Supreme Court rules on federal health care act
The U.S. Supreme Court ruled 5-4 today that the federal Patient Protection and Affordable Care Act of 2010 — often called Obamacare — is constitutional.
Writing for the court, Chief Justice John Roberts addressed the two key provisions in the act that 26 states, several individuals and the National Federation of Independent Business had challenged in their lawsuit. They are:
1) To bring down the cost of health insurance across the country, the act includes an individual mandate that requires most Americans to maintain “minimum essential” health insurance coverage.
Starting in 2014, those who did not comply with this mandate would be assessed a “penalty” that must be paid to the Internal Revenue Service with that individual’s taxes, and which would be “assessed and collected in the same manner” as tax penalties, Roberts wrote.
Roberts concluded that the individual mandate could not be considered constitutional under the “commerce” clause because the mandate does not regulate an existing commercial activity, Instead, it compels individuals to become active in commerce by purchasing health insurance.
Roberts also concluded that the individual mandate could not be considered constitutional under the “necessary and proper” clause because, in prior cases where the Supreme Court upheld a law under this clause, the law “involved exercises of authority derivative of, and in service to, a granted power.” In this case, the individual mandate “vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power.”
Roberts was able to conclude that the individual mandate could be viewed as “a tax on those who do not buy that product,” as the government had presented its case. He noted that “neither the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance beyond requiring a payment to the IRS.”
2) The Act also expands the scope of the federal Medicaid program beyond providing assistance to pregnant women, children, needy families, the blind, the elderly and the disabled to include. For example, the Act requires states to provide coverage for adults with incomes up to 133 percent of the federal poverty level by 2014.
“But if a state does not comply with the Act’s new coverage requirements, it may lose not only the federal funding for those requirements but all of its federal Medicaid funds,” Roberts wrote.
Citing the Constitution’s “spending” clause, Roberts noted that the legitimacy of such a program “depends on whether a state voluntarily and knowingly accepts the terms of such a program.”
Threatening the loss of more than 10 percent of a state’s overall budget “is economic dragooning,” Roberts said, and “when Congress threatens to terminate other grants as a means of pressuring the states to accept a spending clause program, the legislation runs counter to this nation’s system of federalism.”
The solution to saving the Affordable Care Act, Roberts concluded, is to delete the section about the federal government withdrawing Medicaid funds if states don’t comply with the new coverage requirements.
While Justice Ruth Bader Ginsburg disagreed with Roberts’ interpretation of how the “spending clause” applied, she agreed with his constitutional remedy by noting that “Congress’ extension of Medicaid remains available to any state that affirms its willingness to participate.”
She also noted that, “When a court confronts an unconstitutional statute, its endeavor must be to conserve, not destroy, the legislation.”
Justices Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan joined Roberts in some parts and dissented in others.
Justices Antonin Scalia, Clarence Thomas, Anthony Kennedy and Samuel Alito filed dissenting opinions.