It was a five to four ruling showing a sharply divided court that upheld the Patient Protection and Affordable Care Act, also known as the Obama health care law. The details of this decision spoke volumes about the rule of law in the United States versus the role of politics in embracing — or in some cases dodging — hard choices.
At a quarter after 10 this morning the nine justices emerged from their chambers to deliver their ruling. They had four questions to address, but the heart of the Affordable Care Act was the individual mandate which forces Americans to buy health insurance or face a fine. The government had argued that was constitutional under what's known as the 'commerce clause' because if people are uninsured and require treatment, that cost gets passed on to insurance companies and increases costs for those who are insured. Four of the justices — Ginsburg, Kagan, Sotomayor, and Breyer — agreed with that. Chief Justice Roberts also upheld the individual mandate, but he didn't accept the commerce clause justification. Roberts said the mandate was acceptable if it's seen as a tax.
Dissenting justices were Scalia, Thomas, Kennedy, and Alito. Justice Kennedy called the law a vast judicial overreach that undermines state sovereignty. But the majority rules quite literally at the Supreme Court, and that means nearly all of the Affordable Care Act will stand as signed by the President.
The only thing that was not upheld was the provision that compelled states to comply with the Medicaid expansion or risk losing all of their Medicaid funding. The court decided that the government can only restrict new funds, and not all of it.
Dr. Perri Klass is a professor of pediatrics and journalism at New York University. Nate Persily is a professor of law and political science at Columbia University. Todd Zwillich is the Washington correspondent for The Takeaway. Pamela Brier is the president and CEO of Maimonides Medical Center in Brooklyn.
Donna Slater is a health care professional in the pharmaceutical industry and she found a provision in the Affordable Care Act that helped her when she needed it most. Karen Martin is an organizer of the Spartanburg Tea Party. Kathie McClure is a trial lawyer from Atlanta, Georgia. She has two adult children with pre-existing conditions. Brenda Neubauer has a son with hemophilia.