By John Crabtree, johnc@cfra.org, Center for Rural Affairs

The U.S. Supreme Court recently upheld the constitutionality of the Patient Protection and Affordable Care Act, also known as Obamacare.

The Center for Rural Affairs has said from the beginning, the Affordable Care Act is a perfectly legal response to the health care and health insurance challenges facing millions of Americans and rural Americans in particular. The Supreme Court's ruling will continue the already existing benefits and protections helping young adults, Medicare beneficiaries, children, and every one of us from unreasonable health insurance rate increases.

The Supreme Court decision also authorizes states to implement the system that allows Americans to purchase affordable, comprehensive health insurance coverage beginning in 2014. For those of us living in rural America, where we are more likely to be uninsured or underinsured, and where local economies are even more dependent on self-employment and small business, this ruling is a true victory.

It is now time to move forward in implementing the Affordable Care Act and the federal Department of Health and Human Services as well as the states should take action to fully implement the Act and immediately establish health insurance marketplaces with serious consumer protections and a robust governing board. Congress should also continue investing in access to medical professionals in medically underserved rural areas and maintaining rural hospitals.

Now that the legal wrangling is complete, it's time to bind up the nation's political wounds and get about the business of resolving the health care challenges facing the nation and its people.

(DES MOINES) - Gov. Terry Branstad today signed Executive Order 78, which allows state workers to voluntarily pay 20 percent of their health care insurance premium.

According to the Department of Administrative Services (DAS), 88 percent of state workers do not contribute anything toward their health insurance premium, and in total, Iowa taxpayers fund 97 cents of every one dollar spent on health care premiums.

The Executive Order is found here: https://governor.iowa.gov/wp-content/uploads/2012/07/EO-78.pdf

Floor Statement of U.S. Senator Chuck Grassley

Response to Supreme Court Decision on Medicaid

Friday, June 29, 2012

Mr. President, the Supreme Court yesterday overturned the mandatory Medicaid expansion in the Affordable Care Act.

As of yesterday, the states now have a choice to expand or not expand coverage to the poorest people in society without being subjected to harsh federal penalties.

Mr. President, I'd like to draw attention to a speech I gave on the Senate floor on December 2011 on the subject of the constitutionality of the Medicaid expansion.  I expressed my concerns then about the potential impact of a Supreme Court decision on Medicaid expansion.

I said on the floor that day, "... A Supreme Court ruling in favor of the States in this case could not only jeopardize the mandated Medicaid expansion in the Affordable Care Act but could challenge the fundamental structure of Medicaid and have broader implications outside health care."

The concerns I expressed then have, to a degree, come true.

Reading from a Washington Post editorial this morning about the Court ruling on Medicaid, " ... this restriction of federal authority may have greater ramifications than the court's limiting of the Commerce Clause. One can imagine challenges to federal conditions across a wide spectrum of programs, including but not limited to the environment, education and transportation."

This decision overturns the mandatory expansion of the Medicaid program.  And while I realize most of the focus is on the decision related to the tax mandate, we should spend a moment talking about the consequence of the Medicaid decision.

Mr. President, one of the goals of health care reform was to provide coverage for people in need.

I would argue the people most in need of coverage are people without a job, people without an income, the poorest of the poor.

The Affordable Care Act required states to cover people below poverty through Medicaid.

States were mandated to expand to cover people below poverty.

Yesterday, the Supreme Court ruled that mandatory expansion unconstitutional.  Writing for the majority, Chief Justice Roberts said, " ... Nothing in our opinion precludes Congress from offering funds under the Affordable Care Act to expand the availability of health care, and requiring that States accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."

With this decision, states now have the option to expand Medicaid to cover people below poverty.

Mr. President, the states had that option before the Affordable Care Act was passed.  So what does this decision mean in real terms?

It will be up to the states to determine if they will cover the poorest of the poor.  The federal government cannot guarantee coverage.

So now people with jobs will have to purchase insurance under the tax mandate.  People without an income, people who are below poverty are dependent upon the state in which they reside.

Now I know some people will believe that the choice is perfunctory, that Medicaid expansion will move forward because the federal government has offered to pay for more than 90 percent of the expansion.

But if you were a state, would you really trust a promise from a federal government that is $15 trillion in debt?

If you were a state, would you really trust an Obama Administration that proposed eliminating that special federal payment rate through a proposal known as the blended rate?

States will very reasonably be risk adverse.

States can now expand if they choose or not at all.

No one should assume for a second all states will expand to cover as much as was mandated under the Affordable Care Act.

Of course, you might think people below poverty could still get health care through tax credits, but the people who wrote this bill made people below poverty ineligible for tax credits.

That's right ... ineligible.

It's all or nothing for the poor with Medicaid.

With today's ruling, the answer is nothing.

On December 15, 2011, I said on the Senate floor that the expansion of Medicaid and the coverage of poor people was in jeopardy because, "... the White House and the Democratic majority put their partisan goals ahead of collaboration with Republicans and States to build legitimate public policy."

Today, that is the outcome.

When people with income, people with jobs are mandated to purchase health insurance and face a tax penalty if they don't, while the poorest people in society, those without job or income have a guarantee of nothing, I think victory laps are premature.

After this decision, a person in a family with an income of more than $80,000 a year would be guaranteed access to a subsidy to buy private insurance, while a person in a family with no income would be guaranteed nothing.

When people below poverty, the people who least can afford coverage or the consequence of not having coverage are left with nothing, that sounds like a failure to me.

Braley Statement on Supreme Court Healthcare Decision

Washington, D.C. - Rep. Bruce Braley (IA-01) today released the following statement regarding the Supreme Court's ruling on the Affordable Care Act:

"The Supreme Court got it right today.  This decision is good news for the middle class and affordable healthcare.  It makes me think of thousands of Iowans like my nephew, Tucker.  Tucker survived a fight with liver cancer at age 2 because his family had health insurance.  But his parents lived in constant fear of losing their jobs because Tucker would be denied new insurance due to his pre-existing condition.  The healthcare reform law ended those fears -- and this decision means many other critical reforms will stay in place.

"From allowing 18,000 Iowans to stay on their parents' insurance up to age 26, to requiring insurance companies cover screenings for diseases like breast cancer, to saving Iowa seniors hundreds of dollars per year on their Medicare prescription drugs, the law's positive impact on Iowa is just beginning to be felt.

"It's not a perfect law.  That's why I'll be working to bring Republicans and Democrats together to improve it and make it better."

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Branstad and Reynolds release statements on Supreme Court ruling

(DES MOINES) - Gov. Terry Branstad and Lt. Gov. Kim Reynolds today released the following statements on the United States Supreme Court ruling of Obamacare.

Gov. Branstad:

"Today, the Supreme Court handed down a disastrous decision to uphold President Obama's destructive health care law, which means a future of higher costs, higher taxes, and increasing debt for Iowans.  The current health care system is nothing but a federal takeover and continues to exceed its budgeted amount every day.  But, as Governor Romney has said many times, no matter what may happen in Court, the American people must remain vigilant in their fight to repeal the law. Our goal is for Iowa to become the healthiest state in the country and to do so Iowans will need to take ownership of their own health to reduce health care costs and lead healthier lives."

Lt. Gov. Reynolds:

"America needs real health care reform and we need Governor Romney in Washington. Gov. Romney will enact real reforms to ensure that the future of Iowa and America as a whole can replace Obamacare with solutions that put Iowans in control of their own health care and preserve the economic future of Iowa's next generation. "

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Loebsack Statement on the Supreme Court Ruling on the Affordable Care Act

Washington, D.C. - Congressman Dave Loebsack released the following statement after the U.S. Supreme Court issued their decision on the Affordable Care Act.

"Today's decision will bring stability and certainty to Iowans as they make critical health care choices for themselves and their families.  It maintains protections for those who have pre-existing conditions, ensures no Iowan will be denied coverage, and that young Iowans can stay on their parents' health care plans until they are 26.  Additionally, this ruling affirms that preventative care will be provided without a co-payment, and that those who lose their jobs will not lose their coverage.  It also prevents women from being charged higher premiums simply because they are female, and prohibits pregnancy from being treated as a pre-existing condition.  Further, the Medicare prescription drug donut hole will be completely closed by 2020, through reforms that are already saving our seniors $650 each this year.

"As we move forward, the bill is not perfect and I will continue to work with my colleagues on both sides of the aisle to ensure that the Affordable Care Act is enacted in a way that will reduce health care costs and help bring stability to Iowans during these difficult economic times."

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Statement from Lt. Governor Simon on Supreme Court decision

CHICAGO - June 28, 2012. Lt. Governor Sheila Simon today released the following statement on the Supreme Court's decision to uphold the Affordable Care Act:

"The Affordable Care Act is a good law. It helps seniors, young adults and middle class Americans receive stronger, more affordable care. It promotes preventive care, such as checkups and mammograms. And it prevents insurance companies from denying care to people with pre-existing conditions or charging women more based on their gender. The Supreme Court ruling today upholds these commonsense protections and puts our country on a healthier path. In Illinois, I encourage our state leaders to use this ruling as a backdrop as we set policies to make our citizens healthier, train the next generation of health care workers, grow local food systems and find other opportunities to move our state forward."

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Governor Quinn Statement on Supreme Court Decision Upholding Affordable Care Act

CHICAGO ­- June 28, 2012. Governor Pat Quinn today released a statement hailing today's decision of the United States Supreme Court to uphold the federal Affordable Care Act.

"Today is a great day for Illinois and a great day for our country. This decision means that millions of working families across Illinois will continue to receive better healthcare.

"These historic reforms that are strengthening our healthcare system will continue to benefit young people, those with pre-existing conditions and care providers.

"We took a big step forward today as a nation and state, and I will continue to work with President Obama to help working families get the healthcare coverage they need."