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Posted on Friday, Jun 29, 2012

By a vote of 5-4, the Supreme Court ruled yesterday to uphold the Patient Protection and Affordable Care Act. In a massive 182-page opinion, Justices ruled the individual mandate to be constitutional pursuant to Congress’s ability to tax. However, the ruling also found that the mandate violated the Commerce Clause embedded in Article I, Section 8, Clause 3 of the Constitution.

“Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000(a) under the taxing power, and that Section 5000(a) need not be read to do more than impose a tax. This is sufficient to sustain it,” as highlighted on Bloomberg’s SCOTUSblog coverage yesterday morning.

Chief Justice John Roberts joined the majority opinion of the court along with justices Ruth Bader Ginsburg, Sonia Sotomayor, Stephen Beyer, and Elena Kagan. Justices Antonin Scalia, Clarence Thomas, Anthony Kennedy, and Samuel Alito dissented.

“The Affordable Care Act is constitutional in part and unconstitutional in part,” wrote Roberts. “[The individual mandate] cannot be upheld as an exercise of Congress’s power under the commerce clause,” added Roberts, who clarified Congress cannot “order individuals to engage in it.”

Despite upholding the central tenet of the Patient Protection and Affordable Care Act, the Court did in fact modify one key provision of the law, ruling that “the federal government cannot withdraw existing Medicaid funding from states that decide not to participate in a broad expansion of Medicaid eligibility,” reports USA Today.

The individual mandate, long derided by critics as an overreach of federal powers since the law’s passage in 2010, is considered the law’s most controversial provision requiring all eligible citizens to purchase health insurance. Now, the law goes back to Congress where it will be re-assessed, debated and voted on.

“House Republicans said after the Supreme Court’s ruling upholding President Barack Obama’s health care law that they’ll vote to repeal it after Congress returns from its July Fourth recess,” reports POLITICO. “The House will vote to repeal the health care law — again — on July 11, the office of House Majority Leader Eric Cantor (R-Va.) said."

Reports Bloomberg: “The decision on the Patient Protection and Affordable Care Act is the climax to an epic legal fight that featured the longest courtroom arguments in 44 years, a record number of briefs and extraordinary public interest in a Supreme Court case. The case tested both the constitutional powers of Congress and the willingness of the Roberts court to overrule the other two branches of the federal government.”

In its review of the Affordable Care Act, the Supreme Court pondered four key questions:

  • Can Congress force citizens to purchase health insurance under the individual mandate?
  • If the mandate were to be rejected, would that strike down the entire law or just specific parts of it?
  • Is Medicaid expansion an unfair burden on states?
  • Can the Supreme Court review all of the above questions before the law takes effect?

Legal expert Tom Goldstein of SCOTUSblog concluded: “[T]he entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.”

“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,” reports the New York Times. “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.”

Robert Alt and Nina Owcharenko at the Heritage Foundation’s Foundry Blog expressed alarm that the ruling had “seriously damaged the principle of limited government. Indeed, anyone who has any doubts about this need only read the Court’s suggestion that Congress could force Americans to buy energy efficient windows or pay a tax.”

In the meantime, the American public remains skeptical about the Affordable Care Act and even more nervous about the future of health care. A recent ABC News/Washington Post poll found that only “36 percent… express a favorable opinion of the health care law. But ratings of the health care system as it currently stands are about as weak, 39 percent favorable. That means that while the intended fix is unpopular, so is the status quo—leaving the public still in search of solutions,” writes polling expert Gary Langer of Langer Research Associates.

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