[The decision was a victory for President Obama
and Congressional Democrats, affirming the central legislative pillar of Mr.
Obama’s presidency. The ruling upheld the individual mandate requiring nearly
all Americans to obtain health insurance or pay a penalty. ]
By Adam Liptak
And John H.
Cushman Jr
 |
Stephen Crowley/The New York Times
Supporters of the Affordable Care Act reacted after the decision.
|
WASHINGTON —
The Supreme Court on Thursday upheld most of President Obama’s health care overhaul
law, saying it was authorized by Congress’s power to levy taxes. The vote was 5
to 4, with Chief Justice John G. Roberts Jr. joining the court’s four more
liberal members.
The decision was a victory for President Obama
and Congressional Democrats, affirming the central legislative pillar of Mr.
Obama’s presidency. The ruling upheld the individual mandate requiring nearly
all Americans to obtain health insurance or pay a penalty.
“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.”
The justices 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 here Chief Justice Roberts was joined by the court’s four
more conservative members.
The court did substantially limit a major piece of the law,
one that expanded 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, frequently the swing vote,
joined three more conservative members in an unusual jointly written dissent.
He read from the bench that the minority viewed the law as “invalid in its
entirety” and that the court’s intrepretation “amounts to a vast judicial
overreaching.”
The court’s ruling, seen as one of the most significant in
decades, is a crucial milestone for the law, allowing almost all of its
far-reaching changes to roll forward. Several of its notable provisions have
already been put in place in the past two years, and more are imminent.
Ultimately, it is intended to end the United States’ status as the only rich
country with large numbers of uninsured people, by expanding both the private
market and Medicaid.
President Obama spoke from the White House shortly after the
decision was handed down. “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.
Republicans, who have made repeal of the law a priority,
once again bashed the measure.
“Obamacare was bad policy yesterday; it’s bad policy today,”
said Mitt Romney, the presumptive Republican presidential nominee, in remarks
before the Capitol building. “Obamacare was bad law yesterday; it’s bad law
today.”
Although many conservatives were stung that the law will
stand, the court’s ruling did have the potential to restrain Congress in the
longer term. The restriction of the Medicaid expansion could limit the federal
government’s ability to alter other federally financed state programs.
The commerce clause ruling revised the constitutional
structure, handing a victory to conservative legal scholars who say Congress’s
power to regulate interstate commerce must have defined limits. New challenges
to federal laws on commerce clause grounds are likely to follow.
In the opinion, Chief Justice Roberts wrote that the
decision offers no endorsement of the law’s wisdom, and that letting it survive
reflects “a general reticence to invalidate the acts of the nation’s elected
leaders.”
“It is not our job to protect the people from the
consequences of their political choices,” he wrote.
The law was challenged by 26 states, with the individual
mandate the most contested issue.
Many conservatives considered the mandate unconstitutional
under the commerce clause, arguing that if the federal government could compel
people to buy health insurance, it could compel them to buy almost anything --
even broccoli, the archetypal example debated during the oral arguments three
months ago.
A majority of the court reasoned that the individual mandate
penalty, to be collected by the Internal Revenue Service starting in 2015, is a
tax and is not unconstitutional.
The court’s four liberals made it clear that they disagreed
with the view of Chief Justice Roberts on the commerce clause.
In a separate dissent from the bench, Justice Ruth Bader
Ginsburg, speaking for herself and Justices Stephen G. Breyer, Sonia Sotomayor
and Elena Kagan, said the court’s commerce clause ruling was "a stunning
step back that should not have staying power.”
“In the end,” she said, summarizing her position near the
end of a nearly hourlong court session, “the Affordable Care Act survives
largely unscathed. But the court’s commerce and spending clause jurisprudence
has been set awry.”
The Obama administration has argued that the mandate was
necessary because it allowed other provisions of the health care 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 advocates 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. The law offers subsidies to poorer
and middle-class households, varying with their incomes. It also provides
subsidies to some businesses for insuring their workers.
The court upheld a major expansion of Medicaid intended to
add millions of low-income people to its rolls, but limited the power of the
federal government to enforce this provision by penalizing states that refuse
to go along.
Chief Justice Roberts said the federal government could not
compel states to comply by cutting off all the federal money they receive for
existing Medicaid programs. That aid is more than 10 percent of state budgets.
The threatened loss of so much federal money “is economic
dragooning that leaves the states with no real option but to acquiesce in the
Medicaid expansion,'’ the chief justice said. “A state could hardly anticipate
that Congress’s reservation of the right to ‘alter’ or ‘amend’ the Medicaid
program included the power to transform it so dramatically.'’
Congress can offer money to the states to expand Medicaid
and can attach conditions to such grants, the chief justice said. But, he
added, “What Congress is not free to do is to penalize states that choose not
to participate in that new program by taking away their existing Medicaid funding.'’
Rulings by appeals courts on the health care law had split
on the main questions, with two courts upholding the law, one striking down the
mandate and another deferring consideration of the law until 2015, reasoning
that the courts lacked jurisdiction until the first penalties enforcing the
mandate came due.
The Supreme Court’s decision came on the last day of the
term, which the justices extended by three days to deal with the crush of major
issues. On Monday, the court overturned several parts of an Arizona law
intended to crack down on illegal immigrants, which the Obama administration
opposed, while allowing one notable provision to stand. In the immigration
case, Justice Kennedy joined Chief Justice Roberts and the liberal justices in
throwing out portions of Arizona’s law.
Robert Pear contributed reporting.