Audrey Ross breathed a huge sigh of relief when she heard that the U.S. Supreme Court had upheld President Barack Obama's health care law last week.
The 32-year-old works for a Center City nonprofit, suffers from diabetes and has faced anxiety over the prospect of losing her insurance.
"I think health coverage is an absolute right. I also think it is a responsibility. It is not something to be taking for granted," she said. "I understand what is at risk."
But now that her elation has subsided a bit, Ross is alarmed that Republican presidential hopeful Mitt Romney has declared his intention to repeal the law if he's elected to the White House in November.
Ross isn't exactly a political bystander. She sits on the board of the Jewish Social Policy Action Network, or JSPAN, a Philadelphia-based organization that filed an amicus brief to the Supreme Court in support of what many are now calling Obamacare — whether they're for or against it.
In backing the court's landmark 5-4 ruling upholding the Patient Protection and Affordable Care Act, Ross and JSPAN stood with the majority of the Jewish community, according to polls.
In an April survey of more than 1,000 Jewish voters conducted by the Public Religion Research Institute, 58 percent of respondents, including 78 percent of Democrats, said they would be opposed to the Supreme Court overturning the law. At the same time, 40 percent of respondents, including 84 percent of Republicans, said they would favor the court striking down the measure.
Now that the initial shock of the decision has been absorbed — almost no one predicted Chief Justice John Roberts would cast the deciding vote to uphold the constitutionality of the law — the national conversation has turned to the implications for the presidential election, the relationship between the court and Congress, and the future of health care in America.
In addition to some of the big constitutional questions, observers are also looking at more nitty-gritty issues, such as whether or not Republican-controlled states will go along with Medicaid expansion now that they are no longer required to do so. The justices curtailed but did not strike down a provision that would have states expand their Medicaid programs in order to cover health insurance for low-income individuals.
Another variable is whether states like Pennsylvania that opposed the law will have a health insurance exchange up and running by 2014, as mandated by the law.
Pennsylvania's Republican Gov. Tom Corbett has said he's moving forward with setting up the exchange, but has been mum on Medicaid expansion.
In terms of the presidential race, Jeff Jubelirer, a Philadelphia-based communications strategist and political analyst, noted that the ruling "only serves to harden already established positions for Obama and Romney among Jewish Democrats and Republicans.
"Health care is now clearly the second biggest issue in the campaign behind the economy," he added. "For Romney, at least politically, this can take some of the focus off of social issues," which historically has hampered Republican efforts to garner Jewish votes.
Some Jewish Philadelphians played an active role in the case that made its way to the Supreme Court. One was Richard Malkin, a physician who, along with local attorney and activist Ken Myers, helped draft the amicus brief filed by JSPAN, in conjuction with the Boston-based Jewish Alliance for Law and Social Action, in support of the law.
"It's the biggest improvement in health care accessibility and availability since Medicare and Medicaid in the '60s," said Malkin. "It's far from perfect, but it is the optimal thing we were able to achieve."
Many of the fine print details of the law, he said, will ultimately make for a more efficient health care system. And the creation of health exchanges may make people less risk-averse regarding employment because there will be an affordable health care option if they lose or switch jobs.
Ross, the diabetic, estimated that without insurance, her diabetes medication alone would cost her more than $1,000 a month. Then there's her asthma medication.
"It's a huge burden off my shoulders to know that my insurance company could not deny my coverage because of my pre-existing conditions," she said. "Any time I have considered a career move, health insurance has been first and foremost on my mind."
Among those on the other side of the debate is David Edman, a health care consultant who sits on the Pennsylvania Leadership Council of the National Federation of Independent Business, the organization that challenged the health care law along with 26 states.
"This is just a ruling on the law's constitutionality," said Edman, also a Republican Jewish Coalition member. "It is not a ruling on whether it is good policy or not. On Nov. 6, it will be determined if it's good policy or not by the American people."
Physician Nelson Wolf, a fellow RJC member and professor of cardiology at Temple University Hospital, wrote in an email that "Obamacare will not decrease the cost of healthcare, nor will it provide improved healthcare.
"Because the present legislation has made no provision for tort reform, the practice of defensive medicine will continue," he added. "This means that doctors need to order unnecessary and possibly risky studies, procedures and consultations in order to protect themselves in the event of a lawsuit. Lawsuits are often frivolous and always costly."
Some of the largest national Jewish umbrella groups, including the Jewish Federations of North America, did not issue statements on the divisive topic after the Supreme Court ruling.
Robin Schatz, who directs government affairs for the Jewish Federation of Greater Philadelphia, said, "There are some really excellent elements of the Affordable Care Act, and we as Jews have a moral imperative to protect our vulnerable citizens.
"I don't know that everyone completely understands everything and what the impact is going to be on small businesses," she added. "I would hope, moving forward, there is more bipartisan discussion about what the future of health care should be."
But with the notable exception of the Republican Jewish Coalition, the groups that did weigh in expressed support for the decision.
Rabbi David Saperstein, director of the Religious Action Center of Reform Judaism, said he was "elated" with the ruling.
Reform congregations, he said, have been "at the forefront of advocacy on behalf of health insurance reform in their states and at the national level." He cited Maimonides, noting that the medieval scholar and physician "placed health care first on his list of the 10 most important communal services that a city should offer its residents."
Others, including the National Council of Jewish Women, the Conservative movement's Rabbinical Assembly, the National Jewish Democratic Council and Rabbis for Human Rights-North America, all praised the ruling.
Matt Brooks, the RJC's executive director, voiced a dissenting opinion.
"The serious negative effects this law will have on the economy, on jobs, on medical research and development, and on the quality of health care in America are very troubling," he said in a statement. "The American people will have the opportunity to express their opinion on the wisdom of Obamacare in this election year."
U.S. Rep. Allyson Schwartz, a Democrat whose district includes parts of Montgomery County and Philadelphia and who is the only Jewish member of the Pennsylvania congressional delegation, called it "a proud moment for me personally" when she heard the decision. She pushed for the bill's passage and has always considered health care one of her signature issues.
"This is really a win for the American people to have a conservative court and the chief justice affirm the Affordable Care Act," declared Schwartz, who said the law would lower drug costs for seniors and make health care more secure for all Americans.
A number of rabbis also weighed in on the news.
Rabbi Richard Address, who leads Makor Shalom, a Reform synagogue in Cherry Hill, N.J., and has written extensively on health and aging issues, quickly posted a blog to the synagogue's website that was quite clear in its support of the law.
"I ask you to try and look at this not through partisan eyes, but through our Jewish lenses," wrote Address.
"The ability, in this society, for a person to receive basic health care allows them to maintain a sense of emotional, spiritual and, yes, financial dignity," he wrote. "Any law that mandates this is one that we should support."