Impact of health decision will ‘take weeks' to determine

Lawmakers react to Thursday's Supreme Court ruling

Protestors shadows are cast outside the Supreme Court in Washington, Thursday, June 28, 2012, in Washington, as the Supreme Court is expected to announce its verdict on President Barack Obama's health care law. (AP Photo/David Goldman)
Protestors shadows are cast outside the Supreme Court in Washington, Thursday, June 28, 2012, in Washington, as the Supreme Court is expected to announce its verdict on President Barack Obama's health care law. (AP Photo/David Goldman)

DES MOINES — Democrats applied the pressure and called on Republican Gov. Terry Branstad to agree to a statewide health-care summit in the wake of the U.S. Supreme Court ruling that the governor called “disastrous.”

The 5-4 ruling upheld the key component of the Patient Protection and Affordable Care Act, requiring most people to purchase health insurance. The justices also ruled that states could not be punished if they opted out of expanding Medicaid to a larger pool of participants.

The immediate effect on Iowa was not entirely clear, particularly where it involves the Medicaid portion that was overruled.

“We have attorneys and Medicaid technical staff helping review the implications, which are broad and wide-ranging,” said Branstad spokesman Tim Albrecht, noting that the decision itself was 193 pages. “This will likely take weeks to sift through.”

But what is clear is the state is behind more than a dozen others in setting up state-run insurance exchanges that have to be fully operational and certified by Jan. 1, 2014. As envisioned, the exchanges are a place where uninsured Iowans can get subsidized health insurance policies if they cannot afford them or don’t have insurance offered through work.

According to the National Council of State Legislatures, 13 states and the District of Columbia have enacted exchange laws either by legislation or executive order as of June 5. Plans for the exchanges are expected to be in place by Jan. 1, 2013, or the federal government can set up an exchange in the state.

The Iowa Legislature has not passed any legislation to start the exchanges.

“We’ve introduced bills on this several times in the past, and the House wouldn’t pick it up,” said Sen. Jack Hatch, D-Des Moines.

Hatch, who chairs the Senate Health and Human Services Committee, hosted a Statehouse news conference Thursday where he called on the governor to put together a summit “in three or four weeks” where open discussions on how the state will operate can be held.

“To try to have the state of Iowa figure it out in the bowels and the cellars of this Capitol building is probably the wrong approach,” he said. “We need to bring it out in the open, we need to be transparent.”

Hatch said the governor’s staff was open to the summit but the “House leadership has to take a deep breath and find out how they want to proceed.”

In an email response, Albrecht wrote, “We are always interested in discussing significant policy issues of this nature with all parties, but that it would be premature to commit to any specific event until the decision had been rendered and we had adequate time to review its implications for Iowa.”

House Speaker Kraig Paulsen, R-Hiawatha, also seemed skeptical of the idea.

“I, we, don’t want to help Jack Hatch and President Obama in their government takeover of health care,” he said.


Speaker of the Iowa House Kraig Paulsen, R-Hiawatha: “The federal health care law is plain and simple, the government takeover of health care and a massive tax increase on all Iowans. The Supreme Court’s decision today makes it harder for Iowa’s small businesses to hire workers, operate their businesses and grow our state. A full repeal of the law is needed and it’s up to Iowa voters to end the government takeover of health care.”

Iowa House Majority Leader Linda Upmeyer, R-Garner: “Iowans are perfectly capable of making health care decisions on their own; they don’t need Washington, D.C. telling them what to do. This law creates trillions in new government spending that we cannot afford and it ensures Iowans will have limited choices and freedoms. Iowans want an end to bureaucracy and regulations handed down from the federal government. I am confident that as president, Gov. Mitt Romney will enact commonsense reforms based on the free market, not dictated by government bureaucrats.”

Former U.S. Sen. Rick Santorum and Republican presidential hopeful: “Today's outcome is the worst of all scenarios. Not only are our rights being taken away and Americans are being forced to do something we don't want to do, but now we are being burdened with the biggest permanent tax increase in our nation's history. This is a sad day.

“I believe so strongly that if we do not defeat President Obama this November and elect more conservatives in the House and Senate, our country's future prosperity is at risk. President Obama believes he is above the law, entitled to abusing his power to get what he wants, and willing to violate the constitution and the oath he was sworn to uphold.”

Republican National Committee Chairman Reince Priebus: “Today's Supreme Court decision sets the stakes for the November election. Now, the only way to save the country from ObamaCare's budget-busting government takeover of health care is to elect a new president.

“Under President Obama's signature legislation, health care costs continue to skyrocket, and up to 20 million Americans could lose their employer-based coverage. A panel of unelected bureaucrats now has the unprecedented authority to come between elderly patients and their doctors.

“We must elect a president who understands the economy, respects free enterprise, and can provide the leadership we now so desperately need. On Election Day, we must elect Mitt Romney and put America on the path toward a brighter economic future and successful health care reform."

Senate Health and Human Services Committee Chairman Jack Hatch, D-Des Moines: “The U.S. Supreme Court’s decision today is a major victory for all Iowans, both those with health insurance and those without. Now, thanks to the Affordable Care Act, the health care of every Iowan will improve and become more secure while costs for consumers and businesses are reduced.

“Iowa’s nonpartisan, forward-looking approach to health care made us the top state in the nation with regard to children’s health care. We should now take full advantage of the new opportunities presented by this decision to make Iowa the best state in the nation when it comes to health care for every Iowan.”

Republican U.S. House 2nd District candidate John Archer, Bettendorf: “The Supreme Court’s decision today to uphold the individual mandate clears the path for an unprecedented expansion of government, further eroding American’s freedoms and individual choice.

“A great burden for hardworking Americans remains. ObamaCare increases our taxes and adds regulations; it’s a governmental control kind of attitude.

“This was always larger than the individual mandate. It is a dangerous precedent to allow the government to dictate what the American people can do.”

Iowa Senate Minority Leader Jerry Behn, R-Boone: “Today’s disastrous Supreme Court decision allows the largest tax increase in American history to go into effect, thus guaranteeing more uncertainty and unpredictability for Iowa small businesses and employers. This destructive health care law means a future of higher costs, higher taxes and increasing debt for Iowans and it underscores the need to elect a new president that will put our economy first.”

Democratic U.S. House 1st District Rep Bruce Braley: “The Supreme Court got it right today. This decision is good news for the middle class and affordable healthcare.

“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.”

Republican Gov. Terry 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.”

Republican Lt. Gov. Reynolds: “America needs real health care reform and we need Gov. 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.”

One Iowa Executive Director Donna Red Wing: “Today’s Supreme Court ruling upholds the values of fairness and justice and is a huge step forward in the fight for equality for LGBT Americans. The dream of being able to protect your family and to live a healthy life should not be a political football and is something every American should be able to access regardless of sexual orientation or gender identity.

“Unequal access to healthcare is a roadblock to full equality for LGBT Americans. Statistics show that only 57 percent of transgender Americans have health insurance compared to approximately 82 percent of heterosexual adults and 77 percent of LGB adults. And as many as two million children living in LGBT families face significant challenges to accessing adequate healthcare as a result of bias, stigma, and barriers to access. The Affordable Care Act goes a long way to addressing these serious health inequalities that continue to deny LGBT Americans equality under the law.”

Senate Committee on Health, Education, Labor and Pensions Chairman Tom Harkin, Democrat: “Today’s decision by the Supreme Court is a rigorous, resounding confirmation of the constitutionality of the Affordable Care Act. It is great news for America’s families and businesses, and for our economy. This decision keeps consumers, rather than insurance companies, in the driver’s seat, and protects the more than $1 trillion in deficit reduction included in the ACA. Today’s decision allows us to continue our work replacing the current sick care system with a genuine health care system – one focused on wellness, prevention, and public health, keeping people out of the hospital in the first place.

“This law is a critical step in the right direction. I have likened it to a starter home, suitable for improvement. I look forward to working with my colleagues to make sensible changes as we continue to implement the law. I invite them to bring their tool kits, rather than their sledgehammers, so we can work together to improve the law.

Iowa Senate Ways and Means Committee Joe Bolkcom, D-Iowa City: “This is a great day for uninsured Iowans and for everyone struggling to pay health care bills. We succeeded in bringing affordable health insurance to every Iowa child because the federal government was our partner. Today’s Supreme Court decision means the federal government will now be our partner in bringing stable, secure health care to every Iowan. It is time to set aside inflammatory political rhetoric and get back to working together to improve the health care of all Iowans.”

Iowa Republican Party of Iowa Chairman A.J. Spiker: “President Obama clearly lied to the American people when he promised not to raise taxes on middle class Americans. ObamaCare not only raises taxes on every single Iowan, but also guarantees higher health care costs and deficits in perpetuity. The winners today are big corporate health insurance companies who lobbied vigorously for this law and government bureaucrats, while patients have lost control over their personal health care decisions.

“The Supreme Court’s decision today is a setback for believers of individual liberty and smaller government all across Iowa, but rest assured this will only energize us even further. The Republican Party of Iowa will be working tirelessly to send Mitt Romney to the White House along with a full Republican delegation to Congress in order to repeal ObamaCare in its entirety and replace it with meaningful market-driven reforms that will reduce costs, protect patients and increase quality of care.”

Republican U.S. House 4th District Rep. Steve King: “President Obama, Nancy Pelosi and Harry Reid promised us this legislation would make health care costs more affordable without affecting the quality of the system. In reality, ObamaCare has driven up costs, made it harder for small businesses to hire workers, limited Americans' choice in healthcare and intruded on the doctor-patient relationship. Worse, ObamaCare has created trillions of dollars in new government spending we simply can't afford.”

“This is only a minor setback in our fight to protect our individual liberties and freedom. We must rally together and work harder to fully repeal ObamaCare. I will not rest until Congress defunds and completely repeals this legislation.”

Democratic U.S. House Rep. Dave Loebsack: “Today’s decision will bring stability and certainty to Iowans as they make critical health care choices for themselves and their families.

“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.”

Iowa House Minority Leader Kevin McCarthy, D-Des Moines: “Today's ruling is a win for the middle class and will reduce the overall cost of health care in the long term. It means insurance companies can't deny health care to Iowans with pre-existing conditions, charge women more to get health care, or impose lifetime limits on care for Iowans.  It means over 18,000 young Iowans can stay on their parents health care plan until 26.  It means over 42,000 seniors in Iowa will save an average of $615 every year on their prescription drugs.  It also means small businesses can get help to offer health care for their employees.”

Republican U.S. House Rep Tom Latham: “While the Supreme Court has the duty to determine the constitutionality of the health care law, it does not have the authority to determine if it is good or bad policy for hardworking Americans. Thankfully, it is still the American people who ultimately have the power and the right to make that final judgment.

“I opposed and voted against the health care law because it is bad policy that ignored the voices of the people. Congress must set its sights on completely replacing this bad law with measures that truly will lower health care costs for hardworking taxpayers. I have offered a solution made up of better ideas that offer better solutions that will produce the best results for everyone.  My patient-centered approach empowers the American people, not Washington bureaucrats, to choose the best health care plan for themselves, and it puts them in control of their health care, not the government.

“As we move forward, I continue to stand ready to work with any of my colleagues in Congress, regardless of political affiliation, who are willing to enact real solutions for the benefit of the American people.”

Planned Parenthood of the Heartland President and CEO Jill June: “At Planned Parenthood we know how important this law is for women and families because we see the need for affordable health care every day. Quality health care will now be available to millions of women who before had no coverage or inadequate coverage.

“We are closer than ever to having access to quality health care for all. This is a major victory for all Americans.”

Child and Family Policy Center Executive Director Charles Bruner: “Today is a good day for Iowa families. When fully implemented, the ACA will assure health coverage for tens of millions of the uninsured, make insurance more affordable for those who already have it and boost consumer protections for Americans of all ages.

“But Iowa still has work to do to achieve these reform goals, which are ones Iowans truly want. Key will be affirming the expansion of Medicaid and assuring the state creates an exchange that meets the needs of health-care consumers.”

Republican U.S. Sen. Chuck Grassley: “I respect the Supreme Court but strongly disagree with this decision. The court has upheld the law saying that the president’s health care law is a tax on every American – regardless of income – unless that American takes an action the government demands.

“The only way the law is constitutional is by doing what the president denied, that the penalty was a tax. The legislation was sold in Congress and to the country under false pretenses.

“With this decision, the court said that while Congress’ ability to regulate is limited, its ability to tax is unlimited.

“Now, it’s up to the American people. The majority of Americans don’t like this law, and health care will be a major issue in the presidential election, including its impact on the economy and jobs, which should have been the first priority all along.

“The goal has got to be on growing the economy and creating jobs, not making government bigger, but including health care solutions that use free-market principles, don’t get between patients and their doctors, and succeed in driving down health care costs.

Republican presidential hopeful Mitt Romney: “What the Court did not do on its last day in session, I will do on my first day if elected President of the United States. And that is I will act to repeal ObamaCare.

“Let’s make clear that we understand what the Court did and did not do. What the Court did today was say that ObamaCare does not violate the Constitution. What they did not do was say that ObamaCare is good law or that it's good policy.

“ObamaCare was bad policy yesterday. It's bad policy today. ObamaCare was bad law yesterday. It’s bad law today. Let me tell you why I say that. ObamaCare raises taxes on the American people by approximately $500 billion. ObamaCare cuts Medicare, cuts Medicare, by approximately $500 billion. And even with those cuts, and tax increases, ObamaCare adds trillions to our deficits and to our national debt and pushes those obligations on to coming generations. ObamaCare also means that for up to 20 million Americans, they will lose the insurance they currently have, the insurance that they like and they want to keep. ObamaCare is a job killer. Businesses across the country have been asked what the impact is of ObamaCare. Three quarters of those surveyed by the Chamber of Commerce said ObamaCare makes it less likely for them to hire people. And perhaps most troubling of all, ObamaCare puts the federal government between you and your doctor.

“For all those reasons, it's important for us to repeal and replace ObamaCare.”

Obama for America Campaign Manager Jim Messina: “Mitt Romney had an opportunity to rise to the occasion today and tell the American people specifically how he would move the nation forward on health care and ensure people get the care they need. Instead of explaining how he would ensure costs don’t go up and health benefits are protected, Romney promised to repeal the President’s health reform law and take America back to the same old political battles of the past.

“Just six years ago, before Mitt Romney decided to run for president, he passed a law in Massachusetts that achieved universal coverage for the citizens of that state through an individual mandate and tax penalty.  That law became the model for the president’s health reform law. Now, as he is running for president, Romney has run away from his accomplishment in Massachusetts, callously promising to repeal national reform and “kill it dead.”

Democratic U.S. House 4th District candidate Christie Vilsack: “Now that the Supreme Court has made their decision, Congress must reform the Affordable Care Act to control the skyrocketing costs of health care in America,” said Christie Vilsack.

“This law did little to address the rapidly increasing cost of health care. I believe we must control costs and provide stability to families and small businesses in Iowa.

“With the legal battle over health care reform behind us, Democrats and Republicans must focus on having a real conversation about how we can create jobs and economic opportunity in this country.”

Iowa Democratic Party Chairwoman Sue Dvorsky: “Today was an unequivocal victory for the American people. Health care has been protected for 34 million Americans, including the 12 percent of Iowans living without health insurance.

“By virtue of President Obama’s bold leadership, 18,000 Iowans under 26 can now stay on their parent’s insurance and two million Iowans no longer have to worry about lifetime caps or losing insurance when they get sick. Soon, no American will ever again be denied care or charged more due to a pre-existing condition. President Obama believes quality affordable health insurance you can rely on is at the heart of middle class security. The Iowa Democratic Party agrees with this 100 percent.

“We move forward today knowing that this law makes us a stronger and healthier nation. We can now return to the mission of getting Iowans back to work in this recovering economy.”

Democratic 3rd District U.S. House Rep. Leonard Boswell: “The highest court in the land spoke today and found the Affordable Care Act constitutional. Millions of Americans, including children, seniors, and health care providers, have won today.

“This decision reaffirms a major victory for the middle class … Now that this law has been reaffirmed, it is time for opponents to stop spreading misinformation in their attempts to confuse the American people on this law.”

Libertarian presidential nominee and former New Mexico Governor Gary Johnson: “It has been clear for a while that we need a new president and a new Congress. Now it appears we need a new Supreme Court.

“Whether the court chooses to call the individual mandate a tax or

anything else, allowing it to stand is a truly disturbing decision.

The idea that government can require an individual to buy something simply because that individual exists and breathes in America is an incredible blow to the bedrock principles of freedom and liberty. It must be repealed, and Congress needs to get about doing so today.

“There is one thing we know about health care. Government cannot create a system that will reduce costs while increasing access. Only competition and the price transparency that competition will bring can accomplish the imperatives of affordability and availability.

AFSCME Iowa Council 61 President Danny Homan: “Today’s historic U.S. Supreme Court’s decision affirming the constitutionality of ObamaCare is a victory for middle class families.

“Thanks to the Supreme Court’s decision, ObamaCare will continue to ensure that children in Iowa cannot be denied coverage due to pre-existing conditions, seniors will pay less for prescription drugs and students and young adults can remain on their parents’ plans.

“Now is the time to put partisan politics and political posturing behind us. Gov. Branstad should begin the important process of implementing ObamaCare. While the court ruling stipulates that Congress cannot withdraw existing Medicaid funding to states that do not comply, it would be wrong for any politician to hold people’s health care hostage because of a political grudge.”

Kirk Norris, president/CEO of the Iowa Hospital Association: “While there will always be debate over the policy details, there remains a national consensus that everyone should have access to insurance coverage and delivery of care needs to be more efficient with higher standards of quality. Iowa’s hospitals continue to lead by further integrating care with physicians and focusing on process improvement, care coordination and health information technology implementation – all with the aim of providing better care to individuals, better health to communities and lower cost for everyone.”

Republican U.S. House 1st District candidate Ben Lange: “The issue before the Supreme Court today was not about the wisdom of ObamaCare, it was about the legal foundations of our constitutional Republic and the role of federal politicians in the lives of states and individuals.

“The Supreme Court has ruled that there are no longer any meaningful limits on what federal politicians can do to the American people under the auspices of the taxing power. Individual and states' rights have been permanently compromised in our constitutional system.

“While I disagree with the legal conclusion of the Supreme Court, I respect their judgment.”


Ken Sagar, President Iowa Federation of Labor, AFL-CIO

“We encourage the Republicans to respect the court’s decision and stop wasting the public’s time and money with political grand standing. After all, this a nearly identical plan as the one Gov. Romney signed into law.

“Though this may feel like a victory, the fight for affordable health care for all is far from over. The election this November will be between a President who has stood for fairness for the working men and women, and Gov. Romney who has said he will repeal this law in his first few days’ office.”

John Forsyth, Wellmark chairman and CEO

“We plan to remain engaged in state-based health care exchange discussions, and will continue to provide input to policymakers as they develop the best approach to establishing a successful exchange model in Iowa and South Dakota.

“As always, we will remain focused on making sound fiscal decisions that best serve our members. Wellmark is proud to be one of the few Iowa insurance companies to exceed the ACA medical-loss ratio requirement to spend 85 percent of premium dollars on medical claims in the large group market (100+ employees), and 80 percent in the individual and small group markets.  We will be here to serve our members today and in the future.”

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