Supreme Court Health Care Ruling: Preliminary Analysis & Implications Going Forward


The Supreme Court today largely upheld the challenged provisions of the Affordable Care Act (ACA). However, its legal rationale, particularly in relation to the individual mandate, diverged from the main focus of the briefs and oral arguments which had focused on questions related to the scope of Congressional authority under the Commerce Clause.

The mandate requiring that most Americans maintain "minimum essential" health insurance coverage was upheld. Although it can be pointed out that a majority of the Court found that the provision was not a valid exercise of Congress's Commerce Clause power (with potential implications for future cases), it determined that, constitutionally, the mandate can be treated as imposing a tax on those who do not have health insurance coverage and is within Congress's taxing power.

In the end, the law's Medicaid expansion was upheld, with an important limitation imposed the implications of which deserve careful consideration. Although the Court found that ACA's threatening states with the loss of their existing Medicaid funding was unconstitutionally coercive, it held this could be fully remedied by precluding the federal government from exercising its statutory right to withdraw existing funds for failure to comply with the Act's requirements in the expansion. In essence, the Court found that it was legitimate for Congress to expand the program and to make the receipt of new funds conditional upon the states' accepting of the program's new conditions. However, the Court found that it was inappropriate for Congress to make the receipt of existing Medicaid funds conditional upon states' acceptance of the new conditions.

The opinion of the Court was written and delivered by Chief Justice John Roberts. Justice Ginsburg wrote a separate opinion — primarily concurring but also dissenting to portions of the Chief Justice's opinion. Justices Kennedy, Alito, Scalia, and Thomas joined in a dissenting opinion.

Individual Mandate

The Issue

The ACA requires people to obtain health care insurance coverage by 2014 or face a financial penalty.1 Opponents of the ACA have argued that the Constitution does not give Congress the authority to enact such a requirement. The government has argued that Congress has the authority to impose this requirement under two separate Constitutional clauses — the Constitution's "Commerce Clause" and its power to "Tax and Spend" for the "general welfare."

Commerce Clause Analysis

Although ultimately deciding the issue based on the taxing power, the Chief Justice's opinion does address the Commerce Clause issue.

The Commerce Clause gives to Congress the authority to regulate "interstate commerce." The Supreme Court has previously ruled that Congress can regulate a broad range of activities, even activities that are not "interstate" themselves, that have an effect on interstate commerce. Opponents of the ACA, however, argued that the individual mandate goes too far. The authority to regulate interstate commerce does not include the authority to compel individuals not engaged in interstate commerce to do so.

The Chief Justice, as well as dissenting Justices Scalia, Kennedy, Thomas, and...

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