The United States Supreme Court upheld the Patient Protection and Affordable Care Act this morning. The decision of the Court is available here.
The justices upheld the individual mandate and almost all of the remainder of the statute by a vote of 5-4. Chief Justice Roberts delivered the opinion of the Court ruling that the mandate constitutes a "tax" and is therefore a valid exercise of Congress' power to tax and spend for the general welfare - the "power of the purse." Justice Ginsburg authored a concurring opinion in which she concluded that the individual mandate is a valid exercise of Congress' power under the Commerce Clause. Justices Kennedy, Scalia, Alito, and Thomas jointly authored a dissenting opinion in which they would have found that the entire Act was unconstitutional.
In a divided ruling, the Court struck down one possible interpretation of the law. The Affordable Care Act requires the States to expand Medicaid eligibility to all United States citizens earning less than 133% of the Federal Poverty Level. Under the ACA the federal government must pay 100% of any extra costs that the states might incur as a result of expanding coverage to these citizens. Some people worried that the ACA might allow the federal government to cut off existing Medicaid funding to any state that refused to enlarge its Medicaid program. The Court ruled that while it would be constitutional to withhold additional funding to any State that refuses to expand its coverage, it would not be constitutional to withhold existing funding to any State that declines to participate in the expanded program. As a practical matter the federal government never would have exercised this power, and as the concurring justices point out it would appear that existing statutes would prohibit the federal government from doing this.
I will continue to post about this case as I have the chance to review the various opinions.
Wilson Huhn teaches constitutional law at The University of Akron School of Law. He is the author of "ObamaCare: Is It Necessary, What Will It Accomplish, and Is It Constitutional."