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Court rules for the uninsured

  • Eric Richter and his wife, Dani, who were earning too much to qualify for government-sponsored health care when cancer struck him, in their home in Batavia, Ohio, June 9, 2012. No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions. (Tom Uhlman/The New York Times)

"The bottom line: the entire ACA is upheld"

That's what SCOTUSBlog wrote moments after the U.S. Supreme Court announced its ruling on the health care law. But it wasn't upheld in the way most thought it would be. The decision was 5-4, with Chief Justice John Roberts siding with the court's liberals, and Justice Anthony Kennedy casting his vote with the conservatives.

This will be covered, in many quarters, as a political story. It means President Barack Obama — and Solicitor General Don Verrilli — are popping the champagne. It means that Mitt Romney and the Republicans who were fighting the health care law have suffered a setback.

It will be covered in other quarters as a legal story: It is likely to be central to Roberts' legacy and perhaps even to how we understand the divisions in the court going forward.

And, to be sure, it's all those things. But those stories don't capture the effect this decision will have on ordinary Americans.

The individual mandate, by bringing healthy people into the insurance market and lowering premiums, means health insurance for between 12.5 million and 24 million more Americans than if the mandate was struck down. And as Kennedy said in his dissent that the conservatives on the court believed the entire law should have been invalidated, it means health insurance for 33 million more Americans than if Kennedy and the conservatives had their way.

Those are big numbers, But behind them are real people. People like Eric Richter.

Richter, a 39-year-old resident of Ohio, works at a stone drilling company. He and his wife made $36,000 a year. That's too much to qualify for Medicaid, but too little to easily afford insurance. So Richter didn't purchase insurance.

"It's hard to pay for the unknown, when you're struggling to cover the known," he told Sabrina Tavernise of the New York Times. "I know it sounds irresponsible, but that's just the way it was. It's a game of roulette you hope you're going to win."

Then Richter discovered a tumor growing up his leg. He first tried home remedies, cutting out sugar and eating beets, having read somewhere that it might help. But it kept growing. His wife sewed him new pants to accommodate the "melon-sized" lump.


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