On Thursday morning, the Supreme Court announced its ruling on the individual health insurance mandate created by President Barack Obama. The court ruled that it is constitutional, upholding the main provision of the Affordable Care Act. Chief Justice John Roberts wrote the controlling opinion for the court, which upheld the mandate as a tax. The court did say that it is not a valid exercise of the commerce clause power for Congress though. Joining Roberts in the decision were Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor.
The mandate requires that all Americans obtain health insurance coverage or pay a penalty. Five of the justices on the court found that the mandate falls under the powers of the Constitution for Congress to ‘lay and collect taxes.’
“The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause,” Roberts wrote in the decision. “That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress’s power to tax.”
While writing separately for the court’s four liberals, Ginsburg said the mandate would have been upheld under the commerce clause as well. “Unlike the market for almost any other product or service, the market for medical care is one in which all individuals inevitably participate,” she wrote. “Virtually every person residing in the United States, sooner or later, will visit a doctor or other health care professional.”
The justices who dissented were Anthony Kennedy, Antonin Scalia, Samuel Alito and Clarence Thomas. In a section of Roberts’ opinion he noted that conservative dissenters argued that the mandate could be upheld as a tax “because Congress did not ‘frame’ it as such. In effect, they contend that even if the Constitution permits Congress to do exactly what we interpret this statute to do, the law must be struck down because Congress used the wrong labels.”
The court upheld Medicaid expansion but said that the federal government cannot threaten the states that do not comply with the loss of existing funding.
“As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding,” Roberts wrote. “Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer. The States are given no such choice in this case: They must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding. The remedy for that constitutional violation is to preclude the Federal Government from imposing such a sanction.”