The
U.S. Supreme Court today voted 5-4 to uphold all parts of the Patient
Protection and Affordable Care Act, also known as ACA, also known as Obamacare.
Against expectations and party lines, Chief Justice John Roberts joined the
majority, with perennial swing vote Anthony Kennedy writing for the dissent.
Roberts sided with the Court’s four liberal justices, ruling that Congress had
not exceeded its constitutionally-mandated powers in requiring Americans to buy
health insurance.
Interestingly,
the ruling stipulates that Congress has the authority to impose the law’s
individual mandate provision under Congress’s taxing powers, but not, as had
been argued previously by the Obama administration, under either the Commerce
Clause, or the Necessary and Proper Clause (though they had also made the tax
argument as well).
It
seems that the ACA would not have been upheld solely on the basis of the
Commerce Clause alone (that Congress could use its power to regulate commerce
between the states to require everyone to buy health insurance) – there simply
weren’t the votes. It has been able to pass with the votes of five justices,
however, because they ruled that the penalty someone must pay if they refuse to
buy health insurance is in fact a kind of tax that Congress can impose through
its taxing power. Congress has a specific power vis-à-vis the ACA – the power
to tax. As the individual mandate survived, the whole statute was able to stand
(apart from a little niggle about Medicaid and state compliance). The
constitutional scholar Jack M. Balkin had a fine piece in the May edition of
the Atlantic magazine presciently arguing that the healthcare mandate
was clearly a tax, and therefore constitutional.
The
decision – I think we can call it historic – means that thirty million hitherto
uninsured Americans will now get healthcare coverage, and many millions will
receive better insurance than they once had, whether it be extended drug
coverage for the elderly, or the right to appeal against insurer treatment
decisions from those who have to pay for said insurance. Really for the first
time in U.S.
history, millions of Americans will now always have the option of comprehensive
healthcare coverage available to them.
Politically,
the ruling is unlikely to change things much; if anything, it was an affirmation
of the status quo, rather than a dramatic upturning of it. Republican voters
may well be galvanised to turn out in droves come November’s general election.
Speaker of the House John Boehner has already tweeted that “Today’s ruling by
the Supreme Court underscores the urgency of #fullrepeal.” That’s a position
you can expect to be repeated throughout the campaign, a Republican insistence
that Obamacare must be repealed in its entirety. Democrats will be happy
with the ruling, although they must guard against complacency. More broadly, today’s
vote could have important long-term implications for the size and scope of the
federal government.
The
upholding of the ACA will be one of the key issues of the election campaign.
Where President Obama and Mitt Romney are in fact very similar in any number of
areas, Obamacare presents a wonderfully stark and binary choice to voters –
keep it, or repeal it. We know Romney wants to repeal it, but what happens
afterwards? Does he simply wish to return to a pre-Obama status quo? The ruling
will shore up his core vote, but he needs his own healthcare policy, whatever
that may be, to persuade independents to come into the red camp. Healthcare –
which will soon account for fully one-fifth of the American economy – is far
too important an issue to be dodged. But at least now the air has been cleared.
The stakes are enormous, and only an election can settle the matter.




