AP photoRepublican presidential candidate Mitt Romney speaks about the Supreme Court ruling on health care in Washington. President Barack Obama and Romney say the Supreme Courts decision last week upholding the presidents health care law gives them each advantages in the roughly dozen of states they are contesting most aggressively.

DES MOINES, Iowa President Barack Obama and Mitt Romney both are using the Supreme Court decision upholding the federal health care insurance requirement, loved by liberals and hated by conservatives, to rally core supporters in the most competitive states in the presidential race.

Yet while each side may be benefiting from groundswells of volunteers and money, the ruling seems unlikely to sway the legions of undecided voters who are focused heavily on the economy not on the health care debate that has raged in this country for years.

As a result, Republicans and Democrats alike say how the health care ruling influences a race that polls show is close will depend on how the campaigns use it to ramp up activity in the dozen or so states that Obama and Romney are contesting most aggressively.

Whoever gets the organizational advantage ... thats the real impact of the decision, said Jesse Harris, who led Obamas 2008 early vote effort in Iowa. In a state like this, that could be decisive.

A week after the decision, Democrat Obamas campaign is pointing to swollen ranks of campaign volunteers, in places like Iowa and Michigan, who have been emboldened to protect the health care overhaul now that it has been declared the law of the land. Opponents had argued that the requirement that all individuals to buy health insurance was a constitutional overreach.

The law I passed is here to stay, Obama said to applause in Ohio this week.

Republican challenger Romney says the anger on the right has boosted fundraising in presidential battlegrounds, with millions in small-dollar contributions pouring in from conservatives who see the former Massachusetts governor as the last hope for getting the law repealed.

What the court did not do on its last day in session, I will do on my first day if elected president of the United States. And that is I will act to repeal Obamacare, Romney said last week in response to the ruling.

Americans across the country, and in the most hotly contested states like Colorado, Florida, Iowa, Ohio and Virginia remain skeptical about Obamas signature policy accomplishment. Several polls taken in the last year in key states show narrow majorities opposing the law and supporting its repeal.

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Health care law becomes a campaign rallying point

SYRACUSE, NY Former Democratic Rep. Dan Maffei lost in 2010 after facing heat over his health care vote and hed like to just move on as he tries to regain his seat in 2012. GOP Rep. Ann Marie Buerkle beat Maffei by running on an anti Obamacare platform and shes more than happy to keep talking about the Supreme Court ruling from last week.

Something will have to give in this evenly divided, upstate New York swing district that pits a rematch between a self described Big D Democrat and an unapologetic conservative. Buerkle, who won in 2010 by a mere 648 votes, is on board with repealing the health care law and Maffei doesnt see the need to relive the nightmare of 2009s health care debate now that the Supreme Court has ruled.

I dont think people want to repeat past battles over and over again. The health care bill is the law of the land, the court ruled it constitutional, so lets improve it, said Maffei. You dont like whats in it? Give me a suggestion, Im open minded, but lets move forwardlets get past these partisan debates. Lets focus on jobs and the economy.

Its a theme thats sure to play out in swing districts across the country. Democrats will argue that the Supreme Court has spoken on the health care law, and try turn the conversation toward improving the economy. Republicans will say the law even though parts of it are popular tramples on individual freedoms and is a burdensome regulatory juggernaut.

Which side wins the debate in this district may be an important national barometer for how health care plays out in swing districts, with independent voters, across the country.

And its a particularly critical debate in a region where the recession still lingers, manufacturing jobs have gone away, and voters are suspicious that either party in Washington can help improve their way of life, especially when it comes to health care.

(Also on POLITICO: Zombia economy threatens Obama)

They have to come together somehow to get the economy growing again, said retired Fair Haven resident Harris Brown, who says he will most likely vote for Buerkle again, but would like to see Washingtons partisanship toned down. If the economy is good, then health care will take care of itself.

Buerkle, however, has embraced the freshman warrior role, even as she represents a fairly moderate district.

She is one of the most conservative members of the House and Republican leadership continues to tap her to speak out on the health care law. She was one of a handful of lawmakers to address the press with Speaker John Boehner and Majority Leader Eric Cantor immediately after the health care ruling and she gave the national Republican address on the topic over the weekend. For her, the repeal of the health care law is directly linked to economic recovery the area needs. One example, she says, is a local medical device factory that will soon be subject to a 2.3 percent tax should the law fully take effect.

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Health care ruling could tip races

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Critics of Health Care Law Prepare to Battle Over Insurance Exchange Subsidies

06-07-2012 12:18 Rev. Sandie Richards of the First United Methodist Church in Los Angeles speaks with Talking Liberally guest host John Fugelsang about the results of health care reform. She says woman and children are going to " benefit greatly" from health care reform. Rev. Richards says "it's too bad this (health care reform) has become a political punching bag." Comedian Travon Free says, "Romney keeps preaching repeal and replace, but he has not replacement plan." Every weekday morning on Current TV at 9e/6p

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A Reverend, a Comedian, and John Fugelsang take on health care reform - Video

06-07-2012 06:30 President talks about health care, economy, and what has changed

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President talks about health care, economy, and what has changed - Video

06-07-2012 14:43 President Obama says his health care plan is critical to helping the middle class thrive again. For more CNN videos, check out our YouTube channel at Or visit our site at

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Obama: No apology for health care fight - Video

Leading up to and immediately following the Obamacare Supreme Court decision, most health care stocks and funds were in focus. Companies and ETFs in this space saw outsized trading volumes as a result, while many slumped as soon as the final decision was revealed.

Most of the health care firms have since rebounded with many segments of the important industry seeing their stocks rise by a few percentage points over the past week. However, one corner of the industry has stuck out as a big loser, unable to recoup its losses after the announcement; health care plans/HMOs (read Health Care ETFs in Focus On Obamacare Supreme Court Decision).

Overall, this has easily been the worst performing segment over the past week in the broad health care space as all of the biggest companies in the industry are in the red. This is in sharp contrast to the pharma, biotech, and medical device/instrument firms, which have all managed to start July on a strong note.

This trend is especially puzzling because of what the Obamacare ruling could do for the HMO space. Many analysts believe that the controversial individual mandate would be a boon for HMO providers as it would add millions to their rolls, with many being very healthy and younger individuals.

Seemingly, investors have instead focused in on the fact that children will get to stay on the parents plans and the new stipulations regarding a lack of lifetime care caps and rules regarding pre-existing conditions. These changes could potentially cancel out any benefits from the millions of fresh new clients and could possibly be the reason for health care plan companies slump after the Supreme Court decision.

Thanks to this negative sentiment, all six of the health care plan providers in the S&P 500 are down significantly over the past week. This includes a near 11.6% loss for WellPoint (WLP), 7.6% slump for Aetna (AET), a 7.1% slide in Coventry Health Care (CVH), and a nearly 6% loss for the biggest of the bunch, UnitedHealth Care (UNH).

To me, this seems a bit overdone, particularly considering the solid performances that investors have seen in the rest of the health care space. After all, over the past week, the Health Care Select Sector SPDR (XLV) is actually up about 1%, demonstrating that the sickness in health care stocks is pretty much only afflicting health care plans/HMOs at this time (see The Five Best ETFs over the Past Five Years).

Another factor to consider for the HMO space is the current Zacks Industry Rank. At time of writing, the HMO segment was currently rankedadmittedly in a rather large tiefor 106 out of 265 from this metric. This includes a few firms that are Ranked 2 or Buy while it should also be noted that the segment has surged by about 50 places in the past week, suggesting that the underlying fundamentals for the space arent as bad as investors have experienced over the past few days.

While it should be noted that all this could change as we approach the summer earnings season, the space could still be an intriguing choice for investors looking for a beaten down sector in todays market environment.

What do you think? Is now the time to get in on health plan providers/HMOs? Or should investors continue to hold out and put their cash to work in other corners of the health care market?

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What Happened to Health Care Provider Stocks?

Enlarge David Goldman/AP

People gather outside the Supreme Court on June 28, the morning the health care ruling was announced. Lawyers say they're still teasing out the consequences for other key areas of the law including civil rights.

People gather outside the Supreme Court on June 28, the morning the health care ruling was announced. Lawyers say they're still teasing out the consequences for other key areas of the law including civil rights.

There's been lots of talk about how the Supreme Court's landmark decision to uphold the health care law could affect the federal Medicaid program and President Obama's political standing. But days after the historic ruling, lawyers say they're still teasing out the consequences for other key areas of the law including civil rights.

At first blush, it might seem odd that a case about the Affordable Care Act would send civil rights experts scrambling back to their law books.

But the Supreme Court's ruling in the health care case involves the Commerce Clause and Congress' spending power, which happen to be the backbone of most civil rights legislation.

"The Commerce Clause and the impact on interstate commerce of various types of discrimination has traditionally formed the basis for many civil rights statutes," says Washington lawyer Robert Driscoll, who worked on civil rights in the George W. Bush Justice Department. "And unlike the health care case, civil rights statutes generally would not have a taxing provision which could provide the kind of save of the statute that happened for the health care case."

Concern About Coercion

In last week's health care decision, five justices, including Chief Justice John Roberts, put important limits on the Commerce Clause for the first time in decades, raising questions about the implications for federal civil rights legislation.

But it's the second area of the ruling the one that talks about new limits to the Spending Clause that's really got the attention of civil rights lawyers.

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How The Health Care Ruling Might Affect Civil Rights

Referenced Stocks: AET, CVH, UNH, WLP, XLV

Leading up to and immediately following the Obamacare Supreme Court decision, most health care stocks and funds were in focus. Companies and ETFs in this space saw outsized trading volumes as a result, while many slumped as soon as the final decision was revealed.

Most of the health care firms have since rebounded with many segments of the important industry seeing their stocks rise by a few percentage points over the past week. However, one corner of the industry has stuck out as a big loser, unable to recoup its losses after the announcement; health care plans/HMOs (read Health Care ETFs in Focus On Obamacare Supreme Court Decision ).

Overall, this has easily been the worst performing segment over the past week in the broad health care space as all of the biggest companies in the industry are in the red. This is in sharp contrast to the pharma, biotech, and medical device/instrument firms, which have all managed to start July on a strong note.

This trend is especially puzzling because of what the Obamacare ruling could do for the HMO space. Many analysts believe that the controversial individual mandate would be a boon for HMO providers as it would add millions to their rolls, with many being very healthy and younger individuals.

Seemingly, investors have instead focused in on the fact that children will get to stay on the parent's plans and the new stipulations regarding a lack of lifetime care caps and rules regarding pre-existing conditions. These changes could potentially cancel out any benefits from the millions of fresh new clients and could possibly be the reason for health care plan companies' slump after the Supreme Court decision.

Thanks to this negative sentiment, all six of the health care plan providers in the S&P 500 are down significantly over the past week. This includes a near 11.6% loss for WellPoint ( WLP ) , 7.6% slump for Aetna ( AET ) , a 7.1% slide in Coventry Health Care ( CVH ) , and a nearly 6% loss for the biggest of the bunch, UnitedHealth Care ( UNH ) .

To me, this seems a bit overdone, particularly considering the solid performances that investors have seen in the rest of the health care space. After all, over the past week, the Health Care Select Sector SPDR ( XLV ) is actually up about 1%, demonstrating that the 'sickness' in health care stocks is pretty much only afflicting health care plans/HMOs at this time (see The Five Best ETFs over the Past Five Years ).

Another factor to consider for the HMO space is the current Zacks Industry Rank . At time of writing, the HMO segment was currently ranked-admittedly in a rather large tie-for 106 out of 265 from this metric. This includes a few firms that are Ranked 2 or 'Buy' while it should also be noted that the segment has surged by about 50 places in the past week, suggesting that the underlying fundamentals for the space aren't as bad as investors have experienced over the past few days.

While it should be noted that all this could change as we approach the summer earnings season, the space could still be an intriguing choice for investors looking for a beaten down sector in today's market environment.

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What Happened to Health Care Provider Stocks? - Real Time Insight

Court's Ruling on Health Reform Divides Consumers and Doctors Alike

By Brenda Goodman, MA WebMD Health News

Reviewed by Louise Chang, MD

July 5, 2012 -- A WebMD survey of nearly 8,000 Americans reveals that people are divided over last week's Supreme Court ruling on the Affordable Care Act -- with 40% supporting it and 36% disagreeing with the highly anticipated decision.

A corresponding survey of health care professionals on Medscape/WebMD showed that health professionals disagreed just as sharply as consumers.

WebMD and Medscape conducted the surveys immediately following the court's ruling that upheld the health care reform law.

Many people indicated that they were worried that the law might drive up their health care costs (36%) or felt unsure how it might impact them personally (32%).

When asked what should happen to health reform in the future, most said they'd like to see the law either completely or partially repealed. But there was also surprising support for a single-payer, government-sponsored option.

Men were significantly more likely than women to disagree with the 5-4 decision, which upheld key parts of the health reform law but also let states opt out of a major expansion of the Medicaid program. Men were also significantly more likely to say they want to see the entire law repealed.

Age also seemed to shade the results. Compared to older adults, those under age 35 were more likely to voice uncertainty about the health reform and its future. They were more likely to say, for example, that they didn't know whether or not they agreed with the Supreme Court's decision. They were also more likely than older adults to admit that they weren't sure how they would be personally impacted by the law. They also said they felt unsure about what should happen next.

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WebMD Survey: Sharp Split Over Health Care Ruling

Though House Republicans are now attacking Democrats by saying the health care law will cut Medicare by $500 billion, they have voted for just such a reduction twice since 2010.

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Mixed Message as Republicans Claim Health Law Cuts Medicare

Posted: Friday, July 6, 2012 4:00 am | Updated: 7:37 am, Fri Jul 6, 2012.

Texas ranks among the worst in the nation in health care services and delivery, according to an annual scorecard issued by the federal Agency for Health Care Research and Quality. Two local state lawmakers hold out little hope the situation will improve.

In nine out of 12 categories, Texas rated weak or very weak. The only area in which Texas earned the average ranking of good was in maternal and child health care measures. Out of a possible 100 points, Texas earned 31.61, while Minnesota, the highest-ranking state, scored 67.31.

We need health care reform, said state Rep. Bryan Hughes, R-Mineola, who acknowledged the federal study and a lineup of similar rankings consistently place Texas at or near the bottom in taking care of its own.

Hughes does not envision the recently court-approved national health care plan boosting the states standings on the federal scorecard.

We desperately need health care reform, but what is offered to us is anything but, he said.

The federal agency identified 155 areas in which it could compare the quality of health services across the country, such as infant mortality and obesity rates.

Researchers used that data to generate national and regional averages for each area, and they then compared each state to the national and regional averages to generate a score.

The report is designed to help politicians, policy makers, private insurers and state and federal agencies identify strengths and weaknesses in state health care programs.

State Rep. David Simpson, R-Longview, wasnt convinced the state should be in the health care business in the first place.

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Report: Texas health care among nation's worst

AUSTIN, Texas (AP) -- Texas ranks worst in the nation in health care services and delivery, according to an annual scorecard issued by the federal Agency for Health Care Research and Quality.

In nine out of 12 categories, Texas rated weak or very weak. The only area where Texas earned the above average ranking of "strong" was in maternal and child health care measures. Out of a possible 100 points, Texas earned 31.61, while Minnesota, the highest ranking state, scored 67.31.

The agency identified 155 areas where it could compare the quality of health services across the country, such as infant mortality and obesity rates. Researchers used that data to generate both national and regional averages for each area, and they then compared each state to the national and regional averages to generate a score.

The report is designed to help politicians, policy makers, private insurers and state and federal agencies identify strengths and weaknesses in state health care programs.

Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said Thursday that the report goes far beyond what state agencies control, but she said it demonstrates the need to improve access to preventive health care.

"Late last year Texas received approval for a new effort that will help fund innovative local projects," she said. "Hospitals and other health care providers have come together to form regional partnerships, and they'll soon be sending the state their plans for making better use of Medicaid funds to expand access to preventive services and reduce the need for expensive emergency room care."

Texas scored particularly poorly in the home health care category, with the study finding that the state provided little support to the elderly and disabled who chose to live at home. Texas also ranked weak or very weak in preventive, acute and chronic care delivery.

The state's scores slipped from last year in treating cancer and diabetes patients.

The Texas Medicaid law for the disabled and poor offers one of the most limited health care programs in the nation, and more than 25 percent of Texans do not have health insurance of any kind, which is the highest uninsured rate in the nation.

The poor state of the Texas health care system has particular relevance as state lawmakers begin to consider how to respond now that President Barack Obama's federal health care overhaul has been upheld by the U.S. Supreme Court.

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Fed agency ranks Texas at bottom for health care

In a sane climate, Mitt Romney would be running for president on his one big success as a politician: achieving something close to universal private health insurance coverage as governor of Massachusetts. Romneycare cut costs, improved health care outcomes and is quite popular there.

Alas, President Obama's election has driven many Republicans so crazy that the putative nominee makes an unconvincing show of despising his own brainchild. Has there ever been a more unconvincing faker in American politics? Romney acts as if he thinks voters are morons. But then, right-wing hysteria over the Supreme Court's upholding "Obamacare" shows he could be correct.

Mandating health insurance wasn't Romney's own idea. The conservative Heritage Foundation saw it as a way to realize the practical and moral benefits of a socialized, government-run health care system like Canada's through private, for-profit insurance companies -- the best of both worlds.

Romney even wrote a 2009 USA Today column advising President Obama about the mandate's advantages: "Using tax penalties, as we did [in Massachusetts], or tax credits, as others have proposed," he wrote, "encourages 'free riders' to take responsibility for themselves rather than pass their medical costs on to others." The president put it this way in reacting to the Supreme Court's validating Obamacare: "People who can afford to buy health insurance should take the responsibility to do so."

So is it a tax, or is it a penalty?

The correct answer is "who cares?" Provide your family with the security of a decent health insurance policy and you don't need to pay it.

Tyranny? Oh, grow up. The government can already make you sign up for Social Security, educate your children, vaccinate your dog, send you to fight a war in Afghanistan, limit how many fish you can catch, and put you in prison and seize your property for growing pot.

Furthermore, Justice Roberts is right. The U.S. government encourages all kinds of virtuous behavior through the tax code. You can get married, or pay higher taxes. Buy a house, have children, invest in a retirement account, even raise cattle (my personal favorite) or pay higher taxes.

And buying health insurance is an intolerable offense against liberty?

Ask Rush Limbaugh who pays for his Viagra. Answer: his employer-provided health insurance company. Only impoverished people, deadbeats and fools go without it.

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Understanding Health Care Law is public responsibility

BOSTON -- Between the Medicaid program, subsidized insurance under the 2006 health-care-access reform law, and investments in state employee health insurance and public-health programs, health care spending this fiscal year is on pace to rise to 43 percent of the overall state budget, according to an analysis of the spending bill being reviewed by Gov. Deval Patrick.

One in five Massachusetts residents will have their health care largely covered through the budget and taxpayer-supported health-care costs next year will gobble up the majority of new discretionary state revenue, hitting $15.14 billion, up from $14.65 billion. But education accounts will also get a big boost, according to a Massachusetts Budget and Policy Center analysis of the budget lawmakers agreed to last week.

While lawmakers and the Patrick administration this year have described fiscal 2013 spending plans ranging from $32.4 billion to $32.5 billion, the center's analysis estimates total state appropriations and transfers at $35.229 billion. Center officials say the higher figure reflects revenues collected and spent on transportation, school construction, public employee pensions and health care based on directives that carve out such spending before deliberations on the rest of the state budget begin each year.

Patrick has until Sunday, July 8 to sign the budget and announce his vetoes and amendments to the bill.

The center provides independent research and analysis of state budget

Aside from a proposed $546 million increase in spending on Medicaid and health care reform, the fiscal 2013 budget, approved easily last week by the House and Senate after a deal was struck by a conference committee, proposes $6.95 billion in total education spending, an increase of $302 million.

The majority of the increased education spending, or $238 million is targeted for the K-12 education system, with higher education in line for an increase of $58 million to a total of $1.02 billion, and early education and care spending scheduled to fall to $500 million, from $507 million.

Taken together, proposed state spending on health care and education in fiscal 2013 will approach $22.1 billion, representing about 63 percent of all state spending. Health care spending, as a percentage of the budget, will rise to 43 percent from about 42.8 percent.

But even with the 5.3 percent increase in spending on Medicaid, budget managers will need to secure about $500 million in savings in the program to balance the budget next year. The savings, with some spending cuts and $615 million in temporary revenues, are being relied upon to close an estimated $1.3 billion gap between available revenues and projected state spending based on fiscal 2012 levels. The center's analysis identifies $41 million in homeless shelter cuts and $8 million in child care subsidy cuts.

State spending on education and health care, by comparison, towers over investments in other key areas.

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Health-care spending nearly half of state budget

Despite rising cost of health care and a desire to 'fix' the system, the November elections are delaying solutions.

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Clarence Page: Health care takes back seat to election

05-07-2012 07:51 Mitt Romney speaks to Jan Crawford about the Supreme Court's decision to uphold President Obama's health care law, why his Massachusetts mandate is not a tax, and whether he'd still nominate a Justice like John Roberts.

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Romney pans Roberts on health care ruling - Video

05-07-2012 12:51 Business strategistCarol Roth weighs in on the potential impact on businesses from todays health-care ruling.

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How Health-Care Ruling Will Impact Business - Video

Republicans have long pledged to repeal and replace the Obama health care law.

Democrats, however, argue Republicans who want to repeal the law also would reverse the law's most popular reforms, sending the United States back to the days when insurance companies were free to drop people's coverage whenever they liked.

"The choice is to go forward or be dragged backwards," Democratic Sen. Tom Harkin of Iowa said. "It's time for Speaker Boehner and Republicans to put politics behind us, join with us in ensuring that every American has access to quality affordable care, that no person is denied coverage due to a pre-existing condition."

Republicans say they agree the old system will not work.

"The health care system, the status quo, is unacceptable," Rep. Tom Price, R-GA, who is also a doctor, said. "As a physician, I can tell you it doesn't work for patients. It certainly doesn't work for doctors."

"I know the system is broken. It needs to be fixed," Rep. Denny Rehberg, R-Mont., said. "And there are a lot of ideas that Republicans wanted to throw out when it was initially brought up back in 2009, but we weren't given that opportunity."

One conservative analyst says now is the time -- that Republicans should lay out the details of their plans to show people exactly what they would do.

John Goodman, the author of "Priceless: Curing the Health Care Crisis," said Republicans "need to be able to talk about a health care vision that is different from the ObamaCare vision."

"They need to be able to announce some principles that people can understand and agree with," he said. "No one understands ObamaCare. If you lay out a reasonable alternative, people will understand it and agree with it."

"All the Obama administration and the people that supported the president's health care reform did was add more people to a failed system or a failing system," Rehberg added. "That's not health care reform."

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GOP Pushes for Repeal of ObamaCare — Then What?

JUDY WOODRUFF: The debate over whether the health care mandate is a tax remained front and center in the campaign today, even as the president shifted his attention to economic issues at the start of a battleground state bus tour.

(CHEERING AND APPLAUSE)

JUDY WOODRUFF: President Obama was back on the stump today in Ohio, touting his own economic policies and taking a shot at those of Republican Mitt Romney.

PRESIDENT BARACK OBAMA: I don't think that Mr. Romney's plan to spend trillions of dollars more on tax cuts for folks that don't need them and aren't even asking for them is the right way to grow our economy, especially since they want to pay for it by cutting education spending, and cutting job training programs, and raising middle-class taxes.

JUDY WOODRUFF: The president's stop was part of a two-day bus tour across Ohio and Western Pennsylvania, to draw attention to economies in both states which have been buoyed by a stronger auto industry. But, in his first campaign event since last week's Supreme Court's decision to uphold his health care law, Mr. Obama also issued a firm defense of his overhaul of the system.

BARACK OBAMA: I will work with anybody who wants to work with me to continue to improve our health care system and our health care laws, but the law I passed is here to stay.

JUDY WOODRUFF: Yesterday, in an interview with CBS, Mitt Romney said he disagreed with the court's decision, and for the first time, called the requirement that all Americans buy health insurance, the individual mandate, a tax.

MITT ROMNEY (R): Well, the Supreme Court has the final word, and their final word is that Obamacare is a tax. So it's a tax. It's -- they decided it was constitutional, so it is a tax, and it's constitutional. That -- that's the final word.

There's no way around that. You can try and say you wish they had decided a different way, but they didn't. They concluded it was a tax. That's what it is. And the American people know that President Obama has broken the pledge he made.

JUDY WOODRUFF: But that comment signaled a shift in position. A similar requirement is part of the state health care law that Romney fought for as governor of Massachusetts.

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Campaigns Duel Over Calling Health Care Mandate a 'Tax'