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Slight majority opposes Affordable Care Act ruling

By 51 percent to 49 percent, respondents to this week’s RBJ Daily Report Snap Poll narrowly oppose the U.S. Supreme Court decision upholding the Patient Protection and Affordable Care Act of 2010.

By a 5-4 vote, the high court ruled that the law’s centerpiece individual mandate was constitutional.

The opinion, written by Chief Justice John Roberts Jr., rejected the Obama administration’s argument that requiring most Americans to obtain health insurance or pay a penalty fell within Congress’ power to regulate interstate commerce. However, the court majority held that the mandate was allowed under lawmakers’ power to levy taxes.

The court blocked only one provision of the Affordable Care Act, saying the federal government could not compel states to expand Medicaid by threatening to withhold funding for existing Medicaid programs.

Mitt Romney, the likely Republican presidential nominee, said that if elected he would seek to repeal the law and push for market-based solutions. The plurality of respondents—37 percent—agrees that the next step for Congress should be to repeal the Affordable Care Act.

President Barack Obama welcomed the ruling, vowing to implement the law while working to improve it. Thirty percent of respondents support keeping the law as enacted.

Some 17 percent of respondents say Congress should repeal parts of the law, and 16 percent recommend replacing the law with a single-payer “Medicare for all” system.

Roughly 820 readers participated in this week’s poll, which was conducted July 2.

Do you agree or disagree with the U.S. Supreme Court decision upholding the Affordable Care Act?
Agree: 49%
Disagree: 51%

What should Congress do now that the Supreme Court has upheld the Affordable Care Act?
Keep the law as enacted: 30%
Repeal parts of the law: 17%
Repeal the entire law and rely on market-based solutions: 37%
Replace the law with a single-payer “Medicare for all” system: 16%

COMMENTS:

Everyone knows that the Patient Protection and Affordable Care Act is not perfect, but it’s a good starting point toward necessary change. However, to create a working health care system, the politicians are going to have to get past politics and stop trying to make this an emotional issue between Republicans and Democrats. It’s time to stop arguing, think ahead and promote positive change in a health care system that’s broken.
—Nancy May, APPC

There were parts that were excellent. There were parts that were good. There were also parts that were challenging. Health care reform had to happen. Good, bad or ugly, it’s time to move forward.
—Holly Anderson, Breast Cancer Coalition

Market-based solutions are the only way that health care costs can be contained. Until people have legitimate choices across state lines, costs will continue to skyrocket.
—Bob Worden, Penn Yan

Millions who have none will receive coverage and have access to good health care. We are the only wealthy nation with people who have no health care benefits, and that is dead wrong. When the uninsured need emergency care, it costs all of us in the long run. The court decision may help to reduce that expense for all of us.
—Roz Goldman

Every American deserves access to health care. This bill does that. It is not perfect but a good start. Let’s work on making it better; we are a “can-do nation.” Let’s not make the cynics prevail. Affordable, high-quality health care should be a right for all Americans.
—Clay Osborne, True Insights Consulting

The most worrisome aspect of the decision is Roberts’ rewriting of the law rather than only interpreting the law. This could have huge ramifications in the future. I fear that America is straying further and further from the Constitution and wonder what the future will bring. I am not hopeful.
—Jeff Luellen

I see this ruling as yet another step toward socialism and government-controlled central planning of every aspect of our lives.
—Paul Conaway, Lockheed Martin Co.

For too long now, the court has functioned as hacks for their political parties. It is about time the justices made a decision based on the best interest of the American people.
—Gary S. O’Dea, owner, Sourcing Solutions Associates LLC

Chief Justice Roberts did nothing more than live up to his promise, made at his confirmation, to eschew judicial activism and not substitute his judgment for that of the elected branches of government. The Supreme Court should not be deciding whether the ACA is the best solution to the coming crisis in health care. The court should only decide if Congress has the power to adopt this particular solution.
—Michael Harren, attorney

The decision is the lesser of two evils, hardly a cause for celebration. Health care in the U.S. is a national embarrassment, inferior to most advanced economies. We pay two to three times as much as the next most expensive. Both quality of health and life expectancy here are lower than many other countries. The only way we can ever get costs down is a single-payer system that’s powerful enough to negotiate better prices and outcomes. There is no reason my health care dollars should go to insurance companies and not to doctors and other health professionals.
—Gary Bogue, independent consultant

Based on the point that Supreme Court Justice Roberts ultimately exposed the Affordable Care Act as a tax, I would agree with the decision. It will be interesting to see how the collections of penalties (tax) on individuals who do not provide proof of coverage will be done. I liken that to getting blood from a rock. It still remains to be seen how this is going to lower the cost of health insurance. The law needs to be revised because it places additional cost burdens on small business. If it can’t be revised, it must be repealed.
—Dan Macikowski, McAlpin Industries

Having been involved with the initial implementation of Medicare and involved in health care solutions for the past 32 years, I can say that the plan as written is a costly nightmare. It will not assure us of affordable, comprehensive health care or consistency amongst the states. It will assure us that we will continue to be taxed to the max and supportive of government red tape and half-baked solutions.
—Fran Pullano, Pullano & Co.

I was under the impression that in this country, the majority of the population rules. How can five justices ignore the wishes of the majority of the population? Something fishy going on here!
—J.A. DePaolis, Penfield

The Supreme Court said it was a tax, and Congress can tax (although tax bills are to originate in the House and this was not). Obama says this is not a tax. So who is right? One or the other is incompetent and needs to be replaced. Go figure.
—Joe Camar

Government should stick with maintaining public order and defending our borders from foreign powers. It doesn’t do either one of them very efficiently, but there is no one else to do the job. For everything else, the government should stay away. Regulate if necessary, but not run the system. For government to be running health care by telling my doctor how to practice medicine is just nuts, but there are plenty of liberals who want government to decide virtually everything about how we live our lives. No thanks.
—Bob Sarbane

"Agree" or "disagree" is a little dichotomous, for what was ultimately a split ruling. One may agree with the outcome without agreeing with the reasoning that led to that outcome.
—Matthew D. Wilson

Affordable Care Act—oxymoron or not? Here we are two days after the decision and already we are reading articles such as Excellus files for rate increases between 8 percent and 19 percent for 2013. “Health Battle Enters Round 2” as hospital owners want the government to reduce the $155 billion in health care payment cuts they agreed to during negotiations over the law. Makers of medical devices hope to roll back a 2.3 percent tax on their sales contained in the measure. Insurance companies want more leeway to charge older people higher rates than younger people. A new 3.8 percent surtax on investment income. A Medicare surcharge of 0.9 percent. Today’s debate, is it a “penalty” or is it a “tax”? Interesting how the “Affordable” Health Care Act was named. Let’s not keep this one shrouded in mystery—let’s get it out into the open and find workable solutions.
—Tom Nientimp, Victor

For too long now, the court has functioned as hacks for their political parties. It is about time the justices made a decision based on the best interest of the American people.
—Gary S. O’Dea, Owner Sourcing Solutions Associates, LLC

Medicare for all is the obvious answer to the broken health care insurance system. The for-profit system now has the U.S. paying the most and yet being surpassed in life expectancy and infant mortality by the rest of the industrialized nations. Where else can you die due to a lack of health care or go bankrupt do to a catastrophic illness?
—Steve Lipson

Roberts blew it—character is at its best when standing for truth trumps legacy.
—Steve Wichtowski

As a citizen who has a 22-year-old child (college grad seeking employment before law school) who will be able to be on my health insurance until he completes law school, and a sister-in-law who survived ovarian cancer (three years in remission) and needs health insurance even though she has a pre-existing condition, I am pleased that the ACA was found to be constitutional. Will this legislation lower the premiums we as small business people and our employees pay for health insurance—that’s unlikely. In order to drive costs down while providing access to all, we will not be able to rely solely on market based systems. Our health care system seems destined to be a hybrid where both market and public (government) forces must work together to form a better, more cost efficient system.
—Michael L. Harf

If you only have a cost-based system, there is a lack of incentive in controlling costs or taking the high acuity patient. But acuity based systems put bedside care to the rear as documentation is king. We need cost containment, bedside care and coverage for all. Can any one system do that?
—Rich Mileo

It’s official, boys and girls! The U.S. has now officially climbed out of the ranks of the “crony capitalist/banana republic” state and jumped straight into corporatist/socialist state rankings. Run out, hug your neighbor and do your best not to reach into his pocket and steal his wallet—your government will need everything he has got. Oh, and everything you have got, too, so I wouldn’t super-size that value you meal just yet. (And you better make sure you get the small soda. Nothing over 16 ounces, of course!)
—Devon Michaels, Chili 

Get out the vote, repeal and rely on the market?
—Marty Cournan

I’m tired of gang bangers and other irresponsible people cashing in on the "working class health care lottery." Everyone should pay.
—Brenda Porter

Congress and the president said it was not a tax. What Roberts did by calling it a tax is not in his job description. Whatever his motivation—to defend his or the court’s reputation, or to deliver some slow-acting poison to the nanny state—that’s not what justices are supposed to prioritize. If he’s the umpire he claims to be, he should be umping. Instead, he rewrote the statute. I am willing to ascribe the best motives to a very smart individual, but he could have limited the commerce clause and overturned Obamacare. He did neither and when the next "hard issue" comes up, what will he do? I can make a Justice Kennedy joke any more either.
—Peter Durant, Nixon Peabody

When you go to the doctor or the dentist, do they ask you if you want to pay? Payment for good health care is not an option. The ACA acknowledges that fact. Private insurance companies are handed 20 million to 30 million new customers. Care providers are assured that they will paid, at least in part. I guess that the “free market” proponents want the government out of the payment loop. Fine, but why then hasn’t the “free market” solved the financial issues that “health-care freeloaders” create? I support the ACA as a step in the right direction.
—Wayne Donner, Rush

To the politicians in Washington: Stop being politicians and get back to working for the good of the American people in running our government. There are many more important things that need to be done instead of rehashing a good law supported by the Supreme Court of the United States.
—Sandy Johnson, Delaney Educational

It is high time that the U.S.A., in the 21th century, is catching up to the 19th century as far as caring for its people is concerned. Instead of trying to kill something that is long overdue, businesses should concentrate on how to take advantage of Obamacare provisions. Businesses have long enough complained about the burden of taking care of their employees while European companies don’t have this burden. Fighting this trend now is hypocrisy. Working on improving the system has been stymied by President Obama’s opposition, which refused to work with him on this. The Republicans should be ashamed of taking away from the people of the U.S.A. what their candidate Romney introduced in Massachusetts. It stinks of uncaring partisanship rather than caring for their Country. Unfortunately, their declaration that their primary concern is making President Obama a one-term president clouded their mind of what is needed to bring our country back out of this depression, which they after all imposed on us. Shuffling the riches of our country to a few surely is of no help.
—Ingo H. Leubner, Crystallization Consulting 

How can the basic premise of forcing someone to buy anything be constitutional? If they want to collect a tax, they should call it what it is. It seems only the "wealth" gets redistributed—not the "taxes" with this administration.
—Doug Strang

We’re the only "First World" country without a single-payer health care solution. It’s about time for that to change.
—Steven L. Smith

There has got to be a bi-partisan solution for this issue. The insurance companies have way too much power in this matter. There seems to be a myriad of government programs that need to be overhauled and streamlined. We must stop the spending and sharpen the pencil on government handouts.
—Dan Zarpentine

That the four "strict constructionists” dissented says it all. Now Congress must overturn this mess before the Federal Government takes over healthcare!
—George Thomas, Ogden

This is a tough question to answer. I agree with the decision to uphold the ACA, but I disagree with the reasoning behind the decision. I’m not a fan of the ACA as written, but I feel very strongly that we need to do something to improve our healthcare system. The questions as asked, as well as the choices you are giving us, buy into the media hype that this is an either/or all-or-nothing decision. Since our healthcare system is so complex, there is no way that a simple yes/no question can capture our thoughts adequately. Is the ACA the answer to our problems? No. Is it a step in the right direction? Possibly. The only thing we can say certainly is that it’s a step. Sometimes anything is better than standing still.
—David Englert, Sodus

I totally support the result although I’m equally totally mystified by the rationale. It makes about as much sense as the Citizens United decision. We clearly need major fixes to our healthcare system and hopefully this is a step along that path. If our legislators will put aside their ideologies and work on "getting to yes," maybe we’ll be able to make real progress toward solving the pending financial and medical disaster that is our current system.
—Alan Ziegler, president, RABEF

Now that the high court has ruled, let’s just move on! Our elected officials should be sitting at the table and finding ways to improve the situation, anything else is just bad politics. The house Republicans have tried to repeal this bill more than 30 times now, when is enough enough? If replacing certain parts of this law will improve the industry, then do it! If not, then both Republican and Democrats alike need to work with what we have to make it successful. I don’t know about you but that is what I thought we elected our representatives to do. Want to save some tax money? Then once all the rhetoric is over, let’s just insist that our elected officials ALL pull the rope in the same direction.
—Joe Leone, Chili

Many people who want this law repealed do not understand it. They are merely following a distorted interpretation of the law being promoted to derail the current presidency. If people took the time to really understand the benefits of the law for common people and small businesses they would support it. In my opinion, anyone who really understands this law and still wants it repealed are really saying, "Hey, I’ve got mine so to hell with you," an attitude that I think unfortunately speaks volumes about a minority at the fringe of our society.
—Greg Reynolds, East Rochester

I agree completely with the Supreme Court’s decision. Why is the U.S. so late in coming to the realization that health care for all is essential?
—Mary Lynn Vickers

At the very least, if Congress wants to implement this bill, it should be re-introduced for a floor vote, as it was redefined by the court, as a new tax ($1.5 trillion). If it passes again, so be it.
—Michael Hennessy, Open Door Mission

There is need to add better conscience respect provisions to the Affordable Care Act.
—Roy Kiggins, Seneca Falls

How the Republican candidate for president can continue to play partisan politics is really the frosting on the cake. The Affordable Care Act was modeled after his program in Massachusetts. What part doesn’t he like, the fact the conservative minded Supreme Court approved or that he was successful when he pushed for it as governor?
—Tom Sargent

I would like a single payer system but the chance of this type of legislation being enacted is extremely unlikely. Therefore the law as enacted is my second choice.
—Charles Kaplan

At the risk of offending my conservative comrades, I agree that we need a national health care solution. That is not possible unless there is an individual mandate. Having said that, Obamacare is unworkable because it is too complicated and requires too much government control. We need a national health care program that provides universal coverage with broad federal government guidelines but is totally administered in the private sector. The government has proven it is unable to manage something this large. A private market-driven solution is the way to go.
—Mike Kaser, Penfield

It’s about time that we did something right in the country of the people, by the people. This is a good first step for health care for all. Just like mandatory car insurance, seat belt laws, Social Security and mandatory baby seats, health care reform makes sense—common sense. We are the ONLY industrialized county in the world without it. And we think we are leaders! Thank goodness we have three female justices on court now.
—Eve Elzenga, Eve Elzenga Design

7/6/12 (c) 2012 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.

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