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BREAKING NEWS: U.S. Supreme Court upholds health insurance law

WASHINGTON – The U.S. Supreme Court this morning upheld President Barack Obama’s health care reform law, saying that the insurance mandate is unconstitutional but can survive because it falls under Congress' power as a taxing authority.

This means that the nation's high court says that Congress can tax people for not having health insurance.

This historic decision is a huge victory for President Obama and the Democrats, and will go down as one of the President's legacies.

The decision affects millions of people in California and around the nation, including many LGBT Americans.

Chief Justice John Roberts, a conservative who was nominated by Republican President George W. Bush, wrote the 5-4 majority opinion.

"The Affordable care act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," the court said in the ruling.

To read the full court ruling, click HERE.

The major court victory for Obama comes during a heated presidential race. The so-called Obamacare insurance is strikingly similar to Romneycare in Massachussetts, yet presumptive Republican presidential candidate Mitt Romney vowed today to repeal the law if elected in November. Romney would have to get 60 votes in the 100-seat Senate to achieve that goal.

What President Obama said

President Obama briefly spoke to the nation today about the Supreme Court ruling.

"Because this law has a direct impact on so many Americans, I want to take this opportunity to talk about exactly what it means for you," Obama said.

"First, if you're one of the more than 250 million Americans who already have health insurance, you will keep your health insurance -- this law
will only make it more secure and more affordable. Insurance companies can no longer impose lifetime limits on the amount of care you receive. They can no longer discriminate against children with preexisting conditions. They can no longer drop your coverage if you get sick. They can no longer jack up your premiums without reason. They are required to provide free preventive care like check-ups and mammograms -- a provision that's already helped 54 million Americans with private insurance. And by this August, nearly 13 million of you will receive a rebate from your insurance company because it spent too much on things like administrative costs and CEO bonuses, and not enough on your health care," he said.

"There's more. Because of the Affordable Care Act, young adults under the age of 26 are able to stay on their parent's health care plans -- a
provision that's already helped 6 million young Americans. And because of the Affordable Care Act, seniors receive a discount on their prescription drugs -- a discount that's already saved more than 5 million seniors on Medicare about $600 each," Obama said.

"All of this is happening because of the Affordable Care Act. These provisions provide common-sense protections for middle class families, and
they enjoy broad popular support. And thanks to today's decision, all of these benefits and protections will continue for Americans who already have health insurance," he said.

"Now, if you're one of the 30 million Americans who don’t yet have health insurance, starting in 2014 this law will offer you an array of quality,
affordable, private health insurance plans to choose from. Each state will take the lead in designing their own menu of options, and if states
can come up with even better ways of covering more people at the same quality and cost, this law allows them to do that, too. And I've asked Congress to help speed up that process, and give states this flexibility in year one," Obama said.

The LGBT community reacts

California Assemblymember Toni Atkins (D-San Diego) said the Supreme Court ruling means peace of mind for Americans and a healthier California.

"This morning’s Supreme Court ruling upholding the Affordable Care Act (ACA) is great news for America and for California. As a member of the State Assembly's Health Committee, I have worked with my colleagues for the last several years as we have moved to implement the Affordable Care Act. Today's ruling means we can continue our work to ensure that almost 7million Californians will have improved access to quality, affordable health care and health coverage," Atkins said.

"This is particularly important to Californians while we work to bring our state out of recession by restoring jobs. The recently adopted state budget, while it represents a prudent, multi-year approach to achieving financial stability for our state, contains significant further cuts to our safety net programs, including health care for the most vulnerable Californians," she said.

"The Affordable Care Act will repair much of that safety net to ensure that even if you are unemployed or have a pre-existing health condition, the most basic of human needs – medical care – will be available to you," Atkins said.

"When fully implemented, the ACA will expand affordable coverage to nearly 5 million Californians. 3.1 million people will be eligible for subsidized coverage through the California Health Benefit Exchange and 1.5 million people will be newly eligible for expanded Medi-Cal. An additional 2.1 million Californians without pre-existing conditions are expected to purchase guaranteed health insurance without subsidies through either the Exchange or the commercial market. The result will be peace of mind and a healthier California," she said.

"I applaud the wisdom of the Obama administration in crafting this far-reaching proposal and the Court for upholding it," Atkins said.

Rea Carey, executive director of the National Gay and Lesbian Task Force, said that today's ruling highlights the need for our nation's health care systems to be free of desparities and inequities for everyone.

"This ruling is a victory for millions of people and families across the country who have suffered significant health and financial turmoil because of a lack of access to adequate, affordable health care," Carey wrote in an email to NGLTF supporters.

"While today was a significant victory for all Americans, the Supreme Court did limit a key provision that would have expanded coverage to low-income people through the federal Medicaid program. This setback will limit the ability to get health care coverage to the most needy among us. We must continue to press for reform to address the inequity in our health care system. People of color and the poor are disproportionately affected by poor health outcomes, and LGBT people are hampered by systemic, costly discrimination that refuses to recognize our needs or families," she said.

"The Affordable Care Act begins to address many of these inequities by mandating the collection of data so that policymakers will have the information they need to address LGBT health disparities, and prohibiting the denial of health-care coverage to people with a pre-existing condition, such as HIV or a transgender medical history," Carey said.

Noting the 5-4 vote, Carey stressed the importance of voting for the presidential candidate and Senators who will choose future Supreme Court justices. "The Supreme Court makes decisions that affect us all. Immigration, campaign finance rules, Defense of Marriage Act, reproductive freedom – these will all eventually be ruled on by the Court," Carey said.

Scott Schoettes, HIV Project director for Lambda Legal, said this decision will press for expanded healthcare coverage.

"This is a victory for all Americans, but in particular, the Court's decision today will save the lives of many people living with HIV - as long as states do the right thing. The Affordable Care Act will finally allow people living with HIV to access medical advancements made years ago but that have so far remained out of reach of many. With continuing prevention education, early detection, and quality care for everyone living with HIV, we have the power to stem the HIV/AIDS epidemic," he said.

"But this is not a complete victory, because today's decision allows states to opt out of the Medicaid expansion that would provide insurance coverage for many low-income people who cannot otherwise afford it. Our continuing challenge will be to make sure that states opt to expand Medicaid so that more low-income people, and particularly those with HIV, can get the health care they urgently need," Schoettes said.

He noted that he has been an advocate of healthcare reform for over 20 years and represents the legal interests of people with HIV from the start of the epidemic, Lambda Legal submitted a friend-of-the-court brief in this case, which supported the federal government's position that the ACA's minimum coverage requirement (also known as the individual mandate) is constitutional.

The following organizations are listed as signatories in the amicus brief: AIDS United, Asian and Pacific-Islander Coalition on HIV/AIDS (APICHA), Black AIDS Institute, Center for HIV Law and Policy, Gay and Lesbian Advocates & Defenders (GLAD), Gay and Lesbian Medical Association (GLMA), HIV Medicine Association (HIVMA), HIV Prevention Justice Alliance (HIV PJA), Latino Commission on AIDS, National Association of People with AIDS (NAPWA), National Center for Lesbian Rights (NCLR), National Center for Transgender Equality (NCTE), National Native American AIDS Prevention Center (NNAAPC), U.S. Positive Women’s Network/WORLD, and Treatment Access Expansion Project (TAEP).

Chad Griffin, president of the Human Rights Campaign, said that the Patient Protection and Affordable Care Act created or paved the way for important new protections for and investments in the health of LGBT people – among them nondiscrimination in accessing healthcare in the individual market, collection of critical LGBT health data, and an end to barriers to care for people with pre-existing conditions like HIV/AIDS.

“The Supreme Court’s decision means millions of Americans – including many lesbian, gay, bisexual and transgender people and their families – will be better served by our nation’s healthcare system," he said.

"The Affordable Care Act addresses a number of the barriers LGBT people face in obtaining health insurance, from financial barriers to obtaining affordable coverage to discrimination by insurance carriers and healthcare providers. While there is a great deal more that must be done to ensure that the health needs of all LGBT people are fully met throughout the healthcare system, today’s decision is an important victory in the fight for healthcare equality,” Griffin said.

Abbe Land, executive director and CEO of The Trevor Project, said she was thankful for the decision.

"The Trevor Project is grateful that the Supreme Court upheld the important provision in the Affordable Care Act that will enable millions of Americans, including at-risk LGBTQ youth to gain access to healthcare coverage," Land said.

Kate Kendell, executive director of the National Center for Lesbian Rights, said today's decision will have an enormous impact on access to high quality care for LGBT people and their families.

“Today is a banner day for all Americans who care about fixing our broken healthcare system. By upholding the centerpiece of the Affordable Care Act, the Supreme Court has ensured that millions of uninsured people will finally gain access to affordable care and enable the federal government to begin addressing the shameful disparities that lesbian, gay, bisexual, and transgender people face in gaining access to healthcare," she said.

"At the same time, the Court’s ruling puts the healthcare of low-income people at risk. Much work remains to be done to ensure that all Americans have access to quality care,” Kendell said.

Mara Keisling, executive director of National Center for Transgender Equality, said the ruling is a blessing to transgender Americans and those living with HIV or AIDS.

"All the time, people tell me that their health care coverage has been denied or cancelled because they are trans or are living with HIV. Others tell me about doctors who refused to see them because they are trans. Fortunately, the Court looked at the health of our country with fairness and upheld the law ending the practice of denying or dropping coverage for pre-existing conditions and allowing other key provisions to take effect," Keisling said.

Victor Barnes, interim president and CEO of AIDS United, issued the following statement:

"AIDS United applauds the Supreme Court, for upholding the Affordable Care Act (ACA) and maintaining the path to an AIDS-free America. The ACA will strongly benefit the 1.2 million people living with HIV/AIDS in our country. The provisions rightly upheld by today's decision will help millions of people gain access to affordable health insurance markets including subsidized health insurance for many uninsured and underinsured individuals, expand Medicaid coverage to all people whose income is at or below 133% of the federal poverty level (subject to state participation), and expand patient protections that prevent discrimination and denial of coverage for pre-existing conditions. Tens of thousands of people living with HIV will now have greater access to prevention, treatment and care including life saving drugs.

"Other important provisions that benefit people living with HIV/AIDS include rules that prohibit insurers from denying coverage to people living with HIV or other pre-existing conditions, and setting annual and lifetime caps on the dollar value of insurance coverage. Young adults under 26 will continue to have the option of coverage under parental insurance plans. Access to drug coverage and preventive benefits will improve. AIDS United, through its grantmaking, technical assistance and advocacy initiatives will continue to support nearly 400 community-based organizations and partnership networks to use health care reform to help people with HIV/AIDS connect to life-saving prevention, care and treatment.

"AIDS United is concerned that the Supreme Court allows states to opt out of the needed Medicaid expansion. To end HIV in the United States, the states should accept the planned Medicaid expansion. Now that it is clear that the Act is Constitutional, AIDS United calls on lawmakers in the states and in Congress to pull together and fully implement it.

"The end to HIV in the United States is in our sight. The Supreme Court's ruling upholds the ACA'S pivotal provisions that keep us on the course that has been outlined by the first-ever National HIV/AIDS Strategy and by the significant treatment and prevention advances that we've seen over the last year.

"It is time to move forward. AIDS United will work with our allies against all new efforts to repeal or weaken the law of the land. Now it is up to Congress and the states. AIDS United calls for an end to partisan bickering about the ACA, and urges swift, decisive movement forward to implement the most important legislation ever passed for people living with HIV/AIDS in the United States."

One of the few LGBT groups to disagree with the ruling was the Log Cabin Republicans, and its "sour grapes" response followed the party line.

"By upholding even the most intrusive provision of Obamacare, the individual mandate, the court has enabled Washington's addiction to big
government and coercive taxes," said Christian Berle, Log Cabin Republicans deputy executive director.

"The individual mandate forced through Congress was an unprecedented expansion of federal power in blatant disregard of the will of the American people. Log Cabin looks forward to working with our Republican allies in Congress to repeal and replace Obamacare with real, market-driven reforms that will lower costs while preserving the standard of care Americans deserve," he said.

"Log Cabin Republicans also have not forgotten that Democrats in Congress stripped provisions protecting LGBT families out of healthcare reform when it was passed. We remain committed to ending the Internal Revenue Service's discriminatory treatment of employer-provided healthcare for domestic partners. While the Court may have found Obamacare to be constitutional, that does not mean it has been carved in stone. Now is the time to go back to the drawing board and institute reforms that work for all Americans," Berle said.

GOProud, as expected, bashed the decision.

"Today, the Supreme Court has ignored the Constitution and given the federal government unfettered and unchecked power. Today is a good day for big government and a bad day for individual liberty," said Jimmy LaSalvia, executive director of GOProud.

"This decision reminds us of how important it is to elect conservatives to the House, Senate and the White House that will protect our individual liberties, because it is clear that the Supreme Court is unwilling to do so," he said.

"Free market healthcare reform would expand access to domestic partner benefits and put gay people in charge of their healthcare decisions. By upholding Obamacare, the Supreme Court has upheld legislation that hurts all Americans, but especially hurts gay and lesbian families," LaSalvia said.

Stay tuned to San Diego Gay & Lesbian News for updates to this story.

To read a good explainer story, written in advance of today's court ruling, click HERE.