Obama's signature health policy declared legal

WASHINGTON // The US supreme court ruled yesterday that the most controversial parts of the president Barack Obama's signature health care law are constitutional, giving him an important election-year victory.

The justices ruled 5-4 that the key provision that requires Americans to have health insurance or pay a penalty is legal.

The court struck down a provision to expand Medicaid - the government health-insurance programme for low-income people and those with disabilities.

But the bulk of the law, known as the Affordable Care Act, remains intact, handing a significant victory to Mr Obama and Congressional Democrats.

The decision affects nearly every American and marks a major milestone in a century of efforts to make health care available to all. The law is Mr Obama's most significant legislative achievement and perhaps the most polarising issue of his re-election campaign.

He hailed the decision as a "victory" for people across America. "Whatever the politics, today's decision was a victory for people all over this country whose lives are more secure because of this law and the supreme court's decision to uphold it," Mr Obama said.

"The highest court in the land has now spoken. We will continue to implement this law. We will work together to improve on it where we can."

With the ruling, the US president avoided an "unquestionable political setback" just four months ahead of the presidential elections in November, said Patrick Griffin, the academic director of the public affairs and advocacy at American University in Washington. Though not "determinative" for an election in which the economy remains the number-one issue, Mr Griffin said the ruling would be of both personal and political benefit to Mr Obama.

Just hours after the court released its decision, Mitt Romney, Mr Obama's Republican challenger in the presidential race, renewed his promise to repeal the law, which opponents call "Obamacare."

"What the court did not do on the last day in session, I will do on my first day if elected president of the United States, and that is that I will act to repeal 'Obamacare.'"

"Obamacare was bad law yesterday. It is bad law today," he said.

The law was polarising from the start, passing the then Democratically controlled House of Representatives without a single Republican vote in 2010.

In the Senate, only one Republican voted in favour of it. The sweeping law was primarily designed to provide health insurance for more than 30 million Americans without any, providing a form of nationalised health care.

The law requires people to obtain health insurance beginning in 2014, either from their employers, under a government plan or by buying it themselves. After 2014, those without insurance would be penalised.

Some provisions of the law have already gone into effect, including free health exams for senior citizens and allowing children up to the age of 26 to remain on their parents' policies.

It was the provision requiring Americans to obtain health insurance that opponents deemed unconstitutional, however.

That requirement was at the heart of the legislation and necessary to secure support for the bill from the insurance industry.

With insurance companies compelled to take on people with pre-existing conditions and thus likely cost more, the industry saw the enormous expansion of the number of those insured as a way to recoup potential losses.

The individual mandate was originally a Republican suggestion used to block health care reforms in the 1990s, said Mr Griffin, who served as assistant for legislative affairs to the former president Bill Clinton from 1994 to 1996.

This time, however, Republican opponents argued it was unconstitutional for the government to require individuals to buy a product. That quickly became a rallying cry for those on the right of American politics, who consider most federal regulation an attack on individual freedoms.

Opposition to the law galvanised during the 2010 midterm elections, helping Republicans win control of the House of Representatives and fuelling the rise of the Tea Party.

The law remains unpopular. Fifty-four per cent of Americans wanted to see the Supreme Court declare the law unconstitutional, according to a Rasmussen poll taken this month. Only 38 per cent wanted it upheld.

In large part, suggested Mr Griffin, opponents had been more effective in attacking the bill. The Obama administration might now take the ruling as a "hook" to convince Americans that the law has "value and importance", he said. Certainly, the issue will not go away.

"The Republicans are now going to double down on why the law should be repealed," Mr Griffin said.