On June 28, 2012, the Affordable Care Act survived a test before the Supreme Court when a narrow 5-4 majority ruled that the law’s individual mandate to buy health insurance was constitutional.
On Monday, the act, also known as Obamacare, was back before the high court. This time another 5-4 majority exempted family-owned corporations from the law’s requirement that employers cover employees’ contraception.
Monday’s ruling wounded the law, but Obamacare for now remains the law of the land.
The most recent challenge came from two companies — Hobby Lobby and Conestoga Wood — whose owners objected to paying for coverage of some contraceptives they consider abortifacients. The fact that most of medical science disagrees that, for instance, the Plan B pill is an abortifacient didn’t matter. This was a matter of the owners’ religious faith, not a test of reason and science.
What do we make of this ruling? Here are a few ways to look at it:
OBAMACARE OPPONENTS WIN: This time, the court’s conservative justices ruled against the Affordable Care Act. It wasn’t a death blow, but it’s something conservative activists can use to chip away at the law. Bottom line: This won’t be the last legal challenges to Obamacare.
NARROW OR NOT: The court’s ruling on contraceptive coverage applies to “closely held” corporations, meaning those where 50 percent of a firm is owned by five or fewer individuals. Personal service companies aren’t included. Almost half the U.S. workforce is believed to be employed by such companies. However, the vast majority provide contraceptive coverage, and did so even before Obamacare was passed.
HOW MUCH WILL IT MATTER?: Employees of organizations previously exempted from the birth-control mandate — religious nonprofits and others— can receive coverage directly from insurers that (at least on paper) free the employers from paying for objectionable practices. If the government devises such a work-around for employees of Hobby Lobby and other such companies, then Monday’s ruling may have little practical effect.
THE POLITICS ARE TRICKY: Opposition to Obamacare remains a winner for Republicans. Opposing the law in broad sketches works; the small details can be tricky. State-based health exchanges will be difficult to abolish, even in Republican-friendly states. Rules that prevent insurance companies from cruelly dropping sick patients is untouchable. The contraceptive mandate is also tricky. No candidate wants to appear to be meddling in these most personal of health-care decisions.
OBAMACARE’S FLAWS EXPOSED: The ruling displays one of the worst aspects of the Affordable Care Act — a reliance on an employer-based system for health insurance. Granted, Obamacare made some improvements on the old system. Yet, objections from companies like Hobby Lobby and Conestoga Wood were inevitable under such a system.
A SLIPPERY SLOPE: Justice Ruth Bader Ginsburg, writing in dissent, called the ruling a “minefield” of potentially thorny issues. What other religious objections might owners of for-profit corporations raise, she asked? “Would the exemption … extend to employers with religiously grounded objections to blood transfusions (Jehovah’s Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (certain Muslims, Jews, and Hindus),” Ginsburg wrote.