On Thursday, the US Supreme Court announced its long-anticipated decision in a series of cases challenging the constitutionality of the Patient Protection and Affordable Care Act of 2010 (ACA). The central issue was whether the individual mandate to purchase health coverage, set to take effect in 2014, would be upheld or invalidated. By a vote of 5-4, the Court upheld the individual mandate, leaving the ACA largely intact.

In a decision authored by the Chief Justice, the Court described the ACA’s individual mandate as a tax that was intended to encourage individual citizens to obtain health insurance coverage. In this light, the individual mandate had to be sustained as a proper exercise of Congress’s taxing power. Although of no  consequence to the fate of the ACA, the Court also held that the Commerce Clause of the US Constitution could not be read to permit Congress to require individuals to purchase certain products (e.g., health insurance) in anticipation of future economic activity (e.g., consumption of health care services).

The Court did strike down as unconstitutionally coercive an ACA provision that would allow the federal government to withdraw all Medicaid funding from any state that declined to implement the Medicaid expansions contained in the ACA. On this point, the Court said, “Nothing in our opinion precludes Congress from offering funding under the ACA to expand the availability of health care, and requiring the States accepting such funds comply with the condition 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.” NFIB v. Sebelius, et al., No. 11-393, slip op. at 55 (U.S. Jun. 28, 2012). While not invalidating the ACA’s Medicaid expansion, the Court made clear that it must be optional for states to participate.  This is a major victory for state budget writers who have been struggling to fund Medicaid programs. Click here to read the Court’s decision.

Following release of the decision upholding the ACA, the North Carolina Medical Society (NCMS) issued a statement to its members, the media and general public asking policy makers to focus on important health care issues not addressed during by the ACA. Read the statement here.  

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