U.S. Supreme Court Upholds Patient Protection and Affordable Care Act

Thu June 28, 2012

(Washington, D.C.) - On Thursday, June 28, the Supreme Court of the United States (SCOTUS) issued its long-awaited ruling on the constitutionality of the Affordable Care Act (ACA). Chief Justice Roberts, joined by Justices Kagan, Breyer, Sotomayor, and Ginsburg, upheld the individual mandate as a constitutional form of tax. That decision outweighed and rendered irrelevant the question of whether the mandate was constitutional under the Commerce Clause. In fact, the Court held that the mandate was not constitutional under the Commerce Clause, but that it did not matter because the Court found that the mandate was in fact a form of tax which is constitutional. Thus, the ACA was upheld.

With respect to the Medicaid expansion, as we understand it, the Court ruled that while Congress indeed has the power to expand Medicaid under the ACA, and to offer inducements to the states to participate in the expanded Medicaid program, the Federal Government cannot penalize the states if they decline to participate in the expanded program by withholding all or part of their “underlying” Medicaid federal match. Again, expanded Medicaid was upheld, but the penalty for not participating was limited.

The best summary of the decision in plain English comes from SCOTUSblog.com, which says the following:

“The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.”

Undoubtedly, volumes will be written in the next few days about what the decision means and how it will impact the 2012 national elections. The preliminary reaction from opponents is that they intend to make the ACA a major campaign issue, but it remains to be seen how well that strategy will serve to win over undecided voters who are more concerned now about jobs and the economy and weary of the partisan debate over healthcare.

In the meantime, please stay tuned. We will be glad to provide additional information as it becomes available.
Join APA