Update 3:30 p.m.
The battle over the Patient Protection and Affordable Care Act doesn't end with today's Supreme Court ruling that upheld almost all of the law.
It now moves to November's election, as the Twitterverse shows:
In the lead-up to today's Supreme Court decision to uphold the Affordable Care Act, Michigan Speaker of the House Jase Bolger (R- Marshall) insisted on waiting to to set up a health care insurance exchange in the state until the ruling came down, despite the governor's wishes to move forward with establishing a statewide exchange.
In a statement released today, Bolger expressed his disappointment in SCOTUS' decision, but also that the state house plans to create a health insurance exchange.
"I could not be more upset that the Supreme Court has upheld this massive attack on Michigan’s working-class families and mandates for insurance coverage that citizens have repeatedly objected to. I am mad and disappointed, but we remain committed to fighting for Michigan’s future...
"We will work with Gov. Snyder and the state Senate to see that Michiganders have access to healthcare that is marketplace-driven and provides competition, transparency and common sense options.
"Having the state establish a healthcare exchange is not something we wish to do, but we cannot stand idly by and hand over our citizens’ healthcare to an overreaching federal bureaucracy. We will focus on putting people first and protecting them from this massive tax increase on Michigan’s working families.”
Michigan Public Radio Network's Rick Pluta reports that health care advocates in Michigan say it’s time for the state to enact healthcare law.
Karen Holcomb-Merrill is with the Michigan League for Human Services.
“Well, now that the Supreme Court has upheld the Affordable Care Act – which we think is fabulous and will help people all across Michigan and the country – the Legislature and the administration need to move forward on the important parts of implementing it," she said.
That includes creating online health care exchanges for people and businesses to comparison shop for coverage.
Michigan Gov. Rick Snyder, who has criticized the Affordable Care Act but also pushed to create a state healthcare exchange, released the following statement about the SCOTUS ruling:
“The Patient Protection and Affordable Care Act is legislation that misses the point on the most important reforms needed in our health care system. In the meantime, it has been a detriment to the economic recovery of our country by causing massive uncertainty regarding medical costs which discourages job creation.
“The greatest health care opportunity to our citizens is prevention in terms of both personal quality of life and societal costs. The Michigan Health and Wellness 4 x 4 Plan is a good starting point as it is aimed at reducing obesity and improving overall wellness in Michiganders by focusing on four healthy behaviors and four health measures.
“In addition to addressing wellness, our nation needs to make a systematic review of the cost structures of our health care system. We have great people in our system, but we have built a system that focuses on spending more and more to solve acute care problems rather than a person-centered medical home model focused on the overall well-being of the individual.
“While I may not agree with everything in the law, now that the Supreme Court has essentially upheld the Act, we must act quickly to avoid an undue burden on Michigan residents and job providers. Working with our legislative leaders to establish the MiHealth Marketplace will allow Michiganders to make decisions regarding what will be covered as opposed to Washington, D.C. making those decisions for us. It will also allow us to draw down federal dollars to assist with the costs of complying with the law.
“Implementing this law will require an immense amount of coordination between the public and private sectors. We plan on working closely with Michigan consumers, businesses and health providers to ensure that the decisions we make have as much of a positive impact on Michigan as possible.”
Congressmen John Dingell (D-Dearborn), who has worked on health care legislation almost since he was first elected to the U.S. House of Representatives in 1956, released a statement on the U.S. Supreme Court's decision.
"....Today, because of this avowing decision, more families will receive free preventive services, small businesses have more capacity to attract the highest quality employees with the ability to offer comprehensive health insurance, and seniors will be able to afford vital prescription drugs. Furthermore, those men and women with pre-existing conditions, who need health care the most, will not be able to be denied health insurance. With this milestone case behind us, I look forward to collaborating with the State of Michigan as it develops a health insurance delivery programs tailored specifically for the needs of Michigan.
"I hope my Republican friends in Congress take this ruling for what it is, respect it, and accept that it is time to move on. I hope they stop wasting the time of Congress and that of the people who put them in office with constant attempts to repeal bits and pieces of this constitutional law. I will fight these attempts tooth and nail...."
The U.S. Supreme Court has upheld almost all of the controversial Affordable Care Act, dubbed "Obamacare."
If the law withstands looming legislative challenges, beginning in 2014, almost all U.S. citizens will have to obtain health insurance or pay a penalty.
Gov. Rick Snyder has been telling the state legislature that state health care exchanges need to be established before January 2013 under the law.
Many state Republicans have resisted getting them set up. They wanted to wait for the Supreme Court's ruling. Now it appears the state will have to set up these exchanges or face penalties from the federal government.
The expansion of Medicaid was an issue in the case before the court. The court said that if states decide not to expand their Medicaid program to more citizens, the federal government cannot withhold Medicaid funds from the states.
This threat of the federal government withholding Medicaid funds if a state refused to expand its program was the only part of the Affordable Care Act that was struck down.
Under the ruling, the federal government cannot withhold Medicaid payments from state as part the penalties.
We'll have more on how the Supreme Court's decision affects Michigan on this post throughout the day.
The Washington post has an interactive tool to help you see how the upheld healthcare law might affect your future coverage. Take a look below: