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 Supreme Court Hands Obama Victory in Health Care Case, Give States Out

The federal government can’t cancel a state’s Medicaid funding just because it opts out of President Obama’s health care regime, the Supreme Court ruled on Thursday.

In one of the most anxiously anticipated ruling in years, a plurality of the court held that Congress would exceed its constitutional authority if it cancelled all Medicaid payments to punish states that opted out of the Medicaid expansion provision of the law.

It’s a narrow ruling: Only two justices (Ruth Bader Ginsberg and Sonia Sotomayor) said they considered the expansion of Medicaid under the Affordable Care Act (ACA) constitutional, while three justices (Chief Justice John Roberts and Justices Elena Kagan and Stephen Breyer) decided that only the punishment section of the law was unconstitutional. Nonetheless, it represents a victory of sorts for long term care providers, who will, at a minimum, see their states’ Medicaid funding remain intact even if their states want nothing to do with Obamacare.

The American Health Care Association/National Center for Assisted Living hailed Thursday’s decision but urged the nation’s legislators and policymakers to shore up support for Medicaid.

“The shortfall in Medicaid funding for long term care needs reached $6.3 billion in 2011. Against a backdrop of rising health care costs, Medicare has suffered multiple rounds of cuts and reductions in the last few years,” the association said in an e-mail statement. “AHCA/NCAL supports initiatives that create incentives for quality care and help contain health care costs. We look forward to working with the administration and Congress to address these critical issues that ensure access to skilled nursing and assisted living care for our nation’s seniors.”

The court otherwise upheld the ACA by a 5-4 vote. While narrow, it nonetheless was a clear legal victory for President Obama. On Wednesday night, Republicans were all but guaranteeing the court would rule against the president. Presumptive GOP nominee Mitt Romney said that an adverse decision would have proved that Obama’s presidency had been a waste of time.

Romney read a brief statement Thursday saying that Obamacare was an assault on individual liberty and that the only way to fix America’s health care regime was to toss the president out of office. However, as governor, Romney’s Massachusetts was the state that pioneered the individual mandate, which was at the heart of Obama’s reforms.

Triumphant Democrats weren’t above reminding the public about that on Thursday.

Nonetheless, the health care package remains Obama’s singularly most unpopular measure, and Republicans were hopeful that they could tie Thursday’s decision like a millstone around the president’s neck.

In its 190-plus-page decision, the Supreme Court acknowledged that it was answering a legal question, but merely opening a political question. “We do not consider whether the Act embodies sound policies,” Roberts wrote for the majority. “That judgment is entrusted to the Nation’s elected leaders.”

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