Supreme Court Upholds Mandate, Limits Medicaid Expansion

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.  

Related article:

Supreme Court upholds Obama’s health-care law (6-28-12, The Washington Post)
Supreme Court upholds health care mandate (6-28-12, CBS News)
Supreme Court Upholds Mandate as Tax (6-28-12, The Wall Street Journal)
High court upholds Obama health law by 5-4 vote (6-28-12, The News and Observer/Associated Press)
Supreme Court hands President Obama a major victory on health care (6-28-12, The Washington Post)
Following Supreme Court health-care ruling, House GOP will again try to repeal the law (6-28-12, The Washington Post)
Court ruling lets insurers, hospitals exhale, prepare (6-29-12, WRAL)
Health care plan upheld: What will be the impact? (6-28-12, The Shelby Star)
Western Carolina Medical Society releases statement on Supreme Court health-care decision (6-28-12, The Mountain Xpress)
Doctor explains the Supreme Court decision on health care (6-28-12, NBC 17)


Share this Post