In a 5-4 vote, the Supreme Court has upheld the entire Affordable Health Care Act, with Chief Justice Roberts, not Kennedy, voting to save the AHCA.
SCOTUSBLOG is live blogging a deconstruction of the ruling. I’ve excerpted the best of it below.
SCOTUSBLOG: “The bottom line: the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.”
Lyle Denniston: The key comment on salvaging the Medicaid expansion is this (from Roberts): “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.” (p. 55)
Lyle: In opening his statement in dissent, Justice Kennedy says: “In our view, the entire Act before us is invalid in its entirety.”
Amy Howe: In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
EDITOR’S NOTE: From here on out for purposes of discussion, the ACA is the acronym for Patient Protection and Affordable Care Act — the health care bill, also known as Obamacare.
HERE’S A LINK TO THE ACTUAL OPINION.
OKAY, BACK TO SCOTUSBLOG
10:50 a.m. – Lyle: Essentially, a majority of the Court has accepted the Administration’s backup argument that, as Roberts put it, “the mandate can be regarded as establishing a condition — not owning health insurance — that triggers a tax — the required payment to IRS.” Actually, this was the Administration’s second backup argument: first argument was Commerce Clause, second was Necessary and Proper Clause, and third was as a tax. The third argument won.
10:52: Lyle: The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws. Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.
10:59: Amy Howe: By the way, the opinions collectively are a monster. The Chief’s opinion is 59 pages, Justice Ginsburg’s opinion is 61 pages, the four dissenters are 65 pages, followed by a short two-pager from Justice Thomas. You do the math.
11:00 – Amy Howe: Yes, a commenter notes that the Chief Justice’s opinion starts with a mini-civics lesson — definitely an awareness that this is one for the ages. Reminded me of his opinion in Snyder v. Phelps, the funeral protesters’ case last Term.
11:01 – Amy Howe: From the beginning of the Chief’s opinion: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”
11:04 – Tom Goldstein: Here is the money quote on the fifth vote to hold that the mandate is not justified under the Commerce Clause (recognizing that doesn’t matter because there were five votes under the Tax Power): “The power to regulate commerce presupposes the existence of commercial activity to be regulated.” That will not affect a lot of statutes going forward.
11:12 Tom: Lyle is working on his initial post now. He will be adding to it but here’s the first paragraph: Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial — feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.
FULL LYLE DENNISTON POST:
Don’t call it a mandate — it’s a tax
Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial — feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.
Since President Obama signed the new law, it has been understood by almost everyone that the expansion of health care coverage to tens of millions of Americans without it could work — economically — only if the health insurance companies were guaranteed a large pool of customers. The mandate to buy health insurance by 2014 was the method Congress chose to supply that pool. It is not immediately clear whether the Court’s approach will produce as large a pool of new customers. The ACA’s key provision now amounts to an invitation to buy insurance, rather than an order to do so, with a not-very-big tax penalty for going without.
The decision to keep at least some foundation under the expanded coverage will lead almost certainly to renewed efforts by Republicans in Congress to repeal all or most of the new law. And, of course, the Court’s decision is guaranteed to become a very prominent fixture of debate in this year’s continuing presidential and congressional elections.
John Cushman at the New York Times writes, “The decision was a striking victory for the president and Congressional Democrats…”
Josh Levs at CNN has an article entitled “What the health care ruling means to you”
Amy Davison at the New Yorker.
Matthew Yglesias at Slate discusses the Court’s Medicaid decision.
AS ADAM LIPTAK of the NY Times wrote back in March:
“Chief Justice Roberts is just 57, and he will probably lead the Supreme Court for an additional two decades or more. But clashes like the one over the health care law come around only a few times in a century, and he may well complete his service without encountering another case posing such fundamental questions about the structure of American government.”
NOTE: I wasn’t watching TV, but evidently both CNN and Fox got the news wrong and initially reported that the Supreme Court had “gutted” the president’s main provision. (It terms of the state of American mass media reporting, this incident comments on itself. No need for anything extra.)
Adam Winkler from UCLA has just posted this on SCOTUSblog.
“With this deft ruling, Roberts avoided what was certain to be a cascade of criticism of the high court. No Supreme Court has struck down a president’s signature piece of legislation in over 75 years. Had Obamacare been voided, it would have inevitably led to charges of aggressive judicial activism. Roberts peered over the abyss and decided he didn’t want to go there.”
MORE LATER (Back to non-Supreme Court related life, for a while.)
Pre-scribbled photo is Justice Robert’s official photograph.