The Affordable Care Act Survives, Barely, in 5-4 Decision

The Supreme Court, in a 5-4 decision, voted to basically uphold the entire Affordable Care Act. The important thing is that the law is constitutional and for the most part will go into effect as planned.

In a surprise move, Chief Justice John Roberts joined the liberal justices in finding that the individual mandate was constitutional, while Anthony Kennedy actually joined the conservatives in concluding the mandate was not constitutional.

The individual mandate and the overall law survived, but only just barely, thanks to Roberts agreeing with just one of the administration's arguments for the mandate. Roberts found that even though the mandate is not a constitutional use of Congressional power under the Commerce Clause or the Necessary and Proper clause, it is a tax and therefore constitutional because of Congress's taxing powers. From the relevant parts of the syllabus of Robert's opinion:

Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. Congress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle that the Federal Government is a government of limited and enumerated powers. The individual mandate thus cannot be sustained under Congress's power to "regulate Commerce."

(b) Nor can the individual mandate be sustained under the Necessary and Proper Clause as an integral part of the Affordable Care Act's other reforms.Each of this Court's prior cases upholding lawsunder that Clause involved exercises of authority derivative of, andin service to, a granted power. E.g., United States v. Comstock, 560 U.S. ___. The individual mandate, by contrast, vests Congress withthe extraordinary ability to create the necessary predicate to the exercise of an enumerated power and draw within its regulatory scope those who would otherwise be outside of it. Even if the individual mandate is "necessary" to the Affordable Care Act's other reforms, such an expansion of federal power is not a "proper" means for making those reforms effective. Pp. 27-30.

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4. CHIEF JUSTICE ROBERTS delivered the opinion of the Court with respect to Part III-C, concluding that the individual mandate may be upheld as within Congress's power under the Taxing Clause. Pp. 33-44.

Another surprise move, the Court did place some limits on the Medicaid expansion. As the law was written states that don't take part in the Medicaid expansion could not use all their current Medicaid money, making it basically impossible for states to not take part in the expansion. The Court concluded this was unreasonably coercive to the states. As a result, the Court places a limit on how this provision can be implemented. States can choose to take part in the Medicaid expansion but will not lose their current Medicaid money if they don't. Although the individual mandate has gotten most of the attention in the build up to this decision, this aspect of the case could potentially have an even larger policy implication than just striking down the mandate would have.