The Supreme Court has upheld the individual mandate in Obamacare, paving the way for full implementation of the law in the states and ensuring that millions of uninsured Americans haves access to affordable coverage. The court upheld the provision as a tax, but found that it does violate the Commerce Clause.
The Medicaid expansion is limited, but not invalidated, the court found. In short, it decided that if a state does not expand the Medicaid program, as required by the law, the federal government cannot withhold Medicaid funds.
In short, “the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.”
Chief Justice John Roberts joined Justices Sonya Sotomayor, Stephen Breyer, Ruth Bader Ginsburg, and Elena Kagan in the 5 to 4 decision. Justice Anthony Kennedy — who was considered a swing vote on in the case — sided with the conservatives.
From the opinion: “Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.”
On the Medicaid issue, a majority of the Court holds that the Medicaid expansion is constitutional but that it would be unconstitutional for the federal government to withhold Medicaid funds for non-compliance with the expansion provisions. Here is the quote: “Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”
From the dissent, Kennedy writes, “In our view, the entire Act before us is invalid in its entirety.”
A link to the full text of the decision is here.
Republicans have announced that they will take another vote on repealing the law the week of July 9th.