Perhaps you, like myself and many others, were perched in front of your computer, a television, or in front of the Supreme Court itself yesterday, awaiting the decision on the constitutionality of the Affordable Care Act (ACA). As I sat at my desk, attempting to quell flickering speculations about the ruling and its consequences for Americans, the decision that suddenly flashed before my eyes was both unexpected and most welcome: “We have a health care opinion.” I froze. “The individual mandate survives as a tax.”
In a 5-4 decision, Chief Justice Roberts, who wrote the majority opinion, along with Justices Kagan, Sotomayor, Breyer and Ginsburg, ruled that the minimum coverage requirement, the provision that most Americans must purchase health insurance by 2014 or pay a penalty, is a tax and is thus an appropriate expression of Congress’ power.
The federal government’s main justification for the individual mandate was Congress’ power in the commerce clause to regulate interstate commerce. But Chief Justice Roberts opined that the application of the commerce clause depends upon the existence of a market to regulate and, he wrote, the health insurance market is not already in existence. Instead, he argued, the government would be forcing individuals to create such a market, so compelling people to purchase a specific good goes beyond Congress’ authority as allowed by the Constitution. Moreover, his line of argument follows that if the individual mandate is upheld, a slippery slope would ensue in which the government could force individuals to purchase anything it deems “good” for society, such as broccoli (sorry to rehash a hackneyed analogy).
Even though the federal government’s main argument about the commerce clause failed, Chief Justice Roberts found a different argument to sustain the constitutionality of the individual mandate: Congress’ taxing power. Chief Justice Roberts held that the penalty individuals would face for refusing to purchase insurance is a tax, and the power of Congress to collect taxes is soundly undisputed. With this decision, the issue of severability, whether the rest of the law could remain standing if the individual mandate was found unconstitutional, was null and void.
Another main issue before the Court was the constitutionality of the Medicaid expansion. The ACA sought to extend Medicaid coverage to more low-income individuals by requiring states to cover a wider range of these populations or risk losing all of their federal Medicaid funds. The Court ruled that the Medicaid program may be expanded, but should a state refuse to participate, the federal government cannot remove all of its Medicaid funds; rather, it can only refuse to offer the additional funds for the program’s expansion. This aspect of the ruling raises questions as to whether the federal government will be able to fully implement the Medicaid expansion as it attempts to provide health care to more individuals.
Overall, the ruling was not only a victory for the Obama Administration, but it was also a victory for Americans: for those seniors who will be able to afford their prescription drugs, for those individuals who will not be denied coverage because of a pre-existing condition, for those young adults who can continue to stay on their parents’ insurance, and for those low-income individuals who will not have to choose between their health and their rent.
The ACA can now bring the health insurance system closer to reflecting our highest aspirations, not the lowest common denominator.
Our Reform congregations have been at the forefront of advocacy on behalf of health insurance reform in their states and at the national level. They have led the faith community’s call to heed the lesson of Maimonides, the revered medieval Jewish physician and scholar, who placed health care first on his list of the ten most important communal services that a city should offer its residents (Mishneh Torah, Hilchot De’ot IV: 23). We are proud of the work they have done.
Today, the Supreme Court has spoken and spoken powerfully. Now our nation must move forward together.