Running Head: THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 1

Obamacares, But Is It Helping? The Constitutionality of the Affordable Care Act

Rochelle Anne Parocha

Legal Studies Academy

Abstract
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 2

Five main questions will help to guide the direction of this paper and its research. Is this truly a

beneficial addition to the United State Health Insurance Policy? Are we better of now than we

were before? The general public opinion on the Affordable Care Act is negative. Why is this?

Why are so many Americans unhappy with the newly passed law? What is behind this

disapproval? Why is the general public unhappy about a piece of legislation that is meant to

provide universal health insurance? For a piece of legislation that suggests something beneficial

to the general public, any sort of disapproval makes cause for speculation. Is it perhaps, the act is

benefitting a certain class? Is there a certain demographic of Americans who are unhappy? Does

social class, gender, ethnicity, race, effect how Obamacare affects the individual? Is the act only

benefiting a certain population? All of these questions and speculations will help in steering the

direction this research takes in this paper.

Obamacares, But Is It Helping?

In 2012, President Barack Hussien Obama authorized legislation that has polarized a

nation: The Affordable Care Act. This monumental piece of legislation fosters ignorance in the

general public the general public is unaware of what the act entails beyond its objective of

providing universal healthcare insurance. Satisfying the curiosity surrounding Obamacare

requires delving deeper into the legislation of the Affordable Care Act. The complete rediscovery

of this act has uncovered the entirety of the changes it has made to our health laws. Statistically,

Obamacare has been successful. In the pursuit of establishing universal health insurance, it has

achieved its goal by dramatically increasing the amount of insured individuals in the United

States. Despite its statistical success, the Affordable Care Act has received a surplus of negative

opinions from the general public. The law achieved its goal of increasing the amount of

Americans with health insurance, yet many Americans are extremely unhappy with the bill. Why

is this? Dr. Manchikanti, the Medical Director of a Pain Management Center in Kentucky, along

with other medical directors of varying states, discuss the complex content matter of the

Affordable Care Act and the disorder it has caused amongst the public.

It represents the most significant transformation of the American health care system since

Medicare and Medicaid. It is argued that it will fundamentally change nearly every aspect

of health care, from insurance to the final delivery of care. The land and complexity of

the legislation and divisive and heated debates have led to massive confusion about the

impact of Affordable Care Act. (Manchikanti, Caraway, Parr, Fellows, & Hirsch, n.d.)

Why are there heated debates taking place on the Affordable Care Act? Despite its statistical

success, there are many underlying issues in providing universal healthcare that have given rise

to negative opinions on the health reform.

General Information
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 4

On March 23rd, 2010, President Barack Obama signed into law the Affordable Care Act.

More often called by its nickname Obamacare, the ACA was aimed toward providing

Americans with better health insurance and security. It created a mandate that required all

Americans to have an approved level of health insurance. Those who failed to obtain a policy

and did not fall within the exceptions, faced a penalty. This was an extensive new requirement

added on to the health insurance industry. Many regulations on the practice of medicine were

added on along as well.

What Obamacare is, What it Entails

Out of all developed nations in the world, the United States has one of the least efficient

health care systems; we spend the most on health care per capita and get the worst outcomes

(Horowitz, 2015). The bills pile up from the doctors office, prices are much higher in the U.S.

for healthcare, yet our life expectancy numbers are still mid-range (Riley, 2015). Our healthcare

system has changed into more of an opportunity of making a profit, rather than providing

individuals with necessary medical attention. President Obama wanted to change this with the

creation of the Affordable Care Act. Obamacare was created with the intent to ensure all

Americans had access to quality, affordable healthcare by improving patient access, improving

patient experience, increasing quality outcomes, and reducing the cost burden for the country

(Panning, 2014). Prior to President Obama signing the act into law, the healthcare system was in

dire need of a reform. The reforms main goals are universality, finance, cost reduction, payment

reform, quality and process improvement, and prevention and wellness. It expanded federal

funding for medicaid to cover over 138% of the federal poverty level (Panning, 2014).

The biggest component of the Obamas Affordable Care Act, is the individual mandate

that requires all Americans who are eligible, to enroll in a health insurance policy. Those who fail
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 5

to purchase a policy will face a penalty tax. There are exceptions, however. Common exemptions

from the individual mandate include: the individual has not had coverage for a maximum of

three months, the household income is below the tax filing threshold, and health insurance

coverage would cost more than 8% of the household income (Obamacarefacts, n.d.).

Beyond the individual mandate, the Affordable Care Act created more key provisions.

One such additional provision was the requirement for employees to provide insurance. This

employer mandate is only required for employers with at least 50 full-time employees.

Employers who fail to offer coverage that both provides minimal coverage and is affordable

will face a penalty (Cigna, n.d.).

Another provision to the Affordable Care Act is the expansion of coverage required for

health insurance companies. Many essentials are now required by health insurance companies to

provide preventative care, hospitalization, prescription drug coverage, etc.

The final major provision added from the Affordable Care Act is the prohibition of

discrimination in health insurance policies. Health Insurance companies are now prohibited from

denying individuals based on pre-existing medical conditions. Insurance companies are also

prohibited from raising claims on individuals after suffering from illnesses or raising rates on

individuals based on gender (Horowitz, 2015).

Flaws

Many individuals believe the Affordable Health Care Act does not, in fact, fix the

finances of our health care system. Polls suggest public opinion is against the health insurance

reform initiative, and implementation of the law has not bolstered public confidence in the law.

30 million people have been added to an obsolete, broken system (Manchikanti, Caraway, Parr,
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 6

Fellows, & Hirsch, n.d.). This is due to the fact that there are many major underlying problems.

And rather than create solutions, the Affordable Care Act only adds more layers of complexity

and bureaucracy. There have been numerous legal challenges to the Affordable Care Act.

In 2014, there was a challenge to the legislation arguing the constitutionality of requiring

individuals to purchase health insurance from the market. The current Supreme Court

demonstrated a disdain for the settled law. Some people are indecisive however, in repealing

Obamacare. This is due to the fact that some components to the Affordable Care Act are truly

helpful and positive additions i.e. the prohibition of denying those with pre-existing medical

conditions insurance. Repealing the law also means a loss of revenue (Kirsch, 2011).

Universal healthcare is something that is understandably desired. In attempting to

improve the United States and the standard of living in the country, we have looked to providing

Universal healthcare for the entire nation. The biggest problem with universal health care is the

funding that is required to help provide for it. Where does this funding come from? While

Obamacare was still in the works, the lawmakers believed that the majority of funding would be

pulled form young and healthy Americans who would sign up for the insurances and pay the

taxes (P. J. Kemp, Personal communication, November 20, 2016). This did not happen, however.

Instead, the majority of young and healthy Americans saw no benefit in signing up for

Obamacare.

Universal Healthcare has become well established in Europe. However, unlike the United

States, European nations voted on the addition of Universal Healthcare because they knew that

funding would be required for it to work. Switzerland, for instance, held a national vote on

passing universal healthcare. In order to establish Universal Healthcare, taxes would increase for

all citizens. The Swiss citizens agreed to these terms, and thus Universal healthcare was
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 7

established in Switzerland. Unlike Americans, the Swiss agreed on a new tax, which is in part

why Universal Healthcare has been well established in Switzerland. Funding for the program

was instituted. The American government, instead expected the funding for Obamacare to work

itself out. They presumed the young and healthy would sign up for their policies, but it simply

did not happen (P. J. Kemp, Personal communication, November 20, 2016).

Disagreements that Have Stemmed from Flaws

The Unaffordable Care Act has been unable to garner the support that President Obama

hoped to achieve. While many appreciated the prohibition of discrimination based on gender and

pre-existing medical conditions, many were angered at the individual mandate. With this

individual mandate, many individuals argue that the addition of Obamacare only made obtaining

insurance more difficult and more complex. These differences in opinions pushed many

individuals to take legal action (Kirsch, 2011).

Legal Disputes

Born out of the disagreements of the Affordable Care Act, a plethora of legal disputes

have taken place. On October 1, 2013, the government shut down over a disagreement on a

budget for the new fiscal year. Along with this government shutdown in 2013, legal action has

been taken against the Affordable Care Act in the form of repeals and court cases.

Repeals to the ACA in the House of Representative/Senate

A repeal was made to the Patient Protection and Affordable care Act and health care-

related provisions in the Health Care and Education Reconciliation Act of 2010, and for other

purposes. In repealing the law the congressional committees will look for a replacement that

lowers healthcare premiums through competition and choice, preserves ability to maintain their
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 8

old plan, offer access to affordable health coverage, reform medical liability system, increased

rate of insured people, protect doctor-patient relationship, offer states greater flexibility, expand

incentives, foster economic growth, and eliminate redundant programs (Countable.us, 2015).

The total cost to implement a replacement for the Affordable Care Act amount to almost 109

billion dollars (Horowitz, 2015).

King v. Burwell

In 2010, congress passed the Affordable Care Act (ACA) with the intent to increase the

number of Americans with health insurance. The ACA required each state to establish an

exchange. If a state opted out of this, the federal government would establish one. Another

requirement was that people had to obtain a coverage. Unless they fell within an unaffordability

exemption, they would face a tax penalty. The plaintiffs of the case were Virginia residents who

would fall under the unaffordability exemption if it were not for the tax credits. They sued,

arguing that the IRS regulation exceeded the agencys statutory authority and violated the

Administrative Procedure Act. In a 6-3 majority, the Supreme Court held that the IRS regulation

did exceed the agencys statutory authority. Congress did not delegate the authority to determine

whether the tax credits are available through both state and cereal exchanges to the IRS.

However, the language of the statue does show that Congress did intend the tax credits to be

available through both exchanges. King v. Burwell was a challenge to a significant part of the

ACA. Not only was the true purpose of the ACA brought into question, the plaintiffs who filed it

were from the same state: Virginia. This court case shows the discontent of the American public

within a certain state. When discussing the court case and its decision, it brings to light the back-

and-forth battle over health insurance between conservatives and liberals. While a decision has
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 9

been made, the fight is far form over; many republicans promise to repeal the law while

supporters are pushing for expansion (King v. Burwell).

Massachusetts Law

Massachusetts was the first state to create an individual mandate that requiring all

residents in the state of Massachusetts to obtain a health insurance policy. All adults must carry

health insurance if it is affordable to them. If they are unable to obtain a policy, they received an

income tax penalty each month varying by age and income. The income tax penalty was 50-

percent of the least costly available insurance premium (Commonwealth of Massachusetts,

2016). The Massachusetts Health Connector set the standards of salaries that excluded

individuals from the insurance requirements. It was authorized under the Department of

Administration and Finance. It also created the minimum level of benefits adults must carry to be

considered including coverage for services i.e. doctors visits, prescription drug coverage,

emergency services, etc., doctor visits without a deductible, a cap on annual deductibles ($2000

individuals/ $4000 families), and more (Massachusetts Health Connector, ed., 2013). The

Massachusetts Department of Revenue (DOR) administered this requirement. Residents in the

state of Massachusetts were required to report if they were insured when filing taxes. Individuals

were allowed up to three months without a penalty before being penalized for not acquiring

health insurance (Massachusetts Health Connector, ed., 2013).

This piece of legislation was passed in 2006 six years prior to the Affordable Care Act.

Massachusetts Governor, Mitt Romney, first introduced this idea back in 2004. It was designed

to provide state residents with the closest possible thing to universal health care. The legislation

redeployed public funds to more effectively cover uninsured low-income populations. It made

quality health coverage more affordable and promoted individual responsibility by creating the
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 10

requirement to obtain health insurance (individual mandate) and responding to concerns about

barriers to health insurance coverage such as denying coverage to individuals in high-risk pools.

In attempting to provide Universal Health, the individual mandate in Massachusetts reformed the

Insurance Markets in the state. The individual mandate also created the Commonwealth Health

Insurance Connector, which connected individuals to small business with health insurance. This

allowed for portability of insurance, and permitted more than one employer to contribute to an

employee health insurance premium (Commonwealth of Massachusetts, 2016).

Non-profit and small-profit group markets were merged in July of 2007. This produced a

24-percent drop in non-group premium costs, enabling Health Maintenance Organizations to link

to Health Savings Accounts and thus reducing costs (Commonwealth of Massachusetts, 2007).

Adults were able to stay on their parents insurance until the age of 25, and 19-26 year olds were

eligible for a lower cost and specially designed health insurance policies.

The provisions set out in the Massachusetts individual mandate heavily influenced the

provisions passed in the Affordable Care Act. Three main prongs were duplicated by the

Affordable Care Act: A ban on insurers from discriminating against individuals based on pre-

existing medical conditions, requirement of all individuals to obtain a health insurance policy

(which puts everyone into the same risk pool), and subsidies for those too poor who would be

exempted from the individual mandate (Koppelman, 2013).

Government Shutdown

On October 1st, 2013, the government shut down and ceased most non-essential

operations. Lasting from October 1st to October 16th, the shutdown was the first in more than a

decade. House Republicans insisted on new spending bills that included provisions which would
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 11

either defund, derail, or otherwise chip away at Obamacare. Senate Democrats were completely

against this. Therefore, Congress could not agree on passing a spending bill and thus, came to a

halt (Lewis, 2013).The Republican house passed two spending bill amendments that essentially:

one would delay Obamacare for a year, and the other would repeal Obamacares medical device

tax. The bill came back to the senate where Democrats rejected the proposal. The House

proposed another spending plan that would remove the Obamacare individual mandate, but

Senate rejected that too. The last government shutdown occurred back in 1995, lasting 21 days.

inThe shutdown furloughed 800,000 government employees and cost the government almost $55

billion USD (Appleton & Stracqualursi, 2014). The past government shutdowns have affected

many government activists and sectors of the countrys economy. This government shutdown

represented a significant and unanticipated income shock for federal government workers. It also

showed the extent Republicans and Democrats were willing to go to defend or repeal

Obamacare.(Volsky, 2016).

Solutions

There are multiple solutions to the ongoing problems surrounding the Affordable Health

Care Act. One of such solutions is championed by the current crop of conservative legislators on

Capitol Hill; a complete repeal of the Affordable Health Care Act. The benefit of repealing this

piece of legislature is the ability to start anew with economic provisions that not only address the

faults of Obamacare such as individual & employment mandate, but also satisfy the political

base of the incoming politicians. Republicans have already begun their ascent into repealing the

law. The Speaker of the House, Paul Ryan, indicated the following would be provisions included

in the new law:

Moving health care decisions away from Washington to patients, families, and doctors,

Giving patients the right tools, like Health Savings Accounts, to make health insurance

more portable and affordable, Breaking down barriers that restrict choices and prevent

Americans from picking the plan that is best for them and their family, Real protections

and peace of mindregardless of age, income, medical conditions, or circumstances,

Empowering small businesses to provide the kind of affordable health coverage that

meets your needs. (Ricci, 2016)

Paul Ryans plan in repealing Obamacare involves the promotion of high risk-pools for health

insurance companies. The problem, again with these pools, is the funding. There is a lack of

funding, and with this lack of funding the states are prompted to place caps on enrollments, or

raise premiums (Hiltzik, 2016). They are never adequately funded and fail repeatedly every time

they are implemented in the United States.

Taking it off the Board

The issue with repealing such a monumental legislation is leaving behind a gap that the

organization creates. President-elect Donald Trump has already signaled his willingness to fill

the void with his own health care ideas. He has stated that he will work to establish a patient-

centered health care system, secure coverage for individuals who are not already under a policy,

and maximize the opportunity for new Medicaid programs that will help better serve the citizens

of the U.S (Donald Trump for President, 2016). This is currently creating tension that conflicts

with the political direction of his party. Republicans all agree on repealing the Affordable Care

Act. The tension between Donald J. Trump and his party stems from what to do with Medicare:

whether or not Medicare should also be removed along with the Affordable Care Act. House

Speaker Paul Ryan is a forerunner in this disagreement with President-Elect Donald J. Trump.
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 13

Paul Ryan believes that Because of Obamacare, Medicare is going broke, [so] you have to deal

with those issues if you're going to repeal and replace Obamacare (Kodjack, 2016). This is the

most prominent issue regarding repealing the act. Competing interests means that time becomes

an issue. The Republican Party is torn over how to replace the Affordable Care Act. Rather than

working towards a solution, the conflicting opinions within the same party prevents the party

from working together to take the Affordable Care Act off of the board, and the political nature

of the legislation means that not all issues will be addressed.

The Affordable Care Act entails more than the individual mandate. It is more than

providing universal healthcare. It includes mandates on health insurance enrollments, mandates

for employers, prohibitions of discrimination, expansion of coverages, and so many more

provisions both good and bad. Many argue whether repealing the entire act is entirely

necessary. And repealing the entire act, would mean repealing an extremely popular provision:

prohibition based on discrimination (McArdle, 2016). Repealing the entire bill might also prove

costly. Millions of Americans have benefited from the expansion of Medicare under Obamacare.

If Obamacare were to be repealed, would those millions of Americans still be covered?

Obamas Input

President Barack Obama suggested a solution to his own healthcare reform: expansion. In

a speech the President gave at a Miami Florida, the President acknowledged the faults in his own

piece of legislation. He made note that not many young, healthy individuals had signed up for

health insurance policies, which has contributed to the rise in premiums. President Obama argued

that instead of continually trying to repeal the law, Republicans in Congress should think about

how to reach the remaining uninsured Americans, the president urged (Yilek, 2016). The

healthcare reform did what it promised to do: provide universal health insurance. Millions of
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 14

more Americans are now under a health insurance policy thanks to the Affordable Care Act.

Millions of Americans now have access to more services such as covering fees for

hospitalization and prescription drugs. Therefore, Obama argues that the problem does not lie

within the high premiums, it lies with the remaining Americans in the United States who are still

without insurance. The most important thing to focus on, he argues, is not to dissect his reform

act piece by piece; critiquing the negative qualities it has. The bigger problem is providing total

universal healthcare for all Americans (Yilek, 2016).

Ending

The Affordable Care Act, most notably known as Obamacare, has come to be one of

the most controversial, hot topics in our country today. The piece legislation has played a pivotal

role in numerous politicians platforms. It is monuments in size, and much of the American

population is unaware of the entirety of it. The Affordable Care Act was enacted with the goal of

providing universal health to all citizens in the United States. It achieved this goal, but gained an

unpopular opinion from the American public. This was due in part from the high rates that

resulted with the lack of funding. As with any form of Universal Health Care that is to take place

within a country, funding is required to pay for all of the health coverages. The Affordable Care

Act was created with the intention that the healthy, young Americans in the country would sign

on to the health insurance policies and pay for the funding. This did not happen. And when this

did not happen, premiums and rates sky rocketed there was no one to pay for funding. On top

of the high premiums, most individuals were upset with the mandatory individual mandate. The

federal government created a requirement for individuals to sign up for a health insurance policy

that would either be part of an exchange set up by the state or set up federally.
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 15

Disputes both legally and within and between political parties have taken place due

to disagreements over the health reform. The two parties in the United States repeatedly went

back and forth over the repeal of the act. Much like the Democrats and Republicans, the

American public too, has been torn over the health reform. Some praise it for its prohibition on

discrimination and expansion of health coverage. Others criticize it for the individual mandates

and high premiums. Republicans argue both with Democrats and with other fellow republicans

over the repeal of this act. President-elect Donald J. Trump has announced his intentions on

reforming and repealing Obamacare. Members of his political party have openly disagreed with

his planned initiatives, believing only certain portions of the legislation should be repealed. The

in-party conflict has wasted time and resources in coming to a tangible solution for the repeal of

the act.

Delving deeper and deeper into this topic, has given way to more insight on the

Affordable Care Act. Obamacare is more than a legislation that provided universal healthcare. It

is more than a controversial piece of law. It has its popular provisions and it has its not-so-

popular provisions. And considering how unpopular it is, it has still been unable to be repealed.

There are so many factors that have come into play. Essentially, individuals are angry because

they are paying more. The Affordable Care Act has been viewed as a way of creating revenue

and profit for the United States rather than providing universal healthcare. Even if that was not

the true intention of the bill, since its implementation, that is how events have taken place. The

reform fell apart because there was no funding for it. It did increase the number of insured

Americans; it achieved its main goal and purpose. However, it increased premiums and rates for

the remaining insured American population.

References

Appleton, K., & Stracqualursi, V. (2014, November 18). Here's what happened the last time the

government shut down. Retrieved from http://abcnews.go.com/Politics/heres-happened-

time-government-shut/story?id=26997023

Bendersky, C. (2014, July). Resolving ideological conflicts by affirming opponents' status: The

Tea Party, Obamacare and the 2013 government shutdown. Retrieved from

http://www.sciencedirect.com/science/article/pii/S0022103114000389

Chalt, J. (2015, June 8). The Obamacare lawsuit is a government shutdown, but for health care.

Retrieved from http://nymag.com/daily/intelligencer/2015/06/obamacare-lawsuit-is-a-

health-care-shutdown.html

Cigna. (n.d.). Employer mandate fact sheet. EMPLOYER MANDATE FACT SHEET. Retrieved

from https://www.cigna.com/assets/docs/about-cigna/informed-on-reform/employer-

mandate-fact-sheet.pdf

Commonwealth of Massachusetts. (2007). Massachusetts makes health insurance mandatory.

Retrieved from http://www.npr.org/templates/story/story.php?storyId=11689698

Commonwealth of Massachusetts. (2016). Mandatory health insurance. Retrieved from

http://www.mass.gov/ago/doing-business-in-massachusetts/health-care/health-insurance-

mandate.html

Countable.us. (2015, January 27). Should Congress repeal the Affordable Care Act and start

working on a replacement. Retrieved from https://www.countable.us/bills/hr596-114-to-

repeal-the-patient-protection-and-affordable-care-act-and-health-care-related-provisions-

in-the-health-care-and-education-reconciliation-act-of-2010-and-for-other-purposes
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 17

Donald Trump for President. (2016). Health care. Retrieved from

https://www.donaldjtrump.com/policies/health-care/

Fahrenthold, D. A. (2016, February 16). For Ted Cruz, the 2013 shutdown was a defining

moment. Retrieved from https://www.washingtonpost.com/politics/how-cruzs-plan-to-

defund-obamacare-failed--and-what-it-achieved/2016/02/16/4e2ce116-c6cb-11e5-8965-

0607e0e265ce_story.html?utm_term=.b64ab5604931

Hiltzik, M. (2016, November 10). Repealing ObamaCare will be almost impossible. Retrieved

from http://www.latimes.com/business/hiltzik/la-fi-hiltzik-repealing-obamacare-

20161110-story.html

Horowitz, J. (2015, October 24). Health care 101: The complete rundown of Obamacare you've

been looking for. Retrieved November 30, 2016, from

https://mic.com/articles/75475/health-care-101-the-complete-rundown-of-obamacare-

you-ve-been-looking-for#.zo10o3ajm

Kemp, P. J., MD. (2016, November 20). Professional interview [Personal interview].

King v. Burwell (June 25, 2015) (Oyez, IIT Chigago-Kent College of Law, Dist. file).

Kirsch, R. (2011). Fighting for our health: The epic battle to make health care a right in the

United States. Albany, NY: Rockefeller Institute Press.

Kodjack, A. (2016, November 26). Paul Ryan's plan to change Medicare looks a lot like

Obamacare. Retrieved from http://www.npr.org/sections/health-

shots/2016/11/26/503158039/paul-ryans-plan-to-change-medicare-looks-a-lot-like-

obamacare

Koppelman, A. (2013). The tough luck constitution and the assault on health care reform. New

York, NY: Oxford University Press.

Lewis, P. (2013, September 29). US government shutdown: House votes to delay Obamacare

law. Retrieved from https://www.theguardian.com/world/2013/sep/29/us-government-

shutdown-house-delay-obamacare

Manchikanti, L., Caraway, D., MD, Parr, A. T., MD, Fellows, B., & Hirsch, J., MD. (n.d.).

Patient Protection and Affordable Care Act of 2010: Reforming the health care reform for

the new decade. Health Policy Review Patient Protection and Affordable Care Act of

2010: Reforming the Health Care Reform for the New Decade. Retrieved from

https://www.monroecollege.edu/uploadedFiles/_Site_Assets/PDF/2011.14.E35.E67.pdf

Massachusetts Health Connector (Ed.). (2013). Massachusetts individual mandate. Retrieved

from https://betterhealthconnector.com/about/policy-center/rules-

regulations/massachusetts-individual-mandate

McArdle, M. (2016, November 9). Repeal would be even worse than Obamacare. Retrieved from

https://www.bloomberg.com/view/articles/2016-11-09/trump-s-repeal-of-obamacare-

would-make-health-care-even-worse

Obamacarefacts. (n.d.). ObamaCare mandate: Exemption and tax penalty. Retrieved from

http://obamacarefacts.com/obamacare-mandate-exemption-penalty/

Ogles, A., & Hilgemann, L. (2016, October 06). ObamaCare's meltdown has arrived. Retrieved

from http://www.wsj.com/articles/obamacares-meltdown-has-arrived-1475709560

Panning, R. (2014). Healthcare reform 101. Clinical laboratory science. Retrieved from

http://search.proquest.com/docview/1530677767?accountid=3785

Ricci, M. (2016, December 21). A stable transition to a better health care system. Retrieved from

http://www.speaker.gov/general/stable-transition-better-health-care-system
THE CONSTITUTIONALITY OF THE AFFORDABLE CARE ACT 19

Riley, A. (2015, November 30). Health-care check-up: Whose system is least efficient? Retrieved

from https://www.bloomberg.com/news/articles/2015-11-30/health-care-check-up-whose-

system-is-least-efficient-

Volsky, I. (2016, September 23). Republicans threaten another shutdown over Obamacare.

Retrieved from https://thinkprogress.org/republicans-threaten-another-shutdown-over-

obamacare-b963eef33547#.fds2ep5a5

Yilek, C. (2016, October 20). Obama's Obamacare solution: Expand the law. Retrieved from

http://www.washingtonexaminer.com/obamas-obamacare-solution-expand-the-

law/article/2605146