What's at stake for small businesses

National spending

Being insured helps safeguard against pricey medical bills. However, a report released Tuesday from the Centers for Medicare and Medicaid Services suggests that the act won't limit national health spending. In fact, it predicts that spending will skyrocket after a brief recession-induced dip.

Growth in health spending doesn't necessarily correlate with growth in health care costs, but what does it mean? Here's a projection:

Health spending growth to stay low, then jump

America's youth

For today's young adults, health care comes last. If you can't afford to feed and clothe yourself, why budget for something that hasn't happened yet? However, youth get sick too, and their future bank accounts might take a toll if the act is repealed -- or if they don't insure themselves, period. Additionally, the ones who do insure themselves tend to forgo expenditures elsewhere (like graduate school) to make ends meet.

Young adults skip health care as medical debts rise

For 20-somethings, health care hangs in the balance

Senior citizens

Health reform has been the belle of the senior citizen community, saving Medicare beneficiaries a collective $3.7 billion dollars on their medication costs since its inception in 2010. One of the reform's aims is to close the "donut hole," or portion of senior citizens that can't pay for medication out of pocket, by 2020.

Read how Medicare has been affected by health care reform:

Medicare: Seniors saved $3.7 billion on medicine

Doctors at risk

Increases in insurance coverage and changes in Medicare help patients avoid footing hefty medical bills, but sometimes their doctors pay the price.

Read why some doctors are running out of money:

Doctors going broke

Silver linings

Just because a negative ruling would give health insurers and states the ability to opt out of reform-era options doesn't mean they're going to. UnitedHealthcare, the nation's largest health insurer, said that while it will take cues from competitors, it will maintain some of the act's key mandates regardless of the court's decision. Moreover, there is strong bipartisan support for state-created health care exchange programs, many of which have been set into motion, where those seeking insurance can look for subsidized coverage.

UnitedHealthcare to keep some health care mandates

Exchanges could survive even if health reform law dies

The fine print

Very few people take the time to read bills in their entirety, but should we? CNN investigates lesser-known changes to the health care system tucked into "Obamacare."

Check out these tidbits:

10 lesser-known effects of health care reform law

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Health Dialog to Showcase New Online DECISION Dialog® Solution on Capitol Hill

Thu, Jun 28, 2012, 8:12 AM EDT - U.S. Markets open in 1 hr 18 mins

Sorry, I could not read the content fromt this page.

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Day 45 - Fasting For Weight Loss - Still Going Strong!

Another daily update, just 11 days to go until the juice fast is complete.

Today's video is next to some busy traffic and probably the drivers in the cars going past thought I was crazy. Still some interesting information I feel in todays video, so please take a look.

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Ruling Expected on Health Care Reform

There's much anticipation as the nation's highest court makes a decision on health care reform.

*More: http://abcn.ws/KOqjUv

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Health Net Community Solutions Salutes Three Kern County Groups for Helping Build Healthier Communities

Thu, Jun 28, 2012, 8:12 AM EDT - U.S. Markets open in 1 hr 18 mins

Sorry, I could not read the content fromt this page.

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Zacks Investment Ideas feature highlights: ProShares Ultra Health Care ETF, ProShares UltraShort Health Care ETF ...

For Immediate Release

Chicago, IL –June 28, 2012 – Today, Zacks Investment Ideas feature highlights Features: ProShares Ultra Health Care ETF (RXL), ProShares UltraShort Health Care ETF (RXD), Direxion Daily Healthcare Bull 3x Shares (CURE) and Direxion Daily Healthcare Bear 3x Shares (SICK).

Health Care ETFs & the Future of Obamacare

In summary, if the individual mandate is thrown out, it looks likely to spell bad news for the entire sector. That is because the mandate would add a ton of cheap-to-ensure people to the rolls of HMOs while it would drive up demand for devices, services and drugs, helping pretty much the entire industry.

If the bill is upheld in its entirety, a much more mixed outlook could be the result. With that being said, it will definitely be a big win for pharma, and to an extent healthcare providers and service companies as well. However, medical device makers look likely to be hurt by the ruling due to new taxes, while biotech could suffer from a similar issue as well (see Medical Device ETFs: A Better Way To Play Health Care?).

Lastly, if the entire bill is deemed unconstitutional, which at this point seems unlikely, it also could produce a mixed result. Broad health care is likely to stay about even, but investors could see a modest uptick for device makers and biotech, while pharma and the HMO market could be losers due to lower demand for their services.

Beyond these unleveraged choices, investors also have a few ways to play the decision with leverage. In total, there are four ETFs in this segment of the fund world, offering investors exposure to both bull and bear 2x strategies as well as both directions in 3x form as well:

ProShares Ultra Health Care ETF (RXL)/ ProShares UltraShort Health Care ETF (RXD)- These two products track, respectively, the 2x and -2x versions of the Dow Jones Health Care Index. This benchmark is heavily weighted towards big pharma, but it is still relatively spread out among its 122 securities.

Direxion Daily Healthcare Bull 3x Shares (CURE)/Direxion Daily Healthcare Bear 3x Shares (SICK)- These two products track, respectively, the 3x and -3x versions of the Health Care Select Sector Index. Much like their ProShares counterparts, these funds have a focus on big pharma, although they have a heavier level of concentration in their top securities, only holding 52 stocks in total (read Understanding Leveraged ETFs).

While the volumes on these products aren’t exactly the most robust in the ETF world-- suggesting relatively wide bid ask spreads-- they could see higher levels of activity leading up to and immediately following the in-focus decision. Given this, these products could be the way to play the situation, although investors should be prepared for a great deal of volatility and uncertainty no matter what health care stocks or ETFs they hold immediately following the pivotal Supreme Court ruling.

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Health care ruling: Five scenarios

The Supreme Court is set to rule on the constitutionality of the controversial health care law passed in 2010. The election-year rulings will guide how Americans receive medical careThey will also set boundaries for how government regulation can affect a range of social areasAn 1867 law could play a pivotal roleThe government's key lawyer fielded more than 100 questions from the bench

Washington (CNN) -- The Supreme Court is set to release its much-anticipated rulings on the constitutionality of the Affordable Care Act, the comprehensive health care law enacted two years ago.

The election-year rulings will not only guide how every American receives medical care but will also establish precedent-setting boundaries for how government regulation can affect a range of social areas. Your health and your finances could be on the line.

The outcome's possibilities are myriad: a narrow or sweeping decision? A road map to congressional authority in coming decades? Which bloc of justices, which legal argument will win the day?

Here are five scenarios -- strategic markers of a sort -- to watch as the high court weighs in on health care.

Wait another day?

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A little-known federal law -- the Anti-Injunction Act, dating back to 1867-- bars claimants from asking for a refund on a tax until it has been paid.

This "gateway" issue could render moot all the other pending health care questions if the justices think the minimum coverage requirement amounts to a tax.

Most justices seemed reluctant to take that route at the public argument session; they appeared eager to move on and address the broader, more vital constitutional questions. But citing the Anti-Injunction Act might give cautious justices a way out of deciding the explosive issue in an election year.

The majority might conclude that the political branches can best resolve the conflicts, at least for now, or that the matter can be handled after the November elections.

Some court watchers have called this the health care "sleeper issue" that could delay a decision on the constitutionality of the individual mandate for at least four years.

'Weak argument' = certain loss?

Baseball statisticians have nothing on the legal bar. After the arguments, wonky lawyers began counting the number of questions -- some hostile, some polite -- that the nine justices had tossed at opposing counsel. The somewhat squishy idea: the more questions a lawyer gets, the tougher it will be to prevail.

During the two hours of debate over the most closely watched aspect -- the individual mandate -- Solicitor General Donald Verrilli fielded more than 100 questions from the bench. His opponents -- private attorneys Paul Clement and Michael Carvin-- together faced only about 87. Verrilli, as the federal government's key lawyer before the high court, was defending the law from a coalition of 26 states seeking its nullification.

Verrilli, in the view of many court-watchers, had a bad day, struggling at times to find his voice and fend off a furious rhetorical assault by some skeptical members of the bench.

Chief Justice John Roberts was especially tough -- he interrupted Verrilli 23 times, but only on seven occasions on the other side.

As a former government and private advocate before joining the bench, the 57-year-old chief personally argued 39 cases at the high court and was widely regarded as among the best at making his case.

In 2004, while a federal appeals court judge, Roberts wrote a law review article explaining why query counts matter.

"The secret to successful advocacy is simply to get the [Supreme] Court to ask your opponent more questions," he wrote.

Divide and conquer -- 5-4 decisions

But a perceived "weak" argument or a voluminous volley of questions does not necessarily spell doom for the Obama administration. Getting nine intellectual hotshots with big egos to line up all the time along "expected" conservative-liberal lines is largely a myth.

Only eight of the 55 full opinions released by the court this term have been decided by a one-vote margin. Of course, the most contentious cases are normally the last to be finished, and the number of 5-4 rulings is likely to rise with the 15 or so petitions remaining on the docket. But closely "divided" decisions are not the norm overall.

Some legal and political scholars hold out hope the court will offer a united 9-0 voice behind the law's mandate, whatever the outcome, hoping such a decision would instill political and public confidence. They point to the 1954 Brown v. Board of Education case, in which the justices -- despite internal disagreements -- came together to unanimously strike down racial segregation in public facilities.

But this is a different court and health care in many ways is unique in the court's jurisprudence -- the scale, scope, and political underpinnings all make it especially complex and contentious.

To "swing" again

A recent "Time" magazine cover featured an intense, distinguished-looking older man, wearing glasses and the slightest of smiles. Most Americans would not recognize him if he walked down the grocery store aisle.

But, as with most hot-button Supreme Court cases, Justice Anthony Kennedy -- the moderate-conservative often referred to as the "swing" justice -- could decide whether the individual mandate stands.

So many are watching the native of Sacramento, California, who turns 76 next month, as well as another fellow conservative.

"With the four more liberal justices almost certain to vote to uphold the individual mandate, the administration is really hoping for the votes of either the chief justice, who signaled that he had questions for both sides, or the traditional swing vote in the court, Anthony Kennedy, who really was tough on the government lawyer but toward the end suggested that maybe insurance was special enough that he could vote to uphold the mandate," said Thomas Goldstein, SCOTUSblog.com publisher.

Even the perception that his vote might be in play builds Kennedy's power from within, and makes him one to watch.

R-E-S-P-E-C-T

Will the Supreme Court think big when issuing its decision -- sweeping pronouncements on the scope of federal vs. state power when it comes to the Commerce Clause? Or will a narrow approach be the way the justices reach consensus, some sort of workable solution that would give Congress clear guidance going forward -- the discretion to perhaps reshape health care in a way that meets constitutional scrutiny.

The key may be how the court's shaky conservative majority defines a long-standing bedrock principle: judicial deference.

Some states have long complained that their autonomy is being eroded by creeping federal intervention on spending matters.

Article 1 of the Constitution gives Congress the power to "lay and collect ... taxes to pay the debts and provide for the common defense and general welfare of the United States" and to "regulate commerce ... among the several states."

Such authority has long been broadly interpreted, including when imposing conditions on recipients, be they individuals or states.

Every student of government knows the Supreme Court has the power to declare acts of Congress unconstitutional. The precedent-setting 1803 Marbury v. Madison decision remains a cornerstone of federal court authority, codifying the idea of separation of powers as an enduring hallmark of the American system of government.

That power has been used wisely -- judiciously, if you will -- over the years. The courts by their nature are reluctant to frustrate the will of the political branches, which are accountable directly to the people.

It is a message President Obama himself offered just days after oral arguments in the health care cases were completed.

"The point I was making is that the Supreme Court is the final say on our Constitution and our laws, and all of us have to respect it, but it's precisely because of that extraordinary power that the court has traditionally exercised significant restraint and deference to our duly elected legislature, our Congress," said the former law school professor. "And so the burden is on those who would overturn a law like this."

Some conservatives interpreted those and remarks the day before as political interference in an independent branch of government.

"The president crossed a dangerous line this week, and anyone who cares about liberty needs to call him out on it," Senate Minority Leader Mitch McConnell, R-Kentucky, said. "The independence of the court must be defended. Regardless of how the justices decide this case, they're answerable, above all, to the Constitution they swore to uphold. The fact that this president does not appear to feel similarly constrained to respect their independence doesn't change that one bit. So respectfully, I would suggest the president back off."

The justices themselves are not prepared to back off when they issue their decision. Nor are they likely as individuals to back into the political firestorm sure to follow. Their ruling will speak for itself -- however big, small, or confusing it may be. After that, the justices will again retreat largely from public view, to begin a three-month recess.

Timeline of the health care law

Health care's big four issues: What the justices are tackling

updated 10:47 PM EDT, Wed June 27, 2012 At stake in the court's ruling is the well-being of millions of Americans living with chronic diseases such as cancer. updated 1:20 AM EDT, Mon June 25, 2012 It's less of a tongue-twisting jumble than the phrase "Patient Protection and Affordable Care Act."updated 5:48 AM EDT, Mon June 18, 2012 Video: President Obama's health care reform law is in jeopardy. Sanjay Gupta and Will Cain join Christine Romans to explain the possible implications. updated 5:47 AM EDT, Mon June 18, 2012 In the Supreme Court, five majority votes among the nine members are enough to fundamentally change lives and legacies.updated 8:06 PM EDT, Wed June 27, 2012 The Supreme Court is set to rule on the constitutionality of the Patient Protection and Affordable Care Act on Thursday. The landmark decision will dictate the way health care is administered to millions of Americans. updated 10:35 AM EDT, Sun June 17, 2012 Video: Rep. Chris Van Hollen and Sen. John Barraso analyze Obama's healthcare mandate before an upcoming supreme court ruling. updated 11:16 AM EDT, Sun June 17, 2012 A look at key moments in the law's history from the start. updated 7:52 AM EDT, Mon June 25, 2012 A look at the four issues the high court tackled separately during oral arguments in late March. Those issues are expected to play key roles in the judges' final decisions.updated 3:48 PM EDT, Wed June 27, 2012 Elizabeth Cohen explains how the Supreme Court's ruling on health care affects people with real-world examples.updated 7:58 AM EDT, Thu June 28, 2012 The Supreme Court is set to release within a few days its rulings on the constitutionality of the Affordable Care Act.updated 11:15 AM EDT, Tue June 26, 2012 All you need to know about health care reform issues and what is at stake. Most popular stories right now

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US health care reform efforts through history

WASHINGTON (AP) — The Supreme Court's ruling on President Barack Obama's health care overhaul law follows a century of debate over what role the government should play in helping people in the United States afford medical care. A look at the issue through the years:

1912: Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House.

1929: Baylor Hospital in Texas originates group health insurance. Dallas teachers pay 50 cents a month to cover up to 21 days of hospital care per year.

1935: President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first.

1942: Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk.

1945: President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere.

1960: John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress.

1965: President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor.

1974: President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes.

1976: President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside.

1986: President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost.

1988: Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.

1993: President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate.

1997: Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid.

2003: President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people.

2008: Hillary Rodham Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Obama, who has a less comprehensive plan.

2009: Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance.

2010: With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare."

2012: On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care."

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Obamacare & Health Care ETFs: What You Need To Know

After a slew of announcements early Monday prompted speculation that a decision on health care legislation was imminent, we learned that Thursday will be the day for one of the most heavily anticipated rulings in the last several years. The Supreme Court is expected to issue a ruling on the health care legislation that was passed in 2010, bringing a conclusion to years of legal wrangling and politicking behind the scenes. The justices are expected to issue a split opinion, and analysts have been divided over how they will rule. Given the far-reaching impact of the decision, the health care sector figures to see increased scrutiny and trading volumes throughout the week.

Three Outcomes

Analysts see a wide range of possible outcomes in the wake of the Supreme Court ruling, with potential positives and negatives for the health care industry. In a recent research note, S&P Capital IQ ETF Analyst Todd Rosenbluth outlined three possible scenarios for Thursday’s announcement and gave some thoughts on what each would mean for the health care sector [sign up for the free ETFdb newsletter]: 

Scenario #1: Individual Mandate is Constitutional

Under this scenario, which is deemed to be the most positive for the health care industry, the Supreme Court would essentially side with the Obama administration and rule that the mandate for individual insurance is constitutional and can be implemented as scheduled. This could represent a “win” for the health care sector since it would lead directly to an inflow of more than 30 million additional insured customers over the next several years (beginning in 2014).

In the current political environment, however, this scenario could lead to additional uncertainty for the health care industry. Republican presidential candidate Mitt Romney has vowed to repeal the health care package if elected, which could lead to additional doubt over the long term prospects for the law if the November election is close as expected. The implementation and subsequent repeal of the entire law would translate into major expenditures for the health care sector, potentially creating a short term drag on efficiency and profit margins.

This is the “best case” scenario for health care ETFs

Scenario #2: Entire Law Struck Down

Another possibility is that the Supreme Court determines the individual mandate to be unconstitutional, and further rules that the mandate is a primary component of the legislation. That would mean that the individual mandate can’t be stripped out from the rest of the law, and the Court would effectively invalidate the entire law. This would lead to healthcare reform eventually being rolled back entirely, which would likely be a complex process.

S&P sees this as a neutral outcome for the health care sector in general; while the loss of millions of new insured individuals would dramatically reduce growth potential, the elimination of the various fees, taxes, and regulations that are part of the overhaul would disappear as well.

This scenario would likely be neutral to health care ETFs

Scenario #3: Individual Mandate Struck Down, Rest Of Law Upheld

This “hybrid” scenario could be the worst possible outcome for the health care industry. It’s very possible that the Court rules the individual mandate unconstitutional but allows the rest of the law to be implemented as planned. That could be the worst of both worlds for health care providers; the pipeline of 30 million new insured Americans would essentially be emptied, while the various taxes and regulatory burdens would remain in place. According to the Congressional Budget Office, striking down the individual mandate would result in about 16 million additional Americans obtaining health insurance. Many of those would come through the expansion of Medicaid, which would weigh on profit margins of health care companies.

This is the “worst case” scenario for health care ETFs

Health Care & Biotech ETFs In Focus

Broad-based health care ETFs such as the Health Care SPDR (XLV) will no doubt be impacted by the decision handed down on Thursday. In addition, a number of more targeted funds will likely react to the news later this week as well. Among the sectors that could rise or fall depending on the decision handed down:

Pharmaceutical ETFs:  Pharma companies will no doubt be watching the legal developments on Thursday very closely; the Supreme Court’s decision should have a direct impact on demand for pharmaceuticals in coming years. Upholding the law would be the most beneficial scenario for this sector; just as it would funnel tens of millions of Americans towards new insurance, it would result in additional buyers of prescription drugs for years to come.Health Care Providers ETFs: This corner of the market could be very active in coming days, as organizations that provide health care are positioned to see the biggest impact from the ruling. The iShares Dow Jones U.S. Healthcare Providers Index Fund (IHF) includes owners an operators of health maintenance organizations, hospitals, clinics, nursing homes, and rehab centers. If the entire law is upheld, expect IHF to get a boost on Thursday.Biotech ETFs:  The biotech sector has been one of the few bright spots in 2012; this corner of the market has posted gains approaching 30% on the year. Though biotech has less direct exposure to the ruling than other corners of the health care market, the various biotech ETFs could see some limited impact on Thursday.

Disclosure: No positions at time of writing.

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What's Obamacare's prognosis? Health care professionals take the Supreme Court's temperature

Dr. Mary O'Brien, a board member of Physicians for a National Health Program, and former hospital CEO Stan Hupfeld break down what the different possible Supreme Court rulings on Obama's Affordable Care Act tomorrow would mean for health care reform.
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Health plan on Mo. ballot, no matter court ruling

JEFFERSON CITY, Mo. (AP) — No matter whether the federal health care law stands or falls before the U.S. Supreme Court, Missouri voters will get to register their opinions this November on whether the governor should be allowed to set up an online marketplace for patients to shop for insurance policies.

It will be the second time in two years that Missourians may cast a largely symbolic vote related to the health care law signed by President Barack Obama.

In August 2010, Missouri became the first state to officially snub the new federal law when 71 percent of voters approved a proposition barring the government from requiring people to have health insurance. The Missouri law set up a direct conflict with a federal provision requiring most people to have health insurance by 2014 or face penalties. However, it was considered largely symbolic because federal laws generally trump state laws.

The insurance mandate is at the center of a legal challenge expected to be decided Thursday by the U.S. Supreme Court in a case brought by attorneys general in about half the states. The Supreme Court could strike down the entire law, uphold it or issue a mixed ruling invalidating some portions — such as the insurance mandate — while allowing other provisions to stand.

At issue for Missouri voters this November will be one of those other provisions in the federal law: a requirement for states to create a health insurance exchange by 2014 or have the federal government run one for them. The insurance exchanges are meant to provide individuals and small businesses a way to compare and buy health insurance policies online — sort of like what already exists for airline tickets and hotel rooms. Missouri had about 835,000 uninsured residents in 2010, about 14 percent of the population, according to the U.S. Census Bureau.

The Missouri ballot measure would allow a state-created insurance exchange only if it is specifically authorized by a state law or a subsequent vote of the people. It would prohibit the governor or any executive branch officials from taking any steps toward establishing an exchange on their own.

If the Supreme Court strikes down the requirement for health insurance exchanges, Missouri's upcoming vote "becomes much less important," acknowledges state Sen. Rob Schaaf, R-St. Joseph, a family physician who sponsored the ballot measure.

But even if the federal law is upheld, Missouri's vote may be largely symbolic.

That's because Nixon's administration has halted efforts to lay the groundwork of an insurance exchange, and it may be too late for Missouri to do so after the Nov. 6 election. States face a Nov. 16 deadline to submit plans for health insurance exchanges to the U.S. Department of Health and Human Services.

The Legislature is not in regular session again until January, and Nixon has said he won't use an executive order to create an exchange without legislative approval.

At one point, however, it appeared Missouri was on a path toward setting up an exchange.

The state received a $1 million planning grant and was awarded a $20.8 million federal grant to make further preparations for an insurance exchange.

A state board was scheduled last September to allocate a portion of that money for consultants to work on the technical aspects of an insurance exchange. But the board vote was canceled — and never rescheduled — after Schaaf and several other Republican state senators complained that Nixon's administration was attempting to implement an insurance exchange without legislative approval. That feeling of distrust led lawmakers to refer the prohibitory measure to the November ballot.

If the state must have an insurance exchange, Schaaf said he would prefer to let the federal government run it — partly, to save the state money.

State Rep. Chris Molendorp, a Republican who runs an insurance agency in Raymore, had sponsored legislation in 2011 that would have created a state-run insurance exchange. It passed the House but died in the Senate under opposition from some Republicans who didn't want to pass anything that could be viewed as endorsing Obama's health care law.

If the Supreme Court upholds the requirement for health insurance exchanges, Molendorp hopes Missouri lawmakers could rush a bill to passage in January and persuade the federal government to accept a state-based plan — even though it would be past the application deadline. He said there's no guarantee that a federally run insurance exchange would "preserve the uniqueness of our marketplace" or allow people to purchase the policies through local insurance agents instead of online or over a toll-free telephone number.

"I'm trying to be the grown-up about this," Molendorp said. "I understand that the majority of Missourians are not supportive of the health care law, but if the Supreme Court on Thursday upholds it, other than secession, what is my choice?"

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Health Highlights: June 22, 2012

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Seizure Leads to U.S. Commerce Secretary's Resignation

A seizure suffered earlier this month has led U.S. Commerce Secretary John Bryson to resign from the Obama administration.

Bryson, 68, was found unconscious after he was involved in a series of traffic crashes in the Los Angeles earlier this month. A breathalyzer test did not detect any alcohol, the Associated Press reported.

In his resignation letter, Bryson said his decision was a "consequence of a recent seizure and a medical leave of absence."

He also wrote: ""I have concluded that the seizure I suffered on June 9th could be a distraction from my performance as secretary, and that our country would be better served by a change in leadership," the AP reported.

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Traffic Noise Increases Heart Attack Risk: Study

People who live near roads with high levels of traffic noise are at increased risk for a heart attack, according to a new study.

Researchers followed more than 50,000 people in Denmark, ages 50 to 64, for 10 years and found that for every 10 decibel rise in traffic noise near a person's home, there was a 12 percent increased risk of a first heart attack, ABC News reported.

The study was published Wednesday in the journal PLoS One.

Previous research has found some association between traffic noise and heart health but study lead author Dr. Mette Sorensen said she was surprised to find such a direct link between traffic noise levels and heart attack risk, ABC News reported.

"Previously, there seemed to be no effect up to around 60 decibels," she said. "But I see increases at around 40 decibels up to the highest level, around 82 decibels. It doesn't seem to be a level where there are no effects."

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Group Challenges Merck's Marketing of Children's Allergy Medicine

Drug maker Merck is using animated characters from the movie "Madagascar 3: Europe's Most Wanted" to improperly market over-the-counter allergy medicine to children, public health advocates charge in a complaint filed Wednesday with the U.S. Federal Trade Commission.

The Public Health Advocacy Institute and 10 other groups say the marketing strategy for Children's Claritin is dangerous and deceptive. They point to the inclusion of Madagascar movie stickers in some boxes of the allergy medicine, activity books that parents can download for their children, and Merck's enlistment of a group of mothers who blog to hold Claritin-themed Madagascar viewing parties for their children and friends, The New York Times reported.

The complainants also noted that the same animated characters are used to promote other children's products such as candy and gummy snacks. This could lead children to confuse the grape-flavored Claritin tablets and syrup for candy, they warn.

Merck is reviewing the issue, spokeswoman Kelley Dougherty told The Times. But she added: "We advertised in appropriate venues to reach those parents of children who may benefit from the use of Claritin, and not to the children themselves."

The FTC will review the complaint, an official said.

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Fat-Free Salad Dressings Reduce Nutrient Intake: Study

Putting a fat-free dressing on your salad may actually reduce the amount of nutrients your body absorbs from the vegetables and fruits in your salad, a new study suggests.

Purdue University researchers found that some fat in dressings is essential to absorb compounds such as lycopene and beta-carotene, which have been linked with a reduced risk of illnesses such as heart disease and cancer, the Los Angeles Times reported.

The study was published online Wednesday in the journal Molecular Nutrition & Food Research.

"If you want to utilize more from your fruits and vegetables, you have to pair them correctly with fat-based dressings," lead author Mario Ferruzzi, an associate professor of food science, said in a news release, The Times reported. "If you have a salad with a fat-free dressing, there is a reduction in calories, but you lose some of the benefits of the vegetables."

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New Dengue Fever Test Approved by FDA

A new test for dengue fever that was developed by the U.S. Centers for Disease Control and Prevention has been approved by the Food and Drug Administration.

The test can identify all four types of dengue virus types and will help diagnose dengue within the first seven days after symptoms of the illness appear, when is when most people are likely to see a doctor, the CDC said.

This is the first FDA-approved test that detects evidence of the virus itself and the test can be performed using equipment and supplies that many public health laboratories already use to diagnose influenza. Test kits will be available for distribution in early July.

Dengue viruses are transmitted by mosquitoes. Thousands of U.S. citizens in Puerto Rico and the U.S. Virgin Islands develop dengue every year, and dengue is a leading cause of fever in American travelers returning from Asia, the Caribbean and Latin America.

Severe dengue infections can lead to hemorrhage, shock and death. There are no vaccines to prevent dengue or medicines specifically approved to treat the disease, but early medical care can greatly reduce the risk of death, the CDC said.

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