The months of speculation are over. Chief Justice John Roberts delivered the Supreme Court’s ruling on the constitutionality of the Affordable Health Care Act — popularly known as “Obamacare.”
The centerpiece of the Act, the health insurance mandate on individuals, was upheld in a 5-4 ruling by Roberts, who was joined by Associate Justices Stephen Breyer, Ruth Bader Ginsburg, and Obama appointees Elana Kagan and Sonia Sotomayor.
The majority of the Court determined that under the Taxation Clause of the Constitution, Congress has the power to enact the mandate even though the act itself calls fines levied for failure to purchase health insurance, a “penalty.”
Roberts explained that the so-called “penalty” acts like a tax: it is calibrated to income, it is graduated, it is paid to the IRS and most importantly to the Court, it is not a criminal offense.
A majority of the Court ruled that the mandate was not Constitutional under the Commerce Clause within the 10th Amendment. However, Roberts explained that since it is constitutional under the Taxation Clause, the mandate is overall constitutional.
On the second major issue, the law’s expansion of Medicaid, a majority of the Court ruled that Congress overstepped its powers. The law allows the federal government to withhold all Medicaid funding to states that refuse to participate in the expansion of Medicaid to include all people earning less than 133% more than the federal poverty rate.
Ruling the Medicaid expansion unconstitutional and stricken, Roberts stated that the Spending Clause has limits to protect the States as sovereigns. He likened this to a congressional “gun to the head” of the states, transforming Medicaid into a new universal system that goes beyond modifying the current Medicaid plan.
The Court determined that the federal government may withhold new Medicaid spending from states that fail to expand eligibility, but may not withhold money already promised for Medicaid as it existed before the law was passed.
Much like Justice Scalia this past Monday, Roberts ended his bench statement with political commentary.
He stated that the role of the Court was to interpret the Constitution under Marbury v. Madison and not to make policy. “Good policy” is the role of the Congress rather than the Court, he said, arguing that it is not the Court’s job to “save the people from the consequences of their choices.” Observers interpreted Roberts’ words as a rebuke to lawmakers who helped pass the ACA, as well as the voters who supported them.
Justice Anthony Kennedy delivered the dissent, and was joined by Antonin Scalia, Clarence Thomas and Samuel Alito, who argued that both the mandate and the Medicaid expansion are unconstitutional, and that the entire law should be voided.
Kennedy scolded the majority for judicial overreach; arguing that the Court has taken legislative initiative and amended the ACA. He complained that the ruling ignored the concept of federalism and erodes states’ sovereignty. Kennedy warned that that the majority opinion undermines the very structure of the Constitution and, “structure means liberty.”
Justices Ginsburg and Sotomayor wrote a separate opinion concurring in part and dissenting in part, arguing that both provisions were constitutional. The mandate, they said, should have been upheld first and foremost under the Commerce Clause. They warned that this decision will invite numerous attacks on future legislation related to interstate commerce. In addition, they argued that the Medicaid expansion was constitutional as the pre-ACA system of Medicaid provides that the Congress may modify the plan as it chooses.