Supreme Court rules on the Patient Protection and Affordable Care Act

Supreme Court rules on the Patient Protection and Affordable Care Act
National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al., United States Supreme Court, Docket #11-393

In 2010, Congress enacted the Patient Protection and Affordable Care Act, [124 Stat. 119]. The Act’s purpose was to in­crease the number of Americans covered by health in­surance and decrease the cost of health care. While the Act’s 10 Titles run over 900 pages and contain hundreds of provisions, the National Federation case concerned constitutional challenges to two key provisions, usually referred to as the Individual Mandate and the Medicaid Expansion.

In a ruling almost 200 pages in length,*including dissents, the majority first indicated that it did not consider whether the Act embodies sound policies, commenting that “That judgment is entrusted to the Nation’s elected leaders.” It characterized the question for it to address in this action as “Does Congress have the power under the Constitution to enact the challenged provisions?”

Essentially the Act’s “Individual Mandate” requires most Americans to maintain “minimum essential” health insurance coverage. It excludes some individuals, such as prisoners and undocumented aliens from this mandate. While many individuals are expected to obtain the required insurance through their employer or under a government pro­gram such as Medicaid or Medicare, individuals who are not exempt and who do not receive health insurance through a third party are required to purchase insurance from a private company.

Beginning in 2014, individuals required to purchase insurance from a private company that fail to do so would make a “[s]hared responsibility payment” to the Federal Government calculated as a percentage of household income, subject to a floor based on a specified dollar amount and a ceiling based on the aver­age annual premium the individual would otherwise have to pay for qualifying private health insurance.

As to Congress’ authority under the Commerce Clause to enact such legislation, the court ruled: "The commerce power ... does not authorize the mandate.”

However, said the court, “Neither the Act nor any other law attaches negative legal consequences to not buying health insur­ance, beyond requiring a payment to the IRS.”

Thus, the Affordable Care Act’s requirement that certain in­dividuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Be­cause the Constitution permits such a tax, it is not [the Supreme Court’s role] to forbid it, or to pass upon its wisdom or fairness.”

* Chief Justice Roberts announced the judgment of the Court and delivered the opinion of the Court with respect to Parts I, II, and III–C, in which Justices Ginsburg, Breyer, Sotomayor, and Kagan, joined; an opinion with respect to Part IV, in which Justices Breyer and Kagan, joined; and an opinion with respect to Parts III–A, III–B, and III–D. Justice Ginsburg, filed an opinion concurring in part, concurring in the judgment in part, and dissenting in part, in which Justice Sotomayor, joined, and in which Justices Breyer and Kagan, joined as to Parts I, II, III, and IV. Justices Scalia, Kennedy, Thomas, and Alito filed a dissenting opinion. Justice Thomas filed a dissenting opinion.

The Syllabus [prepared by the Reporter of Decisions for the convenience of the reader] and the Opinions of the Court are posted on the Internet at: