Home > Applying Political Science > Supreme Court Rules on PPACA (AKA, Obamacare)

Supreme Court Rules on PPACA (AKA, Obamacare)

English: The United States Supreme Court, the ...

English: The United States Supreme Court, the highest court in the United States, in 2010. Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg. (Photo credit: Wikipedia)

The Supreme Court issued its ruling on the PPACA (i.e., Obamacare) this morning. In a surprising move to many observers, the 5-4 decision upheld the law, though not in the way most thought possible. Justice Kennedy, who we generally think of as the Court’s swing voter, sided with the minority in believing the entirety of the law should be invalidated. The general thought had been that whatever way Kennedy went, so to would the Court’s opinion. That thought turned out to be wrong. Chief Justice Roberts, appointed by President Bush and thought to be a reliable conservative voice on the Court, sided with the majority.

The decision is very complex (you can read it here), and I haven’t read anything except the coverage coming out of the Court this morning. I encourage you to read the analysis at SCOTUSblog if you want to know more. The people there have been doing a fantastic job making the complex decision intelligible to the lay observer.

Here’s the major components (as I understand them) of the decision as it affects both the individual mandate and the Medicaid expansion (remember, both were part of the law):

  • The mandate qua mandate is unconstitutional. A majority of the court (5-4) would have held that simply requiring everyone to buy health insurance would violate the Constitution’s Commerce Clause. I don’t have a good read on the logic here yet, but it doesn’t matter because …
  • In the eyes of the majority the mandate is not actually a mandate. It is a tax, and Congress is well within its constitutional power to levy taxes. Therefore, the law passes constitutional muster and can stand. There is no question of severability. (It should be noted that the minority holds there is no way to severe the mandate from the rest of the law, and as such they would have invalidated the entire law.)
  • Because the entire law stands, everyone has to buy health insurance or pay a small tax. All of the other aspects of the law also stand. Insurers cannot deny coverage for pre-existing conditions, kids can stay on their parents’ insurance until they turn 26, states have to set up the health-care exchanges that would allow people to buy insurance, etc.
  • In terms of the Medicaid expansion, the Court ruled that Congress can expand eligibility but cannot make acceptance of that expansion mandatory for receiving all of the program funds; that is, states can reject the expansion and retain the funding for the extant portions of the program they are already implementing. Congress had made acceptance a condition of receiving all program funds, and the Court said it cannot do that. This part of the ruling represents a partial victory for the states which had argued against the expansion.

The Court’s ruling here, as frequently happens with major decisions, leaves more questions than answers. If the mandate qua mandate would be unconstitutional, how should we understand the Commerce Clause? More importantly, how should we understand the Court’s view of congressional power under the Commerce Clause? Most observers argued that a ruling against the mandate would call into question, if not invalidate, the body of case law that has developed in the wake of Wickard v. Filburn. Has the Court done so here? How does the ruling about the Medicaid expansion affect other programs where Congress dangles funding in exchange for state action? When and how can Congress change program requirements and not run afoul of the Court’s rule? Finally, the Court’s view of federalism has been evolving over the past 20 years as members retire and are replaced. How will this court view the appropriate relationship between the states and the federal government going forward?

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