The decision
was a victory for Mr. Obama and Congressional Democrats, affirming the
central legislative achievement of Mr. Obama’s presidency.
“The Affordable Care Act’s requirement that certain individuals pay a
financial penalty for not obtaining health insurance may reasonably be
characterized as a tax,” Chief Justice Roberts wrote in the majority
opinion. “Because the Constitution permits such a tax, it is not our
role to forbid it, or to pass upon its wisdom or fairness.”
At the same time, the court rejected the argument that the
administration had pressed most vigorously in support of the law, that
its individual mandate was justified by Congress’s power to regulate
interstate commerce. The vote was again 5 to 4, but in this instance
Chief Justice Roberts and the court’s four more conservative members
were in agreement.
The court also substantially limited the law’s expansion of Medicaid,
the joint federal-state program that provides health care to poor and
disabled people. Seven justices agreed that Congress had exceeded its
constitutional authority by coercing states into participating in the
expansion by threatening them with the loss of existing federal
payments.
Justice Anthony M. Kennedy, who had been thought to be the
administration’s best hope to provide a fifth vote to uphold the law,
joined three more conservative members in an unusual jointly written
dissent that said the court should have struck down the entire law. The
majority’s approach, he said from the bench, “amounts to a vast judicial
overreaching.”
The court’s ruling was the most significant federalism decision since
the New Deal and the most closely watched case since Bush v. Gore in
2000. It was a crucial milestone for the law, the Patient Protection and
Affordable Care Act of 2010, allowing almost all — and perhaps, in the
end, all — of its far-reaching changes to roll forward.
Mr. Obama welcomed the court’s decision on the health care law, which
has inspired fierce protests, legal challenges and vows of repeal since
it was passed. “Whatever the politics, today’s decision was a victory
for people all over this country whose lives are more secure because of
this law,” he said at the White House.
Republicans, though, used the occasion to attack it again.
“Obamacare was bad policy yesterday; it’s bad policy today,” Mitt
Romney, the presumptive Republican presidential nominee, said in remarks
near the Capitol. “Obamacare was bad law yesterday; it’s bad law
today.” He, like Congressional Republicans, renewed his pledge to undo
the law.
The historic decision, coming after three days of lively oral arguments
in March and in the midst of a presidential campaign, drew intense
attention across the nation. Outside the court, more than 1,000 people
gathered — packing the sidewalk, playing music, chanting slogans — and a
loud cheer went up as word spread that the law had been largely upheld.
Chants of “Yes we can!” rang out, but the ruling also provoked
disappointment among Tea Party supporters.
In Loudoun County, Va., Angela Laws, 58, the owner of a cleaning
service, said she and her fiancé were relieved at the news. “We laughed,
and we shouted with joy and hugged each other,” she said, explaining
that she had been unable to get insurance because of her diabetes and
back problems until a provision in the health care law went into effect.
After months of uncertainty about the law’s fate, the court’s ruling
provides some clarity — and perhaps an alert — to states, insurers,
employers and consumers about what they are required to do by 2014, when
much of the law comes into force.
The Obama administration had argued that the mandate was necessary
because it allowed other provisions of the law to function: those
overhauling the way insurance is sold and those preventing sick people
from being denied or charged extra for insurance. The mandate’s
supporters had said it was necessary to ensure that not only sick people
but also healthy individuals would sign up for coverage, keeping
insurance premiums more affordable.
Conservatives took comfort from two parts of the decision: the new
limits it placed on federal regulation of commerce and on the conditions
the federal government may impose on money it gives the states.
Five justices accepted the argument that had been at the heart of the
challenges brought by 26 states and other plaintiffs: that the federal
government is not permitted to force individuals not engaged in
commercial activities to buy services they do not want. That was a
stunning victory for a theory pressed by a small band of conservative
and libertarian lawyers. Most members of the legal academy view the
theory as misguided,if not frivolous.
“To an economist, perhaps, there is no difference between activity and
inactivity; both have measurable economic effects on commerce,” Chief
Justice Roberts wrote. “But the distinction between doing something and
doing nothing would not have been lost on the framers, who were
practical statesmen, not metaphysical philosophers.”
Justice Ruth Bader Ginsburg, in an opinion joined by Justices Stephen G.
Breyer, Sonia Sotomayor and Elena Kagan, dissented on this point,
calling the view “stunningly retrogressive.” She wondered why Chief
Justice Roberts had seen fit to address it at all in light of his vote
to uphold the mandate under the tax power.
Akhil Reed Amar, a Yale law professor and a champion of the health care
law, said that it was “important to look at the dark cloud behind the
silver lining.”
“Federal power has more restrictions on it,” he said, referring to the
new limits on regulating commerce. “Going forward, there may even be
laws on the books that have to be re-examined.”
The restrictions placed on the Medicaid expansion may also have
significant ripple effects. A splintered group of justices effectively
revised the law to allow states to choose between participating in the
expansion while receiving additional payments or forgoing the expansion
and retaining the existing payments. The law had called for an
all-or-nothing choice.
The expansion had been designed to provide coverage to 17 million
Americans. While some states have indicated that they will participate
in the expansion, others may be resistant, leaving more people outside
the safety net than the Obama administration had intended.
Although the decision did not turn on it, the back-and-forth between
Justice Ginsburg’s opinion for the four liberals and the joint opinion
by the four conservatives — Justice Kennedy and Justices Antonin Scalia,
Clarence Thomas and Samuel A. Alito Jr. — revisited the by-now-familiar
arguments. Broccoli made a dozen appearances.
“Although an individual might buy a car or a crown of broccoli one day,
there is no certainty she will ever do so,” Justice Ginsburg wrote. “And
if she eventually wants a car or has a craving for broccoli, she will
be obliged to pay at the counter before receiving the vehicle or
nourishment. She will get no free ride or food, at the expense of
another consumer forced to pay an inflated price.”
The conservative dissenters responded that “one day the failure of some
of the public to purchase American cars may endanger the existence of
domestic automobile manufacturers; or the failure of some to eat
broccoli may be found to deprive them of a newly discovered
cancer-fighting chemical which only that food contains, producing health
care costs that are a burden on the rest of us.”
All of the justices agreed that their review of the health care law was
not barred by the Anti-Injunction Act, which allows suits over some
sorts of taxes only after they become due. That could have delayed the
health care challenge to 2015. The conservative dissenters said that the
majority could not have it both ways by calling the mandate a tax for
some purposes but not others.
“That carries verbal wizardry too far, deep into the forbidden land of sophists,” they said.
As a general matter, Chief Justice Roberts wrote that the decision in
the case, National Federation of Independent Business v. Sebelius, No.
11-393, offered no endorsement of the law’s wisdom.
Some decisions, the chief justice said, “are entrusted to our nation’s
elected leaders, who can be thrown out of office if the people disagree
with them.”
Justice Ginsburg, speaking to a crowded courtroom that sat rapt for the
better part of an hour, drew a different conclusion.
“In the end,” she said, “the Affordable Care Act survives largely unscathed.”
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