Supreme Court upholds Obama’s health-care law
A sharply divided Supreme Court upheld President Obama’s health-care law
Thursday, ruling that its key provision – an “individual mandate” to buy health
insurance – is constitutional under Congress’s taxing authority.
The high court rejected the argument, advanced by the Obama administration,
that the individual mandate was constitutional under the commerce clause of the
Constitution. But Chief Justice John G. Roberts Jr. joined the court’s four
liberal justices – Ruth Bader Ginsburg, Sonia Sotomayor, Stephen G. Breyer and
Elena Kagan – in voting to uphold the mandate, ruling that a penalty for
refusing to buy health insurance amounts to a tax.
Ginsburg favored going further, and allowing the mandate under the commerce
clause.
The court also upheld the federal government’s ability to expand Medicaid
coverage, but said the government could not withdraw existing Medicaid funding
from states that opt out of the expansion.
The complex decision— a major victory for the White House less than five months
before the November elections--will help redefine the power of the national
government and affect the health-care choices of millions of Americans.
Passage of the Patient Protection and Affordable Care Act by the
Democratic-controlled Congress in 2010 capped decades of efforts to implement a
national program of health care. The legislation is supposed to eventually
extend health-care coverage to more than 30 million Americans who currently lack
it.
“No longer will Americans be a heart attack or a car crash away from
bankruptcy,” Senate Majority Leader Harry M. Reid (D-Nev.) said in a speech on
the Senate floor Thursday after the ruling. “No longer will Americans live in
fear of losing their health insurance because they lose their job.”
Republicans in Congress and GOP presidential challenger Mitt Romney have
vowed to try and repeal the measure after the November elections.
The health-care issue thrust the Supreme Court into the public spotlight
unlike anything since its role in the 2000 presidential election. The court’s
examination of the law received massive coverage — especially during three days
of oral arguments in March — and its outcome remained Washington’s most closely
guarded secret.
The court reviewed four questions: whether it was within Congress’s
constitutional powers to impose the individual mandate to purchase health
insurance; whether all or any additional parts of the law must be struck down if
the mandate is rejected; whether an expansion of Medicaid was unduly coercive on
the states and whether all of those questions can even be reviewed before the
mandate takes effect.
The individual mandate, known technically as the “minimum coverage”
provision, was considered a crucial part of the overall health-care legislation
because striking it down would have jeopardized the ability of insurers to
comply with other, more popular elements of the law without drastically raising
premiums.
Under those other provisions, for example, insurers can no longer limit or
deny benefits to children because of a preexisting condition, and young adults
to up age 26 are eligible for insurance coverage under their parents’ plans.
During oral arguments in March, conservative justices indicated they were skeptical about the individual mandate, the provision in
the 2,700-page health-care law that requires nearly all Americans to obtain
health insurance by 2014 or pay a financial penalty.
Arguing the case for the Obama administration, Solicitor General Donald B. Verrilli Jr. defended the law as a
constitutional exercise of congressional power under the charter’s commerce
clause to regulate interstate commerce. He said lawmakers were regulating health
insurance to deal with the problem of millions of people who lack coverage and
therefore shift costs to the insured when they cannot pay for their medical
care.
Paul D. Clement, representing Florida and 25 other states
objecting to the health-care law, argued that Congress exceeded its power in
passing the law, which he said compels people to buy a product.
In a 59-page opinion, Roberts wrote: “The Affordable Care Act is
constitutional in part and unconstitutional in part.” He said the individual
mandate “cannot be upheld as an exercise of Congress’s power under the commerce
clause,” which allows Congress to regulate interstate commerce but “not to order
individuals to engage in it.”
Roberts added: “In this case, however, it is reasonable to construe what
Congress has done as increasing taxes on those who have a certain amount of
income, but choose to go without health insurance. Such legislation is within
Congress’s power to tax.”
Neither the plaintiffs in the case nor the Obama administration had argued
before the court that the individual mandate was a tax. Instead, the court asked
a Washington lawyer to present the argument that lawsuits against the
health-care law were premature under an obscure 19th-century law, the
Anti-Injunction Act, which bars suits against a tax until the tax is actually
paid.
Under the health-care law, penalties for refusing to buy health insurance do
not kick in until people pay their 2015 income tax returns.
In its ruling, the court did not accept that the Anti-Injunction Act
precludes a decision on the health-care law, but it appeared to embrace the
argument that the penalty amounts to a tax.
Ginsburg, in a separate, 61-page opinion joined by Sotomayor and in which
Breyer and Kagan concurred in part, said she agreed with Roberts that the
individual mandate provision “is a proper exercise” of Congress’s taxing
authority. But she said she “would hold, alternatively, that the Commerce Clause
authorizes Congress to enact” the provision. Ginsburg wrote in her opinion that
the Constitution’s spending clause “permits the Medicaid expansion exactly as
Congress enacted it.”
The court majority, however, ruled that the law’s expansion of Medicaid can
move forward, but not its provision that threatens states with the loss of their
existing Medicaid funding if the states declined to comply with the expansion.
Roberts wrote that the portion of the health-care law that expands Medicaid
“violates the Constitution by threatening existing Medicaid funding.”
Congress can offer the states grants and impose accompanying conditions, “but
the States must have a genuine choice whether to accept the offer,” Roberts
said. “The states are given no such choice in this case: They must either accept
a basic change in the nature of Medicaid, or risk losing all Medicaid
funding.”
However, the remedy for that violation is to preclude such a sanction, not to
strike down other parts of the health-care law or scuttle the legislation as a
whole, he said.
The finding was unexpected—every lower court that has ruled on the issue has
upheld the constitutionality of the Medicaid expansion. And it raises immediate
questions as to how effectively the federal government will be able to implement
a provision that is central to the law’s goal of substantially reducing the
share of uninsured Americans.
Medicaid provides health insurance to the poor and disabled with a
combination of federal and state dollars. Beginning in 2014, the health-care law
significantly broadens the program’s minimum eligibility requirements.
About half of the tens of millions of Americans who will be newly covered
through the law will gain coverage this way.
Initially, the federal government will foot the entire bill for covering the
newly eligible. But its share will gradually drop to 90 percent by 2020 and
beyond, with states required to pick up the rest. The 26 states challenging the
expansion argued in court that this requirement would impose a crushing burden
on their budgets.
No initiative has exemplified Obama’s progressive domestic agenda or inflamed
his conservative opponents like the health-care law. The court’s decision will
resonate throughout the election season, not only in the presidential campaign
but in House and Senate races across the country.
The law provoked an unlikely debate about the Constitution. Opponents saw it
as a trespass on individual and state’s rights by an omnipotent federal
government, and supporters viewed it as a long-sought guarantee of health care
to Americans regardless of where they live or work.
Although the most controversial provisions of the law are not scheduled to
take effect until 2014, a complex web of new rules has already extended coverage and expanded benefits across the
country.
As a mark of the case’s importance, the justices spent more than six hours
over three days hearing oral arguments on the constitutional
questions and related issues. It was the most time than the court has spent on
any issue in nearly half a century.
As soon as Obama signed the health-care bill in March 2010, opponents raced
to challenge it. Early court decisions followed a predictable pattern, with
district judges appointed by Democratic presidents upholding the law and
Republican appointees striking it down.
But at the appeals court level, that changed. In a decision by the U.S. Court
of Appeals for the 11th Circuit in Atlanta, Judge Frank Hull, an appointee of
President Bill Clinton, joined with a Republican colleague in saying that the
individual insurance mandate in the “unprecedented” legislation exceeded
congressional authority. The judges said that if the law were constitutional, it
would be impossible to say what action on the part of the government would go
too far.
At the U.S. Court of Appeals for the 6th Circuit in Cincinnati and the U.S.
Court of Appeals for the D.C. Circuit, two prominent Republican-appointed judges
agreed that the law is intrusive but said it is within Congress’s powers.
In Cincinnati, Judge Jeffrey Sutton, a George W. Bush appointee, was the
deciding vote to uphold the act. In Washington, Senior Judge Laurence Silberman,
named to the bench by President Ronald Reagan, wrote an opinion saying that the
question was political, not constitutional.
“It certainly is an encroachment on individual liberty,” Silberman wrote. But
then — alluding to other cases in which the Supreme Court has ruled that the
commerce clause gives Congress power — he added that “it is no more so than a
command that restaurants or hotels are obliged to serve all customers regardless
of race, that gravely ill individuals cannot use a substance their doctors
described as the only effective palliative for excruciating pain, or that a
farmer cannot grow enough wheat to support his own family.”
Even as the legal wrangling grew to a crescendo, some aspects of the law were
already being enforced. Those include requirements that many insurance plans
allow young adults to stay on their parents’ policies until age 26; cover a
range of preventive services, including birth control, without imposing
co-payments or other out-of-pocket costs; eliminate lifetime dollar limits on
coverage; and begin phasing out annual caps.
The three cases the Supreme Court considered were National Federation of
Independent Business v. Sebelius; Florida, et al., v. Department of
Health and Human Services; and Department of Health and Human Services
v. Florida, et al.
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