In a 5-4 decision authored by Chief Justice John Roberts, the U.S. Supreme Court ruled today that the Patient Protection and Affordable Care Act is constitutional.
The Court upheld the most controversial portion of the law — the requirement that as of 2014 all Americans must have health insurance or pay a penalty — as a valid exercise of Congress’s tax powers. The penalty, the majority held, is in fact a tax on those who do not have health insurance, as it is enforced through the tax code and assessed on Federal tax returns.
In rendering this judgment, the Court did not support the assertion that the health insurance requirement (often called the individual mandate) is permissible under the Constitution’s Commerce Clause. Congress, the Court said, does not have the power to regulate commercial inactivity — i.e., the decision not to participate in the health care marketplace. The Court also did not endorse the government’s contention that the law was constitutional under the “Necessary and Proper Clause” of the Constitution, which gives Congress the power to “make all Laws which shall be necessary and proper for carrying into Execution” the other powers granted in the Constitution.
While the Court’s decision on these two issues will be analyzed by Court watchers and legal scholars in coming days and may set precedent for future decisions on congressional power, they held no bearing on the validity of the Affordable Care Act once the Court ruled that the law was supported by Congress’s tax power.
Since the Court’s decision in this case turned on the tax issue, the Court could have chosen to kick the decision down the road, based on the provision of the Federal Anti-Injunction Act that holds that courts cannot hear challenges to tax laws until they go into effect (in this case, after 2014). This was a topic that took up the entire first day of the Court’s three-day marathon session of oral arguments in March. Instead, the Court ruled that while the individual mandate is a tax for constitutionality purposes, it is not the type of tax covered by the Anti-Injunction Act.
Chief Justice Roberts was the deciding vote in the case, siding with the more liberal Justices Ginsburg, Breyer, Sotomayor and Kagan (all of whom would have upheld the law under the Commerce Clause, as well). Justices Scalia, Kennedy, Thomas and Alito issued a joint dissenting opinion (which Justice Kennedy read from the bench). They would have struck the law down in its entirety. Justice Thomas also wrote a short, separate dissenting opinion, emphasizing the limits the Chief Justice’s majority opinion places on the Commerce Clause.
Since the Court upheld the individual mandate, it did not have to rule on whether it was severable from the rest of the law (that is, whether the rest of the law could continue in effect without the mandate).
The Court also ruled on the constitutionality of the expansion of Medicaid coverage under the Affordable Care Act, in which the Federal government gave States more money for Medicaid coverage of the poor but required that they make individuals eligible for the service who have income up to 133 percent of the poverty line. (Although the Federal government will pay for 100 percent of the expansion for the first two years, by 2020 its share would drop to 90 percent.)
The Court held that while the coverage expansion was constitutional, States could decline to take the extra money in exchange for not expanding their coverage. The Federal government, the Court held, could not penalize States for such a decision by withholding Federal Medicaid funds they already were receiving prior to the passage of the Affordable Care Act.
The Court’s decision in this case came as a surprise to many, particularly those who do not regularly watch oral arguments and were unfamiliar with the frequently adversarial nature of the proceedings, where justices often sharply question lawyers even though they eventually agree with their side. It’s instructive to remember — particularly when the Court takes up highly visible, controversial topics like this — that the Court’s job is to rule on the constitutionality of laws and not whether or not they are good public policy.
Chief Justice Roberts emphasized this point early in his 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.” Although many may laud or criticize the Court for endorsing the Affordable Care Act as a good law, this is for lawmakers — and the public — to decide, not the Court. What is true, however, is that the Affordable Care Act is a constitutional exercise of congressional power.
The Court now recesses for the summer and will not be in formal session again until October 1. We’ll have wrap-up blog posts on this Court’s term in the coming weeks. The next issue of Supreme Court Debates will be published in August, when we will cover the Arizona immigration law decision in depth. In the meantime, for more information about the arguments on both sides of the health care case, as well as other background material, read the May issue of Supreme Court Debates.