NYSRA News: Supreme Court Upholds Affordable Care Act

Dear NYSRA Member,

As you know, for some time the entire nation has awaited word from the Supreme Court on the constitutionality of the Affordable Care Act, more formerly known as the Patient Protection and Affordable Care Act (and also referred to as Obamacare by some).

This morning the court ruled that the act is constitutional, while placing on limitation on Congressional power to “punish” states who do not choose to expand Medicaid eligibility.

Chief Justice Roberts appears to have been the main key to saving the act. He was joined in most of his controlling opinion by Justices Ginsberg, Sotomayor, Kagan and Breyer. The support for the law by the latter four justices was not unexpected. However, it was largely seen by some that Justice Kennedy – not the Chief Justice – might be the member of the court to vote on the side of the act.

Four dissenting justices – Scalia, Thomas, Kennedy and Alito – filed a joint opinion. The four of them would hold the entire ACA to be unconstitutional.

Perhaps most surprising is the majority opinion by Justice Roberts in which he upholds the law’s “individual mandate,” which essentially decrees that all Americans without health insurance must buy or get coverage. This was a linchpin of the case for many. Most supporters of the law said Congress had the power, under its authority to regulate interstate commerce, to decree such a mandate. Interestingly, Justice Roberts indicated today that Congress does NOT have the power to do so under the Commerce Clause of the Constitution. Rather, he accepted an alternative argument that contended Congress had the authority to issue such a mandate under its taxing powers. One either buys the insurance or pays a tax if he or she doesn’t buy it, basically.

There are several opinions in the case and they are quite complex, with different permutations of justices joining various parts of the majority opinion.

One aspect of interest to the world of Medicaid is that the court did say that states could choose to expand their Medicaid populations and receive additional federal dollars if they do so. But the court limited a provision in the act, however, saying that the federal government cannot punish states who choose not to expand Medicaid eligibility. The Chief Justice indicated that, while the government could withhold new funds from states who choose not to expand, it could not rescind or reduce existing funds that those states receive for their current Medicaid programs.

This result will be considered a major victory for the Obama White House. It will undoubtedly fuel much more debate on the issue of health insurance, however: It comes just as the summer segment of a presidential election campaign gets underway. Moreover, the Republicans who control the House of Representatives have vowed that any ruling upholding the ACA would spur them to move to legislatively repeal the law. It is not believed that the current US Senate, where Democrats hold slim control, would join such a move. But one-third of the US Senate seats will be up for election in November.