In a 5-4 vote on the signature legislative achievement of Barack Obama’s presidency, the US Supreme Court today upheld the Patient Protection and Affordable Care Act, including the central, controversial provision requiring the uninsured to buy health insurance. Chief Justice John Roberts, who usually votes with the court’s conservative majority, switched sides for the crucial fifth vote that upheld the law — and delivered a decisive victory to the Obama administration.
In a key passage of this 59-page decision by Roberts, the chief justice writes of the so called “individual mandate” requiring the purchase of health insurance:
“Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing they may not lawfully do is not buy health insurance and not pay the resulting tax.”
With that, the court rendered moot the question of whether other parts of the law that touch on biomedical research could be preserved if the mandate were struck down; with the law upheld in its entirety, the following provisions relevant to biomedical research and commercialization are preserved:
- The establishment of an abbreviated approval pathway at the US Food and Drug Administration for biosimilar drugs: generic versions of large, protein-based drugs whose makers have long lobbied to be able to compete with brand-name makers.
- The authorization at the National Institutes of Health (NIH) of the Cures Acceleration Network, an effort to speed high-needs cures from lab to bedside. The network is a flagship component of the agency’s new National Center for Advancing Translational Sciences. While authorized to receive up to $500 million annually, in 2012 Congress appropriated just $10 million for the network.
- The establishment and funding of the Patient-Centered Outcomes Research Institute (PCORI), the main government vehicle for conducting comparative effectiveness reaserch — a particular bugbear of conservatives. PCORI issued its first grants, worth a total of $30 million, earlier this month.
- The launch of a new requirement that drug and device companies publicly post all payments to physicians of $10 or more in cash or kind. Called the Physician Payment Sunshine Act, it is the brainchild of Senator Charles Grassley, Republican of Iowa, and is expected to go into effect in late 2014.
Also preserved in the upheld law are $153 billion in Medicare and Medicaid payment cuts to teaching hospitals over ten years ending in 2021. Because the teaching hospitals at academic medical centers provide a disproportionate amount of charity care, lawmakers reasoned that, with an insurance mandate in place, they will begin to be paid for that care, allowing the government to recoup the $153 billion. Groups like the Association of American Medical Colleges (AAMC) will be watching warily to see if the cuts are indeed offset by increased clinical income from the newly insured. But today, in this statement, the AAMC celebrated the high court’s decision, with president Darrell Kirch pronouncing himtself “extremely pleased” with the result.