奥巴马医改方案中的所谓“个人强制保险”(individual mandate)要求美国人必须购买医疗保险，否则会受到经济上的处罚。首席大法官约翰·罗伯茨和高法立场更偏向自由派的大法官们站到了一起，他代表多数大法官撰写的裁决词说，“因为宪法允许该类税赋，因此由不得本法庭下令禁止，或就其是否明智和公平发表意见。”
奥巴马政府争辩说，“个人强制保险”符合宪法，理由是所有的美国人在其一生的某个时刻都需要医疗照顾，人们参与医疗保健市场并非出于个人选择。
有26个州对奥巴马的医改案提出了法律诉讼。这些州争辩说，不能强迫个人购买他们不想要或不需要的保险。
医改法案在2010年初通过。这是奥巴马总统第一届任期的标志性立法举措。医改的目的是解决医疗成本日益增加和买保险难的问题。医保成为很多美国人的财政负担。
但是医改案在国会遇到强烈反对，很多在野的共和党议员称法案在政治上伸手太长，而且把沉重的负担强加给工商界。
预计将成为共和党总统候选人的罗姆尼已誓言，一旦今年11月当选，他就要推翻奥巴马的医疗保健法案。
美国医师协会（AMA)就美国最高法院维持奥巴马医保法案的声明：
In a 5-4 decision issued Thursday, the Supreme Court of the United States confirmed the constitutionality of the Affordable Care Act, including the law’s individual responsibility and Medicaid expansion provisions. The AMA is pleased this decision means that millions of uninsured Americans will have the insurance coverage they need to become healthy and stay healthy.
A longtime supporter of health insurance coverage for all, the AMA remains committed to working on behalf of America’s physicians and patients to ensure the law is implemented in ways that support and incentivize better health outcomes and improve the nation’s health care system.
美西最大的医院系统Dignity Health的CEO就美国最高法院维持奥巴马医保法案的声明：
Today is a victory for patient care. Dignity Health has supported comprehensive health care reform for more than two decades. With the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, the journey to modernize the American health care system and expand access to care began.
We are pleased that today the U.S. Supreme Court upheld all parts of the ACA that were challenged, including the individual mandate and the expansion of the Medicaid program. The ACA, while not perfect, is an important step in correcting an unjust health system that has left millions of people uninsured and forced millions more to cover those costs. We supported this legislation, even though it reduces payments to hospitals, because the new delivery model is focused on increasing the quality of care and reducing costs.
Today’s decisions are a victory for patient care. For all its issues, this bill enables us to bring the American health care system into the 21st Century. The real value of this legislation is that it changes the financing system to incentivize quality care. We look forward to continuing our implementation of the reform measures and we will continue to be strong advocates for universal access.
Switching from providing care mainly through episodic and fragmented engagements, to offering services through clinically integrated and coordinated systems, requires profound change. The breadth and complexity of the ACA reflects just what a large undertaking this is. However, the reforms outlined in the law can be achieved and reflect a wide consensus among clinical experts about how to improve our care system.
We will continue to advocate for changes to the health care delivery system and the ACA to address issues that still remain. Of particular concern is that the undocumented immigrants are still left without access to coverage.
I thank you for your role in providing the highest quality care possible to the communities we serve and for your continued commitment to our mission. Together, we can make the goals of health care reform become a reality.
http://www.wenxuecity.com/news/2012/06/28/1846264.html
http://www.medscape.com/viewarticle/765416?sssdmh=dm1.794217&src=nl_newsalert
