Supreme Court Upholds the Affordable Care Act >>

June 28th, 2012

Supreme Court Upholds the Affordable Care Act

Today, the U.S. Supreme Court issued its long-awaited decision on President Obama’s landmark Affordable Care Act (ACA) of 2010. The individual coverage mandate of the ACA was upheld under the taxing authority of Congress. The Indian Health Care Improvement Act (IHCIA), which is included in the overall ACA, also survived the decision intact.

The Court ruled 5 – 4 in favor of the law, which includes a requirement for all Americans to obtain healthcare insurance. Chief Justice John Roberts provided the key vote by the Court to support the individual coverage mandate. Roberts argued that the mandate could not be upheld under the Commerce Clause of the Constitution, but it could under the taxing powers of Congress.

Although the ruling addresses the individual mandate, which is a controversial component of the law, it does not directly affect Native Americans who receive care through the Indian Health Service (IHS), tribes, Alaska Native entities and urban Indian organizations because they are exempt from the mandatory requirement.

The views below are from the Supreme Court of the United States Blog:, an independent blog devoted to covering the Supreme Court.

“Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial — feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.”

“Essentially, a majority of the Court has accepted the Administration’s backup argument that, as Roberts put it, “the mandate can be regarded as establishing a condition — not owning health insurance — that triggers a tax — the required payment to IRS.” Actually, this was the Administration’s second backup argument: first argument was Commerce Clause, second was Necessary and Proper Clause, and third was as a tax. The third argument won.”

In addition to the individual mandate, the Supreme Court also ruled on the provisions of the ACA that compelled states to expand Medicaid eligibility with additional federal funding by eliminating all Medicaid funding for a state if it did not expand its coverage. These provisions were a critical piece to the Administration’s goal of increasing health care insurance coverage. In a complicated ruling, the Court ruled that under the Constitution, the government could offer the states additional funding to expand Medicaid eligibility, and if the states accepted these funds, then the state would have to accept the new eligibility requirements. However, the Court ruled that the government could not withhold all of a state’s Medicaid funding if it did not accept the new funding. Thus, the Court has essentially created an opt-in provision to the increased Medicaid eligibility requirements, allowing each state to decide whether they want to expand Medicaid coverage or not. Clearly, this ruling will complicate the administration’s desire to expand health insurance coverage through Medicaid, but given the increased federal funding attached to an expansion of Medicaid eligibility for a state, it is not yet clear what the practical effect will be on the expansion of Medicaid throughout the states.

The opinion:

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