Capitol Alert

The latest on California politics and government

Today's U.S. Supreme Court decision upholding a key part of the federal health care law has sparked strong reactions from both sides of the debate.

A collection of statements and responses from California officials and groups is posted after the jump. You can send your statement to hmadans@sacbee.com. Read more coverage of the decision at SacBee.com.

DEMOCRATIC OFFICIALS:

Gov. Jerry Brown

Today's dramatic Supreme Court ruling removes the last roadblock to fulfilling President Obama's historic plan to bring health care to millions of uninsured citizens.

Lt. Gov. Gavin Newsom

There is a healthcare crisis in this country, a crisis with profound implications for each citizen in every city and county in America.

Today's United States Supreme Court decision, which upheld the individual insurance requirement, is just a start. But the decision allowing states to opt-out of Medicaid expansion still leaves millions of Americans vulnerable.

We can -- and must - act now to do more to offer healthcare access to all.

We do not have time to stand on the sidelines. There is a crisis but there is also a solution.

Americans know it is much less expensive to keep people healthy than it is to treat their sickness. This is particularly true when much of the treatment for uninsured Americans is provided in costly emergency rooms. Without a universal healthcare plan, our emergency rooms will continue to bear the brunt of this crisis and citizens will pay the price with higher taxes, more expensive premiums, hidden costs and increased fees.

While serving as mayor of San Francisco, I saw first hand the impact of the healthcare crisis on the insured, uninsured, businesses, emergency rooms and municipal coffers.

We decided to address this crisis head-on and launched the country's first local universal health care program, Healthy San Francisco. It is blueprint that can be replicated by cities and counties across the nation. A public plan can work. San Francisco is proving it.

Since being implemented, more than 80 percent of uninsured San Franciscans have received medical coverage. Healthy San Francisco is not health insurance, instead it provides access to affordable basic and ongoing health care services for the uninsured, regardless of immigration status, employment status, or pre-existing medical conditions.

We must not wait for the federal government to take the lead in the wake of the today's Supreme Court decision.

Cities and counties across the nation, such as Dallas, Indianapolis, and Miami, have already taken steps to establish healthcare service access programs. California must move forward with innovative programs, like Healthy San Francisco, that provide access to healthcare and not simply access to healthcare insurance.

Democratic U.S. Sen Dianne Feinstein

This is an historic day. The Supreme Court today upheld the health care reform law passed by Congress in 2010, meaning Californians can be confident that access to affordable health insurance is finally a reality. ...

I realize that passage of health care reform was extremely controversial. But we cannot forget that insuring fellow Americans and driving down the exploding cost of health care spending in this country is a national emergency. Even with this favorable decision from the court, our work reforming the insurance market and expanding access to health care continues.

U.S. Sen. Barbara Boxer

The decision is great news for the millions of Californians who have already seen the benefits of this law - including the six million who now have access to free preventive health services, 355,000 young adults who now have coverage on their parents' health plans and 320,000 seniors who have received help in paying for their prescription drugs. ... We will continue to fight Republican efforts to repeal these important health benefits while we work to make sure every American has access to quality, affordable health care.

Rep. John Garamendi, D-Fairfield

When people fall ill, we should help them get better. Most of us have experienced hard times. Many of us have gone without health coverage. When you lay all the heated rhetoric and legalese aside, the health care debate is really about what we're going to do when people get sick or injured. In America, we should take care of each other. It is irresponsible to force millions of Americans to delay treatment because they can't afford it, to live one broken leg or one chronic illness away from financial calamity,

Today a 5-4 majority in the Supreme Court made the right decision. President Obama and Democrats in Congress did the right thing. We developed a plan that extended health coverage to most Americans. We fulfilled our moral obligation to seniors, to children, and to hardworking Americans. The Supreme Court sided with our authority to improve health care for all Americans,

The health care law establishes a powerful Patient's Bill of Rights. No longer will Americans with a pre-existing condition be denied health coverage. No longer will women be charged more for coverage. The health law will finally close the prescription drug donut hole, so seniors can afford their medication. The benefits of the Affordable Care Act have already started. 32.5 million Seniors have already received free preventative services. Three million additional young adults now have health coverage because of the law. Small businesses can take advantage of tax credits so they can provide insurance for their employees. Starting in 2014, 30 million more Americans will be able to afford access to health care,

Jesus taught us, "Whatever you did for one of the least of these brothers of mine, you did for me." All the world's great religions urge us to be compassionate and to help the sick. All good people recoil at the sight of needless suffering and cruelty,

We all deserve the freedom from want and the freedom from fear. While I hope to eventually see Medicare for All in America, the Affordable Care Act is a vast improvement over the dark days when we allowed the insurance companies to run roughshod over our health.

Rep. Doris Matsui, D-Sacramento

This decision by the Supreme Court reaffirms what my Democratic colleagues and I already knew; the ACA is constitutional and has already benefited millions of Americans. Access to health care should not be a privilege in this country. It is my hope that now the political games can stop and the ACA will be implemented for those in need of care...

Now that the ACA has been upheld, we must continue pushing forward with implementing the long overdue reforms it calls for. Elected leaders would be wise to stop efforts to chip away at this landmark legislation and instead use their time to make sure the law works for all Americans

Rep. Judy Chu, D-El Monte

Today's ruling marks a watershed moment for the health and wellbeing of every single American. The days of pre-existing conditions, denied coverage and spiked insurance rates are over! The Supreme Court decision does more than reaffirm the Constitutional merits of the Affordable Care Act - it also serves as a case-in-point of how our federal government is supposed to serve the American people. I commend their decision in the highest terms possible, and am grateful that we as a nation can finally rest assured that our health and wellbeing will not be subject to manipulative insurance practices.

Rep. Karen Bass, D-Los Angeles

Today's historic decision by the Supreme Court to uphold the constitutionality of the Affordable Care Act is extremely welcomed news. The American people can now rest assured and claim today as a victory, as everyone in our country will receive quality healthcare that each person is entitled to. When President Obama promised the American people that he would create a system that provided healthcare at a minimum cost - he did just that. With the Affordable Care Act, healthcare is once again a basic human right that allows families to receive quality care without having to spend every penny they earn. I'm pleased that the Supreme Court held firmly to their principles and did not politicize this important decision. Now, the Affordable Care Act can do what the American people need it to do, including providing millions of Americans access to cancer-screenings like mammograms and colonoscopies, ensuring coverage for millions who have preexisting conditions and youth who remain on their parent's coverage; and finally give seniors a stronger Medicare program.

Rep. Adam Schiff, D-Burbank

I am very pleased to see that the Supreme Court has upheld the health care reform law. These hard-passed reforms will be beneficial to the country - already, 17 million children with pre-existing conditions can no longer be denied coverage by insurers, seniors have received additional help with prescription drug prices, college graduates can stay on their parents policies, small employers and the self-employed will soon be able to purchase health insurance at bulk discount rates, and millions of Americans will have health insurance for the first time. I am also pleased for another reason: The Court was at risk of becoming yet another partisan institution if it threw out decades of precedent. The Chief Justice chose a different legacy, and this was not only the correct legal decision, it was also enormously important to maintaining the independence and reputation of the Court.

Rep. Loretta Sanchez, D-Orange County

With today's ruling by the highest court in the land behind us, it's time to move forward, roll up our sleeves, and work together to get our economy back on track and create jobs. I hope my Republican colleagues in Congress will join me in this effort, rather than focusing on new attempts to try to strip Americans of their health care rights.

Assembly Speaker John A. Pérez, D-Los Angeles

Today's ruling by the Supreme Court is a victory for all Californians. The Court's decision to uphold the constitutionality of the landmark Affordable Care Act will ensure that the President's efforts expand access to affordable, quality health care for individuals regardless of age, income, or pre-existing conditions will continue moving forward.

As the author of legislation establishing California's Health Care Exchange, I am committed to continuing our work to reform California's healthcare system to ensure that millions of Californians can get coverage that is comprehensive and affordable and doesn't discriminate based on pre-existing conditions.

President Obama and Congressional Democrats showed great leadership in enacting the Affordable Care Act and today's decision reinforces that leadership. California has been the national leader on implementing federal healthcare reform, and today's decision affirming the wisdom and constitutionality of the Affordable Care Act means we will continue to move full-speed ahead.

Rep. Linda Sánchez, D-Los Angeles

Today's decision is a victory for the American people. It underscores the progress already made for millions of children who can no longer be denied coverage based on pre-existing conditions, for the young adults who are now covered under their parents' health plans, and for the seniors now paying less for their prescription drugs. The Affordable Care Act has made that a new reality for millions of Americans...

I have believed from the start that the Affordable Care Act, and quality access to health care, was Constitutional. This landmark legislation put in place vital patient protections and consumer freedoms that Americans have desperately needed. I will continue to fight any efforts to repeal the Affordable Care Act and work to ensure that every American has access to health care.

Senate President pro Tempore Darrell Steinberg, D-Sacramento

This is a historic ruling on many levels. It affirms our nation's commitment to quality health care and strengthens the credibility of the United States Supreme Court.

No illness should force financial devastation on individuals and their families; limiting access to routine check-ups often leads to severe sickness, expensive treatment, and even greater distress for families.

With the legal case out of the way, we can now use the foundations we've already built to focus 100 percent on maximizing the law's benefits for all Californians. Since the enactment of the Affordable Care Act, California has already secured hundreds of millions of dollars in federal funding to expand coverage to Californians with preexisting medical conditions and increase services provided by community clinics.

And as the first state to establish a health care exchange under the new law, California will soon have the infrastructure to simplify health care enrollment, making it easier for both individuals and businesses to compare plans and purchase coverage.

For too long, California's taxpayers have footed the bill for people without health insurance. This burden will be reduced by billions of dollars with President Obama's Affordable Care Act.

Assemblymember Fiona Ma, D-San Francisco

Today is a historic day for the country and for California. I am very proud that justice prevailed and that the highest court upheld President Obama's Affordable Care Act that will require most Americans to have insurance by 2014. This landmark legislation will expand access to affordable, quality health care for individuals regardless of age, income, or pre-existing condition and will provide coverage to nearly 5 million Californians.

At a press conference this morning, the President urged states to move forward and expand coverage at the same quality and cost. Through my bill, AB 1800, California has the chance to be at the forefront of moving forward with this monumental request.

AB 1800 will ensure that the needs of these families are met and it will provide security for millions of Californians, where the Affordable Care Act is silent. AB 1800 applies essential health benefits to large group employers and grandfathered plans. This would include businesses with over 50 employees that currently are not subject to the caps set by the ACA.

California has been at the forefront of major public health initiatives which have spread throughout the country. They include the establishment of a health insurance exchange, as well as requiring smog checks for clean air, anti-tobacco initiatives and bike helmets laws. In the unfortunate circumstance the Affordable Care Act is repealed, California will continue to move the country forward and protect our most vulnerable.

State Sen. Leland Yee, D-San Francisco

It is a great day for America's families. Today's ruling reaffirms the values of our nation and our collective responsibility to help those in need. Not only will every citizen have access to affordable health care, but the care they receive will be more humane and fairly administered. No longer will insurance companies be able to deny coverage for preexisting conditions. No longer will kids be prematurely kicked off their parents' health care policies. No longer will coverage for cancer patients be capped. I congratulate President Obama on this signature achievement and I look forward to seeing this Act implemented in California.

State Sen. Senator Ed Hernandez, D-West Covina

This is a landmark decision that will put an end to unnecessary delay and allow us to deliver on the promise of this historic law by expanding health coverage to millions of uninsured Californians. Here in California, we have moved quickly to implement many of the important reforms and consumer protections allowed under the ACA, including measures that require health plans to cover children, prohibit insurers from cancelling policies when the policyholder gets sick, and allowing dependents to remain on their parent's coverage until age 26. While much progress has been made there is still so much left to achieve before 2014. The days of people having to choose between buying food and seeking medical care are coming to an end. With today's Supreme Court's decision, California stands ready to implement the president's vision and begin charting a new course for our health care system in this state.

Eric C. Bauman, Los Angeles County Democratic Party Chair and California Democratic Party Vice-Chair

I applaud the Supreme Court's ruling this morning to uphold the Affordable Care Act, the signature piece of legislation of President Obama's first term. More than 44 million Americans without insurance will not lose their opportunity to get health care or be denied coverage due to a pre-existing condition, and those who are insured no longer face the threat of losing their coverage if they get sick.

History always looks kindly on those who show strength and leadership in the face of extreme adversity. Simply put, President Barack Obama's Affordable Care Act is one of the most important pieces of legislation of the last fifty years - legislation that Mitt Romney and the Republicans fought at every turn.

The slim majority of the Court's Justices that upheld health care reform today should serve as a lesson on the vital importance of reelecting our President and keeping the extremists Mitt Romney has pledged to appoint off of the bench.

Assemblymember Mariko Yamada, D-Davis

Today is a historic day in our country. The U.S. Supreme Court has affirmed that healthcare is not a privilege, but the right and responsibility for all Americans.

Assemblymember Nancy Skinner, D-Berkeley

The Supreme Court's decision to uphold President Obama's Affordable Care Act is a victory for the health and future of all Californians who will benefit from preventative care, reduced premiums and consumer protections.

Every individual at some point will need to see a doctor. At the rate at which premiums are increasing, accessing affordable health care has become nearly impossible, especially for anyone with pre-existing conditions.

Today's opinion by the nation's highest court will ensure that all of us have the opportunity and the resources to access affordable health care.

Assemblymember Roger Dickinson, D-Sacramento

I applaud the Supreme Court for ruling to uphold the constitutionality of the groundbreaking Affordable Care Act. I wholeheartedly believe that all Americans deserve access to high-quality health care coverage, regardless of pre-existing conditions. Especially in times of high unemployment and budget cuts, affordable healthcare could not be more critical.

John Burton, California Democratic Party Chairman

The highest court in the land has upheld the historic Affordable Care Act passed by a Democratic Congress and signed into law by President Obama. Millions of Americans are already experiencing the benefits of the law and more stand to benefit still in the near future.

Meanwhile, Mitt Romney and Congressional Republicans continue to talk of repealing the law instead of focusing on strengthening our economic recovery and making sure Americans have good jobs here at home. The reaction from the Republican House leadership and their calls for a full repeal are another reminder that Democrats' work is far from done and reforms won't be fully protected until we win back the House and return the Speaker's gavel to Nancy Pelosi.

Mark Takano, 41st Congressional District candidate

I am very pleased that today the Supreme Court followed the Constitution and upheld a law that ensures that young adults just starting their careers can remain on their parent's health insurance plan, that seniors don't have to choose between paying for food and paying for medicine because of a gap in Medicare coverage, and that no American will be turned down for coverage because of a pre-existing condition.

Unfortunately, House Republicans, who are on in the pocket of big insurance companies, only want to play political games instead of focusing on getting our economy back on track. In Congress, I will stand with middle class families and fight to bring good-paying jobs to the Inland Empire, to improve access to higher education and to protect Medicare from Republican plans to privatize it.

REPUBLICAN OFFICIALS

Rep. Darrell Issa, R-Vista

The Supreme Court has ruled to uphold the President's Obamacare. Despite being viewed as Constitutional by a narrow majority, this law will do great harm to our country by imposing new taxes, burying job creators in new red tape and saddling future generations with debt they can't afford.

In selling Obamacare, Congressional Democrats and President Obama assured the American people that it was not a tax. Today, the Supreme Court ruled it was, in fact, a tax. This tax was imposed on the American people amidst an extended recession and is one of the many reasons our economy remains stagnant under President Obama's leadership.

To date, the Republican-led House of Representatives has voted 30 times to repeal, dismantle and defund Obamacare--and we will continue our efforts to repeal this law and replace it with health care reform that enacts needed reforms without imposing costs that will be paid by subsequent generations.

"In the days ahead, I will work with my colleagues to achieve real solutions to America's health care challenges that do not infringe on doctor patient relationships, impose unpopular mandates, and do not add to the nation's already significant debt."

Rep. Wally Herger, R-Chico

Today, the Supreme Court ruled that President Obama's health care law can be considered constitutional only if it is understood to violate the President's repeated promise that he would not raise taxes on middle-income Americans. Although I continue to believe that the Democrats' health care law exceeds Congress's constitutional authority and am disappointed that the Court has allowed it to stand, nothing in the Court's ruling suspends the laws of math or makes the law any more affordable or sustainable. According to the Congressional Budget Office, the health care law is now expected to cost $1.8 trillion over the next 10 years. Due to perverse incentives in the law, independent analyses estimate that many employers will find it cheaper to pay the fine than to continue providing insurance for their employees. As a result, millions of American workers could lose the coverage they have and like, breaking another of the President's pledges. This is an incremental step to a complete government takeover of health care. If you prize the efficiency of the Department of Motor Vehicles, you will love healthcare under the Democrat law.

The Supreme Court's ruling makes it clear that it is up to the people's elected representatives to overturn this bad law. House Republicans believe the solution to our health care challenges lies in putting patients in control instead of insurance companies or government bureaucrats, and I remain committed to fully repealing this bad law and replacing it with reforms that reduce costs and make health care more affordable without expanding the size of government.

Rep. Elton Gallegly, R-Simi Valley

By ruling that the individual mandate is a tax and that the president and Congress have the right to tax, the U.S. Supreme Court exposed President Obama and House Minority Leader Nancy Pelosi's predisposition to tax the American people to pay for big government programs that kill jobs and place unreasonable burdens on all Americans. But just as Congress can tax, it can repeal taxes. A recent Reuters poll found that 56 percent of respondents oppose Obamacare and 61 percent oppose the individual mandate tax. I will continue to work with my colleagues to rescind Obamacare and its burdensome taxes and regulations. Then Congress can take a strong look at the health insurance system and our overall health care system, analyze where it can be made more efficient and responsive to patients and health care professionals, and take the steps necessary to make it more accessible and affordable for all Americans without big government taxes.

Rep. Ed Royce, R-Fullerton

I am extremely disappointed in today's ruling. The president's health care bill, one of the most intrusive bills this nation has ever seen, was a huge step toward a Washington-controlled health care system that rations care, limits choice, and reduces quality, innovation, and competition. Today's disappointing ruling means it is now on Congress to reform the most egregious aspects of this law. In its current form the president's health care law is bad news for patients, doctors and small businesses. This law fails to deliver the reforms needed to fix the health care system, while creating a massive new entitlement program. The $2 trillion price tag (and rising) is "paid for" by taxpayers (who will see more than half a trillion in new taxes) and seniors (who will see $500 billion in cuts from Medicare), as well as by adding to the deficit. The administration's approach - reckless spending and government takeovers - is driving up health care costs and making it harder for small businesses to hire. This health care law has already broken a number of promises. Nonpartisan researchers have found that millions of Americans will lose their insurance coverage; so if you like your coverage, you can't keep it. Premiums continue to rise, despite promises to reduce them by up to $2,500 per family, per year. The 4 million jobs promised by Pelosi have failed to come to fruition. In fact, the law's enactment has contributed to our sluggish economy and high unemployment rate. Americans want the freedom and opportunity to make health care choices for their family. I am committed to working with my colleagues to achieve this objective by repealing this flawed law and beginning work on common sense solutions to lower health care costs.

Elizabeth Emken, Republican U.S. Senate nominee

The high court's decision makes it crystal clear that the only way to ensure that Americans repeal this dishonest attempt at health care reform is to take back the White House and the U.S. Senate this November.

Democrats like Dianne Feinstein lied about the cost of Obamacare, then stole from Medicare to justify the initial price tag. Now they are attempting to steal from core institutional programs at the Centers for Disease Control that support programs for the disabled to cover up the ballooning cost. That's not just shady politics, it's just plain wrong. And now the Supreme Court ruling has brought Obamacare's hidden taxes to the light of day.

Obamacare will continue to have a negative impact on job creation and hiring, and businesses will be forced to continue to grapple with all of the uncertainty and costs the law creates. The simple truth is that businesses across the nation are not hiring as a result of this administration's mismanagement of health care reform.

Only with new leadership in Washington can we expand access and lower costs through competition and choice while keeping in mind our responsibility to care for the truly vulnerable without raising taxes or increasing debt. I will vote to repeal the Obamacare tax dragging down our economy and hurting families. Dianne Feinstein won't. It's a simple choice.

State Sen. Tom Harman, R-Huntington Beach

The Court has ruled, so our duty now is to implement the ACA responsibly and cautiously. I look forward to working with my colleagues to do just that. Anything we do must be examined through the prism of affordability - which could be a challenge in this legislature. My concern is that the Court's ruling will be seen as a green light by some to expand beyond what the Federal law requires. California can't afford to do that.

Just yesterday the Democrats moved 880,000 poor children currently enrolled in the popular and successful Healthy Families Program (HFP) into the problem plagued Medi-Cal program to "save money." There is no pot of gold at the end of this rainbow and there are many challenges facing the state that need to be addressed as well as health care.

Assemblymember Dan Logue, R-Marysville

Today's ruling by the Supreme Court punishes American families and workers by upholding the individual mandate as a 'tax' under the Constitution, but it also leaves it up to the states to decide whether to participate in the massive expansion of Medicaid. The result is that California may again be the only state in the region to attempt a massive new government program, while our neighbors stand by and watch us struggle under the multi-billion dollar cost. Sacramento has already enacted most of the laws needed to implement Obamacare in California, including the creation of a new Health Benefit Exchange bureaucracy and new mandates on private health insurers, and the remaining pieces are in the works.

Just because the Supreme Court upheld the constitutionality of Obamacare does not mean that it is the best thing for our state as we struggle to recover from the economic downturn. The top-down approach of the law will mean higher healthcare costs for families and businesses, more employers dropping healthcare coverage for their employees, and more jobs lost. This will further harm the doctor-patient relationship by inserting more layers of bureaucracy, and will make healthcare decisions more about whether the government thinks it is worth the investment rather than what kind of care a doctor believes the patient needs. Repealing these laws is essential to protecting taxpayers, preventing top-down rationing of care by unelected bureaucrats and stopping more jobs from leaving the state.

Assemblymember Jim Nielsen, R-Gerber

"While I agree with the four dissenting justices who opined that the 'act is completely invalid', today's majority ruling from the Supreme Court is certainly a disappointment," said Nielsen. "The Court ruled today that Obamacare is nothing more than a massive tax increase on every American, likely the largest in U.S. history. With a stagnant economic recovery and millions of Americans still unable to find jobs, it is imperative that Congress moves immediately to repeal this costly new tax. I fear that Obamacare will do nothing more than confuse and diminish health care nationwide."

"I urge my constituents, and the majority of Americans who strongly disagree with this policy, to keep fighting and let their voices be heard," said Nielsen. "Now, more than ever, we need fiscally-responsible health care reforms that will give patients more affordable choices without raising taxes or growing government."

Tom Del Beccaro, Chairman of the California Republican Party

Today, our American system of government changed dramatically if not irrevocably. Congress can now tax citizens into doing what it wants. We used to have a Supreme Court Justice, John Marshall, that believed the "power to tax" was the "power to destroy." Now we have a Chief Justice who believes that the power to tax is the "power to mandate."

The stakes of this election have now doubled if not more. The fate of this legislation is now in the hands of voters. By re-electing Obama, they will keep this law. If they elect Romney, it could well be repealed. Few elections provide such a clear choice.

For California, a state already in more than financial distress, this represents a potential huge new financial burden. Californians cannot afford the government we have - there simply is no way for us to afford this new and massive expansion of government.

Assembly Republican Leader Connie Conway, R-Tulare

There's no doubt that affordable health care is a problem that needs to be addressed, but Obamacare is not the solution. It's disappointing that the Supreme Court ruled in favor of a law which violates the freedom of Americans to make the personal choice of their medical needs.

This costly tax on Americans will result in the rationing of medical care and will cost jobs. The Valley already suffers from high unemployment and limited access to health care.

We need new leadership in Washington, D.C. to repeal this law and move forward with sensible solutions that protect patient choice, keep health insurance affordable and increase access to quality care.

Abel Maldonado, R-Santa Maria, Former CA Lt. Governor and 24th Congressional District candidate

We are a nation built on the right to be free and the right to make choices for ourselves and I believe that government should never force anyone to buy a service. The fundamental truth is that the American people want a health care solution that expands access to care, preserves choice and lowers costs.

As it turns out, the 'big gamble' Rep. Lois Capps (D-Santa Barbara) voted to pass without knowing what was in it, was in reality, a big tax on millions of middle-class American families and seniors. The Supreme Court's decision couldn't be clearer - ObamaCare is a tax and the Congress has the sole authority to repeal that tax. I support a bipartisan repeal and replace of the ObamaCare tax.

Across the country, small businesses and working families are struggling to cope with the crippling effect of the ObamaCare tax. I believe that health care decisions should be made by patients, families and their doctors, not by Washington bureaucrats who have forced upon the American people a $525 billion tax increase, a $575 billion Medicare cut for seniors and a 9% increase in premiums for working Americans.

Kim Vann, Colusa County Supervisor and 3rd Congressional District candidate

Today's Supreme Court ruling underscores the urgency with which Obamacare should be repealed and replaced with solutions that do not tax and cripple our economy. Rather than providing a lasting solution to the challenges facing our health care system, the health care law places a $600 billion tax on American families and businesses, while cutting over $500 billion from Medicare, empowering an unelected and unaccountable board of bureaucrats to make decisions regarding seniors' health care, and imposing burdensome and costly regulations on our small businesses. It's clear these solutions aren't working. We must work for real reforms that lower costs and increase access to quality care, while ensuring that patients and their doctors--not government bureaucrats--remain in control of their healthcare decisions.

Ricky Gill, 9th Congressional District candidate

Jerry McNerney promised that his health care plan would reduce health care costs, but today we learned it is simply a massive tax increase that is already contributing to skyrocketing health care premiums for middle class families. Jerry McNerney stands for the status quo, but I am committed to moving responsibly towards bipartisan, comprehensive health care reform that increases patient choice, reduces costs, and protects coverage for seniors, young people and those with pre-existing health conditions.

HEALTH CARE GROUPS:

Anthony Wright, executive director of Health Access

Today, the Supreme Court has said the Affordable Care Act is here to stay. We are pleased to put the legal wrangling behind us, and all policymakers of both parties can focus on maximizing the benefit for California and California. This decision means there should be no more excuses or delays by detractors--we need to go full speed ahead to ensure that millions of Californians enjoy these new options and consumer protections." said Wright. "California has and will continue to lead in taking advantage of the new options, benefits, and consumer protections under the Act."

California Medical Association

Today's ruling by the United States Supreme Court draws a mixed reaction from the California Medical Association (CMA), the organization that represents over 35,000 physicians in all modes of practice throughout the state.

"From the beginning, we have both agreed and disagreed with portions of the Affordable Care Act (ACA)," said James T. Hay, M.D., CMA President. "CMA vigorously supported the individual mandate to ensure universal insurance coverage for the millions of uninsured Californians and the reforms on the for-profit insurance industry, and we are pleased that those reforms were upheld. However, there are serious flaws in the ACA that do not address the underlying problems of patient access to physicians that need to be addressed by Congress and the President immediately."

Throughout the health care reform debate, CMA has strongly advocated for affordable access to care for California's uninsured and for expansion of health insurance coverage. The physician organization has also supported eliminating egregious health plan rescission practices, pre-existing condition bans, and ending excessive insurer profit and administrative costs. CMA was also instrumental in arguing for state based health insurance exchanges, rather than one national exchange of private health plan choices and urged reinvestments in primary care, public health and the physician workforce.

While the ACA provides insurance coverage for millions of previously uninsured Californians, it does not guarantee that these newly insured patients will have access to doctors because the Medicare and Medicaid programs were left grossly underfunded. CMA was also strongly opposed to the ACA's creation of an unaccountable Independent Medicare Payment Advisory Board (IPAB), which will mandate arbitrary spending cuts, force more physicians out of the program, and limit seniors' treatment options.

Expanding coverage to more Californians, putting an end to insurance industry abuses, and support for primary care are essential for our patients and the future of medicine," added Dr. Hay. "Despite these wins, the ACA builds reform on the broken foundations of Medicare and Medicaid without addressing the underlying problems and inadequate funding. CMA will continue to work to fix those ills."

CMA will continue to fight to repeal the flawed Medicare Sustainable Growth Rate (SGR) payment system, which is slated to slash physician reimbursement by 32 percent next year and harm seniors access to care.

Additionally, as nearly 3 million new uninsured Californians enter the Medi-Cal program under the ACA, CMA will continue the fight in Congress and the state Legislature to increase the dismally low Medi-Cal payment rates so that more physicians can afford to care for these patients. Recent reports have found that 50 percent of Medi-Cal patients have difficulty finding a physician.

"There is an enormous amount of work yet to be done," said Dr. Hay. "We'll be active in helping to implement the State Health Benefit Exchange as a fair marketplace of appropriate plan options and we will continue to help our patients take advantage of the coverage expansions offered as part of the ACA.

C. Duane Dauner, president of California Hospital Association

The California Hospital Association (CHA) is pleased by today's Supreme Court decision upholding the Affordable Care Act (ACA). California's hospitals have long supported the goal of expanding coverage to the uninsured. Today's ruling means that California will continue to make progress towards this goal.

The court's decision that the ACA - including the individual mandate - is constitutional will help ensure that all Californians have access to health insurance coverage.

The court also ruled that the federal government cannot withhold federal Medicaid funding to states that don't expand their Medicaid programs. We do not expect that this ruling will have significant impact in California. It's our expectation that California will comply with the Medicaid expansion in the law, even though it will increase the state's costs in future years. This Medicaid expansion could extend coverage to an estimated 2 million low-income uninsured Californians. Additionally, we expect the state to move forward with full implementation of the California Health Benefit Exchange, which is expected to provide coverage to more than 2 million additional California residents.

Today's ruling also provides much needed clarity to hospitals in our ongoing efforts to meet the "Triple Aim" of improving quality of care, reducing health care costs and improving the patient experience. California has long been on the forefront of innovative and cost-efficient health care delivery, which has led to per capita health care costs that are 8 percent below the national average.

We look forward to continuing our partnership with state and federal officials and other stakeholders as we move towards implementation of health care reform.

Patrick Johnston, president and CEO, California Association of Health Plans

The Supreme Court's decision means that California will continue to pursue the shared goal of helping as many citizens as possible get health care coverage. Health plans continue their commitment to effectively implement the Affordable Care Act and constrain the cost of care for all Californians.

Much remains to be done to get more Californians covered, especially the launching the California Health Benefit Insurance Exchange.

Now that the link between the individual mandate and insurance market reforms has been upheld, we all need to address underlying cost drivers that are increasing the cost of care.

In order to ensure consistency and clarity for Californians, any state implementation of elements of the Affordable Care Act should mirror the federal law. If we go beyond the already complex ACA --by piling on costly mandates, taxes, and regulations-- we could create unintended consequences and risk increasing state costs, as well as adding to the cost of health coverage for California families and businesses.

Health plans will continue to work with policymakers to improve affordability and choice for all Californians to ensure the stability of our health care system.

Peter V. Lee, executive director of the California Health Benefit Exchange

Today's ruling by the Supreme Court means that we, as a nation, can continue to move forward on our work to expand access to affordable, quality health care for all Americans.

We are moving full-speed ahead to expand options that will make affordable care available to more than 5 million Californians currently without insurance. This ruling removes a distraction from the job that thousands of Californians have come together to address - making health care work better for all.

David L. Gollaher, executive officer California Healthcare Institute

The Supreme Court's ruling, finding most provisions of the Affordable Care Act constitutional, surprised almost everyone. Chief Justice John Roberts, writing for the 5-4 majority, said that the Act's individual mandate could stand not, as the Obama Administration argued, under the Constitution's Commerce Clause, but based on congressional authority to impose taxes. As for the Act's enormous expansion of Medicaid, seven justices (all except Justices Ginsburg and Sotomayor) held that it went too far in imposing potential penalties on the states for noncompliance. Medicaid will expand, but how this plays out will take weeks and months to understand.

Meanwhile, the Court's decision leaves important parts of the Act untouched. These include the medical device excise tax, the authority for FDA to create a pathway for approving biosimilars, and the Independent Payment Advisory Board.

CHI will continue to work with policymakers to ensure implementation of the law enabling the biomedical community in California to continue to develop lifesaving therapies and medical technology while protecting patient access to critical medical innovation. CHI will continue to support implementation of the bipartisan supported biosimilars pathway, including its critical provision providing 12-years of data exclusivity that was enacted under the Affordable Care Act. CHI will also work to support efforts to repeal the Independent Payment Advisory Board, or IPAB, which threatens patient access to important and innovative medical interventions.

CHI has also strongly opposed the medical device excise tax and will continue to work to support its repeal. Our nation's medical technology companies employ nearly 519,000 people, with California home to more than 1,200 of these firms -- more than any other state in the nation. More than 107,000 medical device jobs in California represent roughly 20 percent of the total U.S. medical technology workforce. For most companies, the device tax would threaten payroll reductions and slash R&D investments. This is especially the case for small companies that make up the bulk of the sector in California. It is difficult to quantify, but recent studies estimate the tax threatens the loss of up to 43,000 jobs nationwide. As home to the largest segment of the nation's medical technology industry, California would be disproportionately impacted. Given our still uncertain economy, it is especially important that we do everything we can to encourage, investment, entrepreneurship and innovation.

California was the first state to create a Health Benefit Exchange following the passage of federal healthcare reform. It is charged with creating a new insurance marketplace in which individuals and small businesses will be able to purchase competitively priced health plans using federal tax subsidies and credits beginning in 2014. People would have no obligation to carry insurance; however, insurers would still legally need to accept applicants regardless of pre-existing conditions and limit the amount their oldest and sickest customers are charged.

The state of California is estimating that 2.5 million in the state are still likely to enroll in subsidized coverage in Medi-Cal and the exchange without the individual mandate. Enrollment could be affected by outreach and enrollment efforts and potential premium increases that would result from not having as many insured raise costs above what has been modeled, anywhere from 3 percent to more than 20 percent.

Our state and our country still face huge problems with the rising cost of healthcare, which in our estimation will require major changes to Medicare. CHI is dedicated to working with policymakers and our members in California to ensure that the biomedical community here is able to continue to thrive, providing well-paying jobs while ensuring groundbreaking therapies get to the patients who need them. Over the coming weeks, CHI will be distributing more in-depth information on the affect today's Supreme Court decision will have on our community.

Children's Health Advocates

The Affordable Care Act has already been a huge win for California children," said Jamila Edwards, Northern California Director of Children's Defense Fund-California. "Tonight, parents can rest easier knowing the law's benefits will be there for their children tomorrow, and that more benefits are on the way. We are excited to move forward towards full implementation of the Affordable Care Act in a way that maximizes the benefits for California children.

Today the Supreme Court has answered the hopes of millions of Americans - and Californians - by upholding the Affordable Care Act. For those of us in the faith community, health care reform has been about affirming the dignity of every person and the proper role of both individuals and government in safeguarding this dignity, through such means as providing access to basic health care," said Corey Timpson, Executive Director of PICO California. "This decision strengthens the moral fabric of our nation by affirming these principles"...

Among the many families who have already benefited from the Affordable Care Act is the Charlton family of Los Angeles. Rebecca Charlton is thankful that her 1-year-old son Trevon will never be denied treatment for his complicated asthma, because the Affordable Care Act prohibits insurers from denying coverage to children with pre-existing conditions. "I knew that this could be a life-long problem, and I was aware that only a few short years ago before health care reform was passed, this diagnosis could have plagued my son for years," Rebecca said.

"Even as we celebrate this victory for California children, we recognize the hard work that is needed to get all eligible children enrolled in coverage as the law continues to be implemented," said Wendy Lazarus, Founder and Co-President of The Children's Partnership. "Together we must build upon the substantial progress for children's health care under the law and work until every child is guaranteed access to comprehensive, affordable health care."

"Hundreds of thousands of California children can enroll today in free or low-cost comprehensive health coverage," added Suzie Shupe, Executive Director of California Coverage & Health Initiatives.

California Chronic Care Coalition

Leading California patient advocacy and provider organizations join advocates across America to praise the decision made by the Supreme Court of the United States.

"Our system has been broken for too long and must be reformed," said Liz Helms, President, California Chronic Care Coalition. "Today's ruling by the Supreme Court will benefit millions of Californians with chronic conditions and will expand access to affordable health care to many individuals in desperate need." ...

"The only way to guarantee a stable health care market is to make sure that everyone, including and especially the healthy, are part of that market," states Bill Remak, Chairman, Hepatitis C Task Force, and CCCC board member, "By making everyone a part of the market and therefore ensuring the best mix of health and high risk, health care premium rates are better controlled."

Lloyd H. Dean, President/CEO Dignity Health

This is a victory for patient care. While it is not a perfect bill, the Affordable Care Act does enable us to finally bring the American health care system into the 21st Century. The real value of this legislation is that it changes the financing system so that we are incentivized for quality. We look forward to continuing our implementation of the reform measures and we will continue to be strong advocates for universal access.

LAW GROUPS AND OFFICIALS

California Attorney General Kamala D. Harris

Today's decision is a historic victory for Californians, for the President, and for the country. The Affordable Care Act repairs a healthcare system badly in need of reform and ensures that every American has access to affordable health care. We never doubted the constitutionality of this law, and it is already making a difference in the lives of millions of Californians.

Marcia D. Greenberger, co-president of National Women's Law Center

Women in this country can breathe a huge sigh of relief that they and their families can continue to receive the many benefits of the health care law. It is clear that the federal government and the states must continue the essential work of implementing the law, and it is especially important that the states step up to the plate and provide health care coverage for all of their citizens, including those who are economically vulnerable and sorely need the expanded Medicaid coverage that the law provides.

Timothy Sandefur, principal attorney Pacific Legal Foundation

The Obama administration won a battle today, but it lost a war that its lawyers had been waging against bedrock principles of limited government. Yes, the administration's heavy-handed mandates were upheld under a technical analysis of tax law. But the Court refused to stretch the Commerce Clause - federal power to regulate people's activity - to cover this intrusive scheme of forcing people to buy health insurance. The administration was in essence arguing that the Commerce Clause sets no limits on federal regulatory power. If the justices had bought that claim, it would have been code red for our constitutional heritage of federalism, limited government and individual rights. Instead, we have a decision that rejects unlimited federal regulatory power, even while it allows the feds to impose a health-related tax.

Dr. Mitchell Katz, Director of Health Services L.A. County

Over half of these individuals are eligible to receive coverage through Medi-Cal in 2014. This coverage will be contingent on the State of California's participation in the Medicaid expansion component of the legislation. In anticipation of this expansion of Medicaid, the Department of Health Services (DHS) has already enrolled over 200,000 low-income County residents into Healthy Way L.A., the County's coverage program known as the "Bridge to Reform." While the ultimate decision on California's participation is yet to be determined, the Supreme Court's decision preserves a path for enrollment into Medi-Cal on January 1, 2014 for these individuals, as well as for three-quarters of a million other low-income Los Angeles County residents.

In addition to those who will be newly eligible for Medi-Cal, three-quarters of a million additional County residents will be able to purchase affordable health insurance through the state's health insurance exchange, take control of their health, and reduce pressure on our strained County-run health care system. With a sustained commitment to serve as the safety net for low-income Los Angeles County residents, over the coming 18 months DHS will continue to transform our clinics and hospitals into a system of choice for these newly insured.

Beyond the impact of the ACA's coverage components, DHS will continue to contend with the effects of other aspects of the legislation. Notably, this will include efforts to advocate for fair allocation of the Disproportionate Share Hospital funding cuts which were included in the legislation. These funds are an important revenue stream for Los Angeles County in that they provide a mechanism to reimburse hospitals for provision of uncompensated care. On this issue, DHS will advocate for a fair level and allocation of DSH funding. Finally, in recognition of ongoing fiscal challenges at the federal level, DHS will closely monitor the political environment and advocate for fiscal policies that safeguard DHS' ongoing ability to serve as a safety net provider in Los Angeles County.

Over the coming weeks to months, DHS will continue to assess the full impact of the Supreme Court's decision and take the steps necessary to secure a robust health care safety net for Los Angeles County residents.

California Endowment

In a historic decision, the Supreme Court of the United States has upheld the constitutionality of the Affordable Care Act, landmark legislation that will extend access to affordable, quality health care to millions of additional Americans regardless of age, income, or pre-existing condition and shift our health care system to one that prioritizes prevention.

"Today's decision by the United States Supreme Court is an affirmation that Americans, regardless of age, income, or pre-existing condition, are entitled to and deserve quality, affordable health coverage, including the more than seven million Californians who are uninsured", said Daniel Zingale, Senior Vice President of The California Endowment. "For our state, today's decision is both a fiscal blessing and a clear signal that there should be no more excuses. Covering the uninsured currently costs our state nearly $10 billion per year and we need to continue to move full speed ahead to ensure that millions of Californians take advantage of the new options and consumer protections provided by the law."

INSURANCE AND BUSINESS GROUPS

Dave Jones, California Insurance Commissioner

The passage of the Affordable Care Act is one of the most significant legislative achievements in the last forty years. The Court's decision today is a critically important one for the future of the entire nation. The Affordable Care Act is especially important for California, which is home to over seven million uninsured people, one million of whom are children. And it means that the millions of Californians who have health insurance will continue to enjoy benefits such as keeping their kids on their insurance to age 26, prohibitions on rescinding your insurance, elimination of lifetime and annual caps on your benefits, no co-payments for preventive care, cheaper medications for seniors on Medicare--the list of immediate benefits goes on and on.

While the Supreme Court's decision is good news for Californians, there is one reform missing from the Affordable Care Act. The missing piece of the Affordable Care Act is the absence of authority to reject excessive health insurance rate hikes. Californians have been hit with double digit health insurance rate hikes year after year. Health insurers have been making record profits at our expense. As Insurance Commissioner, I do not have the authority to reject excessive health insurance rate hikes. Since 1988 the Insurance Commissioner has had the authority to reject excessive rate hikes for auto, home, property and casualty insurance, and saved consumers and businesses tens of billions of dollars. But not health insurance. We need to pass a law in California to give the Insurance Commissioner the authority to reject excessive health insurance rate increases. The State Senate should do this by passing Assembly Bill 52.

Since the beginning of my tenure as Insurance Commissioner I have fought hard to ensure that the various reforms comprising the Affordable Care Act would be implemented in California. On the night I was sworn in, I issued an emergency regulation to implement one of the most important pieces of federal health care reform--the requirement that health insurers put more of the premiums they collect from us into medical care.

I also issued regulations to implement another important benefit of federal health care reform-- the requirement that health insurers provide health insurance to children even if they have a pre-existing condition. It used to be health insurers could deny children health insurance if they had a pre-existing condition, but thanks to the Affordable Care Act, we were able to put an end to this deplorable practice. In 2014 millions of adults who have been denied health insurance due to pre-existing conditions will also gain this critical access to health insurance coverage.

Today's ruling is a validation President Obama's leadership in enacting the Affordable Care Act and of our efforts toward implementation of these reforms. Since its inception, I have been a strong supporter of the Affordable Care Act and I will continue to work diligently to implement its components in California in order to make sure that all Californians have affordable access to health care. And I will continue to work for even stronger reform, such as single payer universal healthcare and the authority to reject excessive health insurance rate hikes.

Jim Wunderman, President & CEO Bay Area Council and Micah Weinberg, Senior Policy Advisor for the Council on healthcare

"Today's ruling by the U.S.- Supreme Court frees us to focus on the state-based details of fixing our broken healthcare system," said Jim Wunderman, President and CEO of the Bay Area Council. "The next step is to use the tools available at a state level to reduce costs for businesses and consumers, make the system more efficient, transparent and understandable, and improve the quality of care for everyone."

"Fixing our broken healthcare system is an economic imperative," Wunderman continued. "Our current healthcare costs put us at a distinct economic disadvantage with our global competitors that we can't afford as we work to lift ourselves out of recession. The Bay Area Council is focused on achieving market-based solutions that will drive greater efficiencies in the delivery of health care, control costs for businesses and consumers, and improve the value we get from our healthcare system."

Under the legal framework provided by the Affordable Care Act, the Bay Area Council has been at the forefront of ensuring that changes to our healthcare system are implemented in a way that works for California businesses. Last year, the Council issued a Roadmap to a High Value Health System that laid out the key priorities for promoting quality and affordability and recently issued a separate study on The Economic Impact of the Affordable Care Act on California. The study concluded that implementing the federal legislation will create almost 100,000 jobs in California and boost economic activity by $4.4 billion.

"The Council is working to ensure that any fixes we make fairly spreads the burden of healthcare responsibility and costs across all those who have a stake in the system," Wunderman said. "A healthcare system that shifts a disproportionate share of costs to businesses and employers is ultimately unfair and unsustainable and will irreparably harm our economy and our ability to compete globally."

Through that lens, the Council has been deeply involved in developing California's Health Benefit Exchange, a new marketplace authorized by the Affordable Care Act for private insurance that aims to make health coverage more affordable and accessible for all, and provide greater transparency for businesses and consumers to make informed choices about their healthcare purchases.

"We need greater focus on controlling costs, increasing the value we get from our healthcare system, and improving public health," said Micah Weinberg, senior policy advisor for the Bay Area Council. "If we're not working to provide more value, make the system more efficient and transparent, we're focused on the wrong things."

Greater Sacramento Urban League

"Today's Supreme Court ruling upholding the Affordable Care Act represents life-altering access to health care for millions of Americans, particularly African-Americans who have been twice as likely as whites to lack health insurance," Greater Sacramento Urban League President and CEO David DeLuz said today.

"Health insurance can mean the difference between life and death, but even more often it can mean the difference between financial stability and ruin," DeLuz said. "Today the Supreme Court affirmed that our mission to build a fairer health care system is not only appropriate and pro-family, but constitutionally valid."

This morning's Supreme Court ruling upheld the constitutionality of the Affordable Care Act, landmark legislation which provides new consumer protections and secures and expands access to affordable, quality health care for all Americans regardless of age, income, or pre-existing condition.

"In California, that means that hundreds of thousands of children, young people, seniors, and low income people once locked out from access to healthcare will now be able to find affordable, quality coverage."

DeLuz noted that the Court's ruling on Medicaid expansion increases the pressure on California to ensure that the implementation of ACA ensures that more African Americans - indeed more Californians - receive coverage.

"Californians have much at stake in the implementation of the ACA," DeLuz said. "Californians are more likely that people in other states to lack insurance, lack access to coverage on the job, and are more likely to be denied coverage due to a pre-existing condition. Our partners in the Healthcare community have fought hard to remove the hurdles to access, and now is the time to join with them and for our voice to be heard in the Capitol. The fight is by no means over."

Scott Hauge, president Small Business California

In a historic decision, the Supreme Court has upheld the constitutionality of the Affordable Care Act. California has already made great strides in implementing ACA provisions and preparing for full implementation, shifting our health care system towards an emphasis on prevention and near-universal coverage. The health care law has triggered a fundamental shift in our health care system that is now motivated to keep people healthy and reduce cost, so employers and employees can focus more time and energy on what matters most - building a strong economy while keeping more money in their pockets. Now, more than ever, employers need to understand the ACA in order to take full advantage of its benefits and incentives, including tax credits that make it easier for businesses to provide coverage to employees and manage costs. That's why Health Law Guide for Business, a website tailored specifically for the business community, will continue to be an important resource for business owners to navigate the law.



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