Additional reporting by Max Rivlin-Nadler and Gizelle Lugo.
UPDATE: The entire ACA has been upheld by the Supreme Court, with Chief Justice Roberts joining the majority. According to SCOTUSblog, “the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.” The Court decided 5-4, with Kennedy dissenting and Roberts essentially saving the ACA, going against party lines.
The Nation’s David Cole parses the decision:
The law has long been that Congress can enact a tax for any purpose to further the general welfare. Unlike its regulatory powers, Congress can point to a specific power that they have for the ACA—the power to tax. Because the only consequence is that a person who doesn’t get insurance will be taxed, there’s no restriction on what Congress can do. The court upholds the mandate as an exercise of the taxing power.
Two things are remarkable about this decision. Everybody thought that Kennedy would be the decisive vote. If he went with the conservatives, then it would be struck down. If he went with the moderates, it would be upheld. The shock is that Chief Justice Roberts was the one who broke with the conservatives. The other remarkable thing about the ruling is that the conservative justices would have invalidated the entire law based on one provision, the individual mandate. It would have put us way back, well beyond square one.
You can’t let the perfect be the enemy of the good. This is a law that will expand healthcare insurance to millions of Americans who didn’t have it before. It’s not the best law, obviously. The question was, does Congress have the power to deal with a large social issue and regulate the industry and make citizens buy into a system that will help everyone? Thanks to Roberts, they can do this. If the ACA doesn’t end up helping people, then there can now be better reform in the future. People who think that it would be good if it was struck down and would make us closer to single-payer, is just ridiculous.
Kevin Russell over at SCOTUSBlog has a good analysis of the Court’s ruling on Medicaid expansion. The Court was deeply fractured on this question, with Ginsburg and Sotomayor seeking to uphold the expansion entirely; Roberts, Kagan and Breyer arguing that the federal government can’t strike all of a state’s funding under the Constitution; and the dissenters—Scalia, Kennedy, Thomas and Alito—backing the chief justice. This would have struck down the entire expansion, so Sotomayor and Ginsburg voted with the plurality. The impact of the ruling decision, as Russell puts it, is as follows:
The Court’s decision on the constitutionality of the Medicaid expansion is divided and complicated. The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.