Supreme Court upholds health-care law

Originally posted on for the Scripps Howard Foundation Wire. Photos by Maddie Meyer.

A Tea Party protester rallies the outside the Supreme Court on Thursday. He was joined by hundreds of people voicing support or calling for the act’s repeal. Photo by Maddie Meyer

WASHINGTON – The Supreme Court ruled Thursday that President Barack Obama’s key domestic policy, the Affordable Care Act, is largely constitutional.

Chief Justice John G. Roberts joined the 5-4 decision upholding most of the law. He wrote the majority opinion.

In the complex 193-page opinion , the justices primarily addressed the individual mandate and the expansion of the Medicaid program. Both issues were brought to the court on the grounds that Congress overreached its constitutional power to compel citizens and states to buy insurance or create new programs.

The Affordable Care Act requires virtually all Americans to buy health insurance or pay a “penalty,” or an additional tax. Challengers argued that this mandate, known formally as the “minimum coverage provision,” expanded Congress’ powers too broadly over personal decisions.

The court said the law could not be upheld under the Constitution’s Commerce Clause.

“The individual mandate forces individuals into commerce precisely because they elected to refrain from commercial activity. Such a law cannot be sustained under a clause authorizing Congress to ‘regulate Commerce,’” Roberts wrote.

The court decided instead to uphold the mandate under Congress’ taxation power because those who don’t buy insurance will pay the Internal Revenue Service. The financial consequence is not overbearing, Roberts said as he delivered the court’s opinion– in fact, he said, many individuals may find it less of a burden to pay the extra tax than to  buy health insurance.

“While the individual mandate clearly aims to induce the purchase of health insurance, it need not be read to declare that failing to do so is unlawful,” he said.

The Affordable Care Act also includes a dramatic Medicaid expansion – covering a larger portion of poor individuals under government-funded insurance.

The law would have taken away federal Medicaid funding from states that do not expand their Medicaid programs. The court concluded that Congress cannot coerce a state by threatening to take away existing funding. However, it said, Congress can legally provide additional funding only to states that comply with the new rules.

Justice Anthony M. Kennedy read the dissent in the courtroom. He said the court overstepped its boundaries in defining the Affordable Care Act as a tax and suggesting a remedy to Medicaid expansion.

“It our view, the Act before us is invalid in its entirety,” he said.

Roberts said the court’s role was to rule on the plan’s legality, not whether it was good policy.

“Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them,” he said. “It is not our job to protect the people from the consequences of their political choices.”

The health-care plan has been a highly charged political issue since its conception in Congress in 2009, when no Republican voted for it. In general, liberal supporters of the law appeal to equality and quality of life, while conservatives who oppose it appeal to  individual liberty.

It is both a point of pride in Obama’s presidential campaign and a frequent punching bag in Romney’s.

Supporters of the Affordable Care Act march in front of the Supreme Court Thursday before the decision was made public. The group chanted "We love Obamacare." Photo by Maddie Meyer

“Today’s decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court’s decision to uphold it,” Obama said in a press conference after the decision was announced.

Romney joined other Republicans who said they would try to repeal the law.

“You can choose whether you want to have larger and larger government, more and more intrusive in your life, separating you and your doctor. … If we want to get rid of Obamacare, we have to get rid of Obama,” Romney said at a press conference in Washington.

Both candidates once supported their opponent’s viewpoint.

In the 2008 presidential primaries, Obama attacked Hillary Clinton’s health care plan because it “forces everyone to buy insurance, even if you can’t afford it, and you pay a penalty if you don’t,” according to Politifact, an independent fact-checking website.

Romney calls for a full repeal of Obama’s health-care plan, but there are many similarities between the plan and his own health-care plan in Massachusetts. Romney’s plan included an individual mandate using tax penalties and created an exchange of private companies – and he even commended the president for “copying that idea,” he said in an interview with CBS in June 2009.

The court announced the majority opinion, dissenting opinion and concurring opinion in the court room. But the full decision papers show an even more complex relationship between the justices’ opinions. Justices Ruth Bader Ginsburg, Stephen G. Breyer, Sonia M. Sotomayor and Elena Kagan joined Roberts in the majority opinion. Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito joined Kennedy in the dissent. Ginsburg wrote an opinion concurring in part and dissenting in part with Roberts’ opinion, joined by Sotomayor and joined in part by Breyer and Kagan. Thomas wrote his own dissenting opinion.