I'll give this a try Jon. Understanding of course that I am vastly oversimplifying to keep from having to go on for several pages just to attempt to explain it all. Trying to explain the Byzantine and nonsensical U.S. health care system to someone who has lived with universal health care all their lives is difficult at best.
This was a huge week for Obama because his signature achievement so far (other than making sure the economy didn't go into another Great Depression in 2009) was his health care reform bill. Democrats named it the Affordable Care Act. Republicans and other opponents of the health reform bill derisively call it "Obamacare". It provided that insurance companies could not refuse coverage or refuse to pay for treatment due to pre-existing conditions. It provides that parents can keep their children under their health insurance plans to the age of 26. It gradually lowers the out of pocket cost of prescription drugs for seniors and those on disability under the Medicare D plan.
The more controversial part of the bill requires that every citizen purchase health insurance. If they refuse, they are required to pay an annual penalty fee annually to offset the cost to taxpayers if they become ill and require care without insurance. If they are too poor then they will go on a government plan...Medicaid. If their income is too high to qualify for Medicaid but not high enough to purchase health insurance in the open market...the government will set up pools of insurance for people to purchase it at an affordable rate based on their income level.
Most people in the U.S. get their health insurance through their employers, and not so much privately in individual policies. Many companies are nervous as to how much their expenses will go up under the ACA. Many state governments are concerned about how much their expenses will go up as more people qualify for Medicaid. Because Medicaid is paid for with not just federal funds but also from tax receipts of individual states.
The ACA was passed by the Congress and the Senate when Democrats were in the majority there. That is no longer the case. The same bill would have no chance of passing right now since the Republicans are in the majority. And of course if Obama is
for something, then they have to be against it. Yet Republicans know that they don't have a large enough majority to vote again and overturn the ACA.
States with mostly Republican governors and majority Republican state governments decided to try to overturn the ACA, not with another vote in the Congress and Senate, but by taking a lawsuit to the Supreme Court. They claimed that the Mandate requiring everyone to purchase health insurance was unconstitutional. An infringement on individual freedom as it were. (Never mind that government forces people to buy car insurance if they drive a car and nobody is up in arms over that.)
The Supreme Court is the last legal recourse in the land right now where the justices could have overturned only the mandate that people buy health insurance....or more importantly, they could have overturned the entire ACA law altogether. The Supreme Court of 9 people is dominated right now by conservatives who were appointed by Republican presidents. They are appointed for life. Like the Pope, they have to die or voluntarily retire before they can be replaced. There are 4 liberals, 4 conservatives and one who usually votes with conservatives. He is often considered the swing vote because he has voted with liberals on the court a few times in the past. He is Justice Kennedy. Justice Kennedy is no relation to the more famous Kennedy family who are all very much liberal Democrats. Chief Justice Roberts is one of the die-hard Republican conservatives.
When the case was brought before the court the assumption was that lawyers for the Obama administration were going to have to really appeal to Justice Kennedy with their arguments if they were to have any chance of the law being upheld. Conservatives are so adamantly opposed to "Obamacare" that the thinking went that if the conservative justices had their way they would overturn the entire law rather than just the individual mandate to carry health insurance.
Justice Kennedy had some very harsh questions during oral arguments for the lawyers defending the ACA on behalf of the Obama administration. There was a pervasive sense that the 4 conservatives, with Kennedy's vote, would overturn the entire health care reform law. Yesterday was a day I was dreading because I was convinced that the ACA would be struck down.
As you know now the ACA was upheld, including the requirement that everyone purchase health insurance or pay an annual fine. What was more shocking after that was finding out which justices voted which way. Kennedy voted against the insurance mandate and wanted to vote down the entire ACA. His vote should have been enough to overturn the law. What happened?
Yesterday we found out that hell froze over. One of the most conservative Republican justices of the court voted to uphold the law. That being Chief Justice Roberts. He weighed his legal decision and went not with party affiliation, but with his interpretation of constitutional law. He said that if someone refusing to buy health insurance were to be threatened with jail or prison...rather than just a fine, then that would be unconstitutional. The ACA does not threaten said person with imprisonment for failure to comply. (Unlike with refusal to carry car insurance for example.)
Roberts says that he interprets this fine as a tax. His legal reasoning therefore was that since Congress does have the legal constitutional authority to tax citizens, then the individual insurance mandate is constitutional. Therefore there are no legal grounds for the Supreme Court to throw out the entire ACA law.
Conservatives are frothing at the mouths in anger because Roberts gave Obama an important political victory in a close presidential election year. Chief Justice Roberts will be vilified by most of the Republican establishment for years to come. He has now alienated many, if not most, of his close personal friends and colleagues.
While we still do not yet have universal health care in the U.S., we are now much closer to a point where access to good and affordable health care will be seen as more of a right of citizenship, rather than as a privilege to be enjoyed only by those who can afford to pay for it.
Oh Happy Days!!
only further water-down legislative efforts for addressing the real problem - the ever-expanding costs of high-cost Health Insurance plans for American families. 
and the "
survive with only limited governing skills and still remain in control. Alas, these pitiful excuses for legislators are left as scavengers normally would be picking up political favors from the lobbists and other special interest groups that no longer feel accountable to the very constituents they were elected to represent. This isn't a "
