The fine for failing to comply with the individual health insurance mandate can be considered a tax and is thus constitutional, the U.S. Supreme Court ruled Thursday, upholding the core provision of President Barack Obama's signature Affordable Care Act.
The 5-4 majority opinion written by Chief Justice John Roberts concludes removing the requirement that all U.S. citizens purchase health insurance was not valid as an exercise of the commerce clause power of Congress, effectively clipping the wings of lawmakers bent on overturning the health reform law.
Because the individual mandate is considered the funding arm of the entire health reform law, many had speculated its removal would have doomed key provisions of the Affordable Care Act already benefiting millions of Americans, including allowing children to remain on their parent's insurance plan until age 26 and stopping insurers from dropping customers when they become sick.
Democratically appointed Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan joined in the majority opinion with Roberts, a conservative member of the court appointed by President George W. Bush.
Republican presidential nominee Mitt Romney has vowed to repeal "Obamacare" despite it being modeled after universal healthcare built on an individual mandate he signed into law as Governor of Massachusetts.
Reaction from nursing leaders was positive but tempered with concern about what many see as a broken private health insurance system.
The American Nurses Association lauded the decision, hailing it as "a victory for all patients and their families." This is particularly true, ANA noted, for those 50 million adults and children who currently lack adequate health coverage. Leaders praised the law's consumer protections and the opportunity it opens for RNs to assume an even greater role in providing high-quality, cost-effective care.
"This decision means that millions of people will have access to the basic healthcare and preventive services that they've lacked," said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. "Instead of getting sicker and developing serious and costly complications because they can't afford to manage their health conditions, people will get the care they need to recognize problems earlier or avoid them altogether. There will be savings throughout the system.
"Registered nurses are well-positioned to lead in providing essential prevention and wellness services and care coordination for individuals and families," Daley added. "The law enhances opportunities for nurse practitioners and nurse midwives to provide primary care. This will increase accessibility for the growing number of people needing basic health services."
To read the Supreme Court decision in its entirety, click here.
Greater access to healthcare should translate into viewer emergency department visits for routine care and fewer people waiting until they are seriously ill before going to hospital, added Emergency Nurses Association President, Gail Lenehan, EdD, MSN, RN, FAEN, FAAN.
"Though people will continue to require emergency care, this decision means that millions of people will have access to basic, primary healthcare and preventive services, which should ultimately reduce the numbers of patients seeking routine care in the emergency department," Lenehan said, adding, "Patients will get the care they need earlier instead of becoming seriously ill and requiring complex, acute care in a hospital emergency department."
Like ANA, ENA welcomes the opportunities the health reform law affords advanced practice nurses.
"Emergency nurses are critical members of the healthcare team who provide care and coordinate resources for patients and families every hour of every day," says Lenehan. "The ACA provides new and enhanced opportunities for nurses, especially nurse practitioners, to become more appropriately utilized to the full extent of their knowledge, skills and training."
Leaders of the country's largest nursing union, National Nurses United, though pleased with the decision overall, noted that the health reform law "will still leave 27 million Americans without coverage, does little to constrain rising out of pocket healthcare costs or to stop the all too routine denials of needed medical care by insurance companies because they don't want to pay for it." NNU argues private insurance should be replaced by Medicare for all.
Following the Thursday's Supreme Court ruling, NNU leaders pledged to step up a campaign for a reform that is not based on extending the grip of a failed private insurance system, but "on a universal program based on patient need, not on profits or ability to pay. That's Medicare for all," said NNU Co-President Jean Ross, RN. "It is not time to stop, but a reminder to begin that effort anew."
"Nurses experience the crisis our patients continue to endure every day," added said NNU Co-president Karen Higgins, RN. "That's the reason we will continue to work for reform that is universal, that doesn't bankrupt families or leave patients in the often cruel hands of merciless insurance companies."