A health care victory for all Americans

With a historic and just decision from the U.S. Supreme Court, the nation Thursday moved a giant step closer to a health care system that will work for all Americans.

By ruling the individual insurance mandate constitutional under the taxing authority of Congress, the court preserved the delicately balanced structure of the Patient Protection and Affordable Care Act.

In order to make medical insurance accessible to the sick, Congress needed to ensure that plenty of healthy people were paying into the insurance pool. That was the rationale for requiring all Americans to either purchase an insurance policy or pay a fine.

Reflecting the complexity and emotion that have always characterized President Barack Obama’s signature health reform law, the court split 5-4 on the constitutionality of the insurance mandate.

Though a majority of justices rejected the argument that Congress could use its power to regulate commerce between the states to require all Americans to purchase insurance, Chief Justice John Roberts joined with the court’s four liberals in deciding that the mandate is constitutional as a kind of tax. The law requires Americans who don’t purchase insurance to pay a penalty.

The bottom line is that the Affordable Care Act has survived a court challenge that would have been unthinkable in a more politically sane era. It’s worth noting again that the individual insurance mandate came to life as a conservative Republican idea, and that many members of the U.S. Congress were for it before they were against it.

It was written into the Affordable Care Act as a compromise plank, after Democrats failed to muster support for a public insurance option to care for people who might otherwise be turned down for coverage by private insurers.

The court’s decision means that the provisions of the Affordable Care Act, which already have begun to transform the health care landscape, will remain and move forward.

Americans can count on insurance coverage without caps on expenses.

Insurers will not be able to revoke policies after people become sick.

Young people can remain on their parents’ plans until age 26.

Insurance companies will not be able to deny coverage to children with pre-existing conditions, and that protection will soon be extended to adults.

Republican members of Congress and Mitt Romney, the presumptive Republican presidential nominee, are still vowing to repeal the Affordable Care Act. But the court’s decision strips them of their best rationale.

The act is constitutional. What basis can Republicans cite for dismantling a law that greatly benefits Americans and returning to a broken, costly system in which only people fortunate enough to be healthy and employed, or else in government programs, are guaranteed access to medical care?

Romney and Republicans in Congress would do the nation a favor by ceasing with attempts to demonize health care reform. Instead, they should initiate bipartisan efforts to build on the provisions of the law that are designed to make health care delivery more effective and less expensive.

The court decision will take some time to parse and interpret. One wrinkle concerns the ruling that Congress cannot penalize a state that refuses to expand Medicaid eligibility, as required in the new law, by taking away existing Medicaid funding. That could provide incentives for renegade governors and legislators to attempt to wreak havoc with the law’s provisions.

Wiser states will get serious about moving ahead with insurance exchanges and other provisions called for in the Affordable Care Act. It is legal and likely here to stay. Americans in the years to come will recognize it as a gateway to medical and financial security.

Congratulations are in order for Obama and the congressional Democrats who succeeded in moving closer to a goal that has eluded presidents since Harry Truman — affordable, accessible health care for all Americans.