The Full Spectrum Blog

President Obama signs the Affordable Care Act into law in 2010

Amid great anticipation, fanfare – and even a belly dancer – the Supreme Court of the United States (SCOTUS) announced a 5-4 ruling to UPHOLD the constitutionality of the Affordable Care Act (ACA) – the health care reform legislation passed by President Obama in March 2010.

Question of Constitutionality

The ruling hinged on the question of constitutionality of the law; particularly the clause that would require Americans to purchase health insurance. The Court ruled that while it is unconstitutional for the government to command citizens to purchase insurance, as a part of its power to regulate commerce between states, five Justices agreed that Congress DOES have the authority to levy a tax on those who do not purchase insurance. As cited in Footnote #11, on page 44 of the 193 page ruling, this is laid out as:

“Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing they may not lawfully do is not buy health insurance and not pay the resulting tax.”

In a move that came as a surprise to many, Chief Justice Roberts sided with the liberal element of the Court in voting to uphold the mandate as a tax. In his lengthy ruling, Roberts noted that “The Affordable Care Act is constitutional in part and unconstitutional in part,” while adding that the decision “makes going without insurance just another thing the Government taxes, like buying gasoline or earning income.” As experts have pointed out, the ACA’s primary provision is now more of an invitation to purchase insurance – as opposed to a requirement – with an, arguably light tax penalty for those who chose to go without.

States Access to Medicaid

While the ruling that the individual mandate is constitutional made moot many of the other constitutionality questions surrounding the law, the Court did rule on the Medicaid provision that required states to comply with new requirements or risk losing funding. In a complicated decision, that favors the supporters of states rights, the Court ruled that the provision is constitutional if states would only lose access to NEW funds if they chose not to comply with new requirements, rather than lose access to all Medicaid funding.

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