Supreme Court delivers ruling on Patient Protection and Affordable Care Act
By Eric Veram
The court ruled first on the part of the act known as the "individual mandate"; the part that requires individuals to purchase health insurance or pay a penalty. Though the court rejected the individual mandate in respect to arguments that Congress was using power given it by the Commerce Clause, it was ultimately upheld as an exercise in Congress's ability to impose a tax. Essentially the court ruled that the penalty for not carrying health insurance is a tax, and individuals are free to opt to pay it instead of complying with the mandate. Chief Justice John Roberts delivered the majority's opinion saying, "the mandate can be regarded as establishing a condition -- not owning health insurance -- that triggers a tax -- the required payment to IRS." As a result of the mandate surviving the challenges to its constitutionality, the court did not rule on the issues of whether or not that part of the act could be severed from the rest.
The second item the court ruled on was the act's expansion of the Medicaid program. At issue was a part of the act that allowed Congress to offer additional Medicaid funding to states that complied with certain conditions laid out by Congress. The court did uphold this aspect of the act but stipulated that while Congress can offer new funding on conditions, it could not withhold existing funding for states' refusal to participate in the new program. Justice Roberts's key comment on the matter was, "Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."
Not only did the court split 5-4 on the ultimate ruling, but the majority also split on which arguments were accepted in favor of the act's constitutionality. Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor all accepted the case that the mandate was a legal use of Congress's powers under the Commerce Clause, however, Justice Roberts did not and only agreed that the mandate is legal as a tax. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented with Justice Kennedy delivering their opinion saying, "The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."
In summary the Patient Protection and Affordable Care Act has survived the various legal challenges almost entirely unchanged, however, the court's ruling has called into question just how far Congress is allowed to go under the Commerce Clause.
The court's full opinion can be found here.