By ADAM LIPTAK June 28, 2012 New York Times
WASHINGTON — The Supreme
Court on Thursday upheld President Obama’s health care overhaul law, saying its requirement
that most Americans obtain insurance or pay a penalty 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 Mr. Obama and Congressional Democrats, affirming the central
legislative achievement of Mr. Obama’s presidency.
“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.”
At the same
time, the court 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 in this instance Chief Justice Roberts and the court’s four more conservative
members were in agreement.
The court
also substantially limited the law’s expansion of 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, who had been thought to be the administration’s best hope
to provide a fifth vote to uphold the law, joined three more conservative
members in an unusual jointly written dissent that said the court should have
struck down the entire law. The majority’s approach, he said from the bench,
“amounts to a vast judicial overreaching.”
The court’s
ruling was the most significant federalism decision since the New Deal and the
most closely watched case since Bush v. Gore in 2000. It was a crucial
milestone for the law, the Patient Protection and Affordable Care Act of 2010,
allowing almost all — and perhaps, in the end, all — of its far-reaching
changes to roll forward.
Mr. Obama welcomed the court’s decision on the health care law,
which has inspired fierce protests, legal challenges and vows of repeal since
it was passed. “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 at the White House.
Republicans,
though, used the occasion to attack it again.
“Obamacare was bad policy yesterday; it’s bad policy today,”
Mitt Romney, the presumptive Republican presidential nominee, said in remarks
near the Capitol. “Obamacare was bad law yesterday;
it’s bad law today.” He, like Congressional Republicans, renewed his pledge to
undo the law.
The historic
decision, coming after three days of lively oral arguments in March and in the
midst of a presidential campaign, drew intense attention across the nation.
Outside the court, more than 1,000 people gathered — packing the sidewalk,
playing music, chanting slogans — and a loud cheer went up as word spread that
the law had been largely upheld. Chants of “Yes we can!” rang out, but the
ruling also provoked disappointment among Tea
Party supporters.
In Loudoun County, Va.,
Angela Laws, 58, the owner of a cleaning service, said she and her fiancé were
relieved at the news. “We laughed, and we shouted with joy and hugged each
other,” she said, explaining that she had been unable to get insurance because
of her diabetes and back problems until a provision in the health care law went
into effect.
After months
of uncertainty about the law’s fate, the court’s ruling provides some clarity —
and perhaps an alert — to states, insurers, employers and consumers about what
they are required to do by 2014, when much of the law comes into force.
The Obama administration had argued that the mandate was
necessary because it allowed other provisions of the 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 supporters had 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.
Conservatives
took comfort from two parts of the decision: the new limits it placed on
federal regulation of commerce and on the conditions the federal government may
impose on money it gives the states.
Five
justices accepted the argument that had been at the heart of the challenges
brought by 26 states and other plaintiffs: that the federal government is not
permitted to force individuals not engaged in commercial activities to buy
services they do not want. That was a stunning victory for a theory pressed by
a small band of conservative and libertarian lawyers. Most members of the legal
academy view the theory as misguided,if
not frivolous.
“To an
economist, perhaps, there is no difference between activity and inactivity;
both have measurable economic effects on commerce,” Chief Justice Roberts
wrote. “But the distinction between doing something and doing nothing would not
have been lost on the framers, who were practical statesmen, not metaphysical
philosophers.”
Justice Ruth
Bader Ginsburg, in an opinion joined by Justices Stephen G. Breyer,
Sonia Sotomayor and Elena Kagan,
dissented on this point, calling the view “stunningly retrogressive.” She
wondered why Chief Justice Roberts had seen fit to address it at all in light
of his vote to uphold the mandate under the tax power.
Akhil Reed Amar, a Yale law professor
and a champion of the health care law, said that it was “important to look at
the dark cloud behind the silver lining.”
“Federal
power has more restrictions on it,” he said, referring to the new limits on
regulating commerce. “Going forward, there may even be laws on the books that
have to be re-examined.”
The
restrictions placed on the Medicaid expansion may also have significant ripple
effects. A splintered group of justices effectively revised the law to allow
states to choose between participating in the expansion while receiving
additional payments or forgoing the expansion and retaining the existing
payments. The law had called for an all-or-nothing choice.
The
expansion had been designed to provide coverage to 17 million Americans. While
some states have indicated that they will participate in the expansion, others
may be resistant, leaving more people outside the safety net than the Obama administration had intended.
Although the
decision did not turn on it, the back-and-forth between Justice Ginsburg’s
opinion for the four liberals and the joint opinion by the four conservatives —
Justice Kennedy and Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito
Jr. — revisited the by-now-familiar arguments. Broccoli made a dozen
appearances.
“Although an
individual might buy a car or a crown of broccoli one day, there is no
certainty she will ever do so,” Justice Ginsburg wrote. “And if she eventually
wants a car or has a craving for broccoli, she will be obliged to pay at the
counter before receiving the vehicle or nourishment. She will get no free ride
or food, at the expense of another consumer forced to pay an inflated price.”
The conservative
dissenters responded that “one day the failure of some of the public to
purchase American cars may endanger the existence of domestic automobile
manufacturers; or the failure of some to eat broccoli may be found to deprive
them of a newly discovered cancer-fighting chemical which only that food
contains, producing health care costs that are a burden on the rest of us.”
All of the
justices agreed that their review of the health care law was not barred by the
Anti-Injunction Act, which allows suits over some sorts of taxes only after
they become due. That could have delayed the health care challenge to 2015. The
conservative dissenters said that the majority could not have it both ways by
calling the mandate a tax for some purposes but not others.
“That
carries verbal wizardry too far, deep into the forbidden land of sophists,”
they said.
As a general
matter, Chief Justice Roberts wrote that the decision in the case, National
Federation of Independent Business v. Sebelius, No.
11-393, offered no endorsement of the law’s wisdom.
Some
decisions, the chief justice said, “are entrusted to our nation’s elected
leaders, who can be thrown out of office if the people disagree with them.”
Justice
Ginsburg, speaking to a crowded courtroom that sat rapt for the better part of
an hour, drew a different conclusion.
“In the
end,” she said, “the Affordable Care Act survives largely unscathed.”
Reporting
was contributed by John H. Cushman Jr., Robert Pear, John Schwartz, Ethan Bronner and Sabrina Tavernise.