[author: Aaron Kase]
The Supreme Court of the United States ruled today to uphold most of the provisions of the controversial 2010 federal health care law, including allowing the individual mandate requiring all Americans to purchase health care to survive as a tax.
In the 5-4 ruling, with Chief Justice John Roberts providing the swing vote, the court gave a green light to health care reform almost in its entirety.
The only limit the court put on the Patient Protection and Affordable Care Act, or Obamacare, was a narrow reading on the federal government’s ability to terminate Medicaid funds to the states if the states don’t expand eligibility as the health care law demands. In other words, states can refuse extra money to expand their Medicaid programs, but still get the money and run the programs as they currently stand.
Reading from a dissent, Justice Anthony Kennedy told the gallery, “In our view, the entire Act before us is invalid in its entirety.”
Eagerly Anticipated Ruling
The eagerly anticipated ruling brought over 800,000 visitors to the live chat at the Supreme Court reporting and analysis blog scotusblog.com. Observers on the scene reported on hundreds of spectators, media, protestors and even belly dancers waiting outside the court building.
The law would set up exchanges to make it easier to shop for insurance online, and contains popular provisions like banning insurers from denying coverage to people with preexisting conditions. In order to spread the costs and ensure that people wouldn’t simply sign up for insurance when they became sick, the law contains an individual mandate that everyone purchase coverage or face a fine, a requirement that has proved deeply unpopular and was at the root of the constitutional challenge.
Arguments in March left the court with four decisions to consider: Whether the individual mandate was constitutional, whether Washington could force states to enact certain measures or risk losing Medicaid funding, whether the court could strike down a portion of the law without gutting the entire thing, and whether they could even hear the arguments since the tax hasn’t yet come into effect.
Clearly the justices decided it was okay to issue an opinion, and the court didn’t have to parse what to keep and what to leave in because it decided the mandate was acceptable as a tax.
Back to Work
Pundits have argued back and forth for months what a ruling on the health care law, in victory or defeat, would mean for President Obama’s chances in the November election.
House Republicans have already vowed to repeal any parts of the health care law that remained after the court’s decision. Presidential candidate Mitt Romney has indicated that he would do the same if elected.
A recent poll found that three quarters of Americans wanted our elected officials to get back to work to pass another version of health care reform in the event Obamacare had been repealed. In 2010 healthcare spending in the United States reached $2.6 billion, a tenfold increase from thirty years before. One common criticism of the Obama reform is that while it would extend insurance to over 30 million Americans who currently have none, it has few provisions in place to slow down runaway costs that already account for 17.9 percent of the GDP.
Favorability at an All Time Low
The United States Supreme Court
Coverage of the expected ruling reached a fever pitch in the week of buildup. Walter Dellinger at Slate opined that “if the court were to strike down this major reform effort, 40 years in the making, the court would own the resulting health care system for the next decade and beyond.” Legal scholar Douglas Kmiec also predicted that the law would be upheld, stating, “Justice Kennedy understands something the health care opponents do not; and that is, freedom is not lost by being mindful of the needs of others, it is enhanced.”
A Bloomberg story noted that an overwhelming majority of legal scholars considered the law constitutional, yet less than half predicted the court would uphold the law, perhaps a cynical view on the motives and politics of the justices.
The ruling comes as public opinion of the court hits an all-time low, with a 52 percent favorability rating, down from a high of 80 percent in the mid 1990s.
In particular, observers have questioned public perceptions of the court after so many major decisions have come down on partisan, 5-4 rulings so far this century, like Citizens United v. Federal Election Commission and Bush v. Gore. A recent New York Times poll found that 76 percent of respondents thought that the justices let their personal political views affect objective legal analysis. In 2006, Chief Justice Roberts said he was concerned that the ongoing slew of partisan 5-4 rulings threatened the “credibility and legitimacy” of the court.
Today’s vote was indeed 5-4, but with Roberts crossing traditional ideological lines to provide the vote that saved the health care law in its current incarnation.