In a stunning turn of events, the Supreme Court upheld the Affordable Care Act, the signature legislative accomplishment of the Obama Administration.
In a 5-4 decision (more on that in a minute), the Court upheld the contentious individual mandate, determining that it was indeed constitutional under the commerce clause, justifying the requirement to purchase health insurance as a tax and therefore within the purview of Congress to enact.
Perhaps the most stunning development, however, was how the 5-4 decision came about. It was largely assumed that if the law were to be struck down, it would be along strict party lines with Justice Anthony Kennedy voting with the conservative members of the court. It was also widely thought that if the law were upheld–as it has been–that it would likely be a 6-3 vote with Chief Justice John Roberts joining Kennedy and the liberal members of the court to justify the law.
Instead, Kennedy voted with the conservatives, and Roberts–appointed by George W. Bush and himself a stalwart conservative–sided with the liberal wing of Elena Kagan, Sonia Sotomayor, Ruth Bader Ginsburg, and Stephen Breyer. Kennedy, who Time magazine called the most powerful person on the court as the lone moderate who usually holds the deciding vote in those 5-4 split decisions.
A 5-4 split on the Supreme Court always viewed as politically tenuous. But in this case, with Justice Roberts joining the majority and writing the majority opinion, it lends an additional measure of credibility to the ruling that would have faced extra scrutiny and consternation had it been the usual, expected 5-4 split.
From Roberts’ majority opinion: “”The framers created a federal government of limited powers, and assigned to this court the duty of enforcing those limits. The court does so today but the court does not express any opinion on wisdom of the Affordable Care Act under the constitution. That judgment is reserved to the people.”
The court did decide, however, that a provision in the Affordable Care Act that required states to implement the expansions in Medicaid funding required by the law in its entirety or risk losing Medicaid funding altogether was unconstitutional. The Court determined that the federal government could not withhold funds available to all other states and hold them hostage for further implementation. The states maintain the ability to determine how much or how little Medicaid assistance they will provide for their residents. The Court also in effect bolstered states’ abilities to “opt out” of the Affordable Care Act without penalty.
The Affordable Care Act will now continue on to be implemented as planned, with all of the most popular provisions intact. The most controversial aspect of the law is the individual mandate, which was viewed as the lynchpin that would make the Act work. By requiring everyone to purchase health insurance, and by providing subsidies to those who needed help in doing so, it would increase the risk pool for the insurance companies, allowing costs to come down and making it more palatable for the insurance companies to cover the sickest Americans that they were no longer allowed to deny coverage to: The Act prohibits the denial of coverage by insurance companies on the basis of pre-existing conditions.
The law also calls for the formation of government organized insurance exchanges, a sort of one stop shop for individuals to visit to get their pick of the different insurance plans offered by the various insurance companies.
This is a developing story. Please check back later for updates.