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Supreme Court Upholds Affordable Care Act In 5-4 Decision, Narrows Medicaid Provision
The Supreme Court upheld the Patient Protection and Affordable Care
Act in a complex, nuanced 5-4 decision—with Chief Justice John Roberts
casting the deciding vote in favor of the constitutionality of the controversial
healthcare reform bill June 28.
The individual mandate—which supporters say is fundamental to lowering
the cost of health insurance, and was opponents’ main example of the law’s
invalidity—was deemed constitutional, but not through the Constitution’s Commerce
Clause, which gives Congress the power to regulate interstate commerce.
The individual mandate, which goes into effect in 2014, was upheld under the
federal powers to levy taxes. If a person does not purchase health insurance by 2014,
they will incur a penalty to be collected by the IRS.
In a 193-page decision, the justices explained why they voted in favor of the
individual mandate being constitutional. Justices Stephen Breyer, Ruth Bader-Ginsburg,
Elena Kagan, Sonia Sotomayor and Chief Justice Roberts voted with the majority. Justices
Samuel Alito, Anthony Kennedy, Antonin Scalia, and Clarence Thomas dissented, saying
that the Affordable Care Act should be struck down in its entirety.
Regarding the Commerce Clause, the court said that a mandate to purchase a
product or service would create economic activity, rather than simply regulating economic
activity—and that that was too broad of an interpretation of the powers given to Congress.
People can still refuse to purchase health insurance, but they will have to pay a tax.
The second main issue in the law’s constitutionality—the federally imposed expansion
of Medicaid coverage—was upheld in principle, but the law’s power to enforce that
measure and enact consequences was drastically narrowed.
The law, as it was written, offered federal funds to help states expand Medicaid
coverage to all people under the age of 65 living below 133 percent of the poverty line—to
help poorer individuals comply with the individual mandate. If states refused to expand their
Medicaid coverage, they would forfeit all of their incoming federal Medicaid funding.
The court said that coercion went too far—however, a majority agreed that there was
nothing wrong with the federal government offering funds to states to expand coverage. If the
state accepts the additional funds, they will have to obey the Medicaid provisions in the
healthcare law. But if they do not agree to expand their coverage, they will only forfeit the
amount of additional money they would have received.
The federal government is offering to cover 100 percent of the states’ expansion costs
for the first few years, with that percentage gradually declining afterwards.
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