Supreme Court Upholds Almost All of Health Care Reform Law


The controversial individual mandate, requiring most Americans to purchase health insurance or pay a penalty, was deemed constitutional.

The controversial individual mandate, requiring most Americans to purchase health insurance or pay a penalty, was deemed constitutional.

In one of its most eagerly awaited decisions in years, the Supreme Court has upheld almost all of President Obama’s signature health care reform law by a vote of 5 to 4.

Chief Justice John Roberts, who wrote the majority opinion, voted along with the court’s 4 liberal justices to uphold the law’s controversial individual mandate requiring most Americans to purchase health insurance providing a minimum level of coverage or pay a penalty. In their dissent, 4 of the court’s conservative justices argued that the entire law should have been struck down.

The decision limited one important part of the law—its expansion of Medicaid designed to expand health coverage to millions of low-income and disabled Americans. The ruling limits the federal government’s ability to revoke funding from states that refuse to go along with the expansion. (To download a pdf of the decision, click here.)

The breakdown of the justices’ votes in the case was somewhat surprising, with Chief Justice Roberts, a conservative appointed by President George W. Bush, joining the court’s liberals—Justice Ruth Bader Ginsburg, Justice Stephen Breyer, Justice Sonia Sotomayor, and Justice Elena Kagan—in largely upholding the law. On the dissenting side, Justice Anthony Kennedy, a conservative appointed by President Ronald Reagan who was nonetheless viewed as a likely swing voter in the decision, joined the conservative justices Antonin Scalia, Clarence Thomas, and Samuel Alito.

There was a slight fissure between Justice Roberts and the 4 liberal justices in the rationale for upholding the individual mandate. All 5 argued that the mandate was constitutional based on the federal government’s power to levy taxes, while the 4 liberal justices argued that it was also allowed based on the federal government’s power to regulate interstate commerce. After oral arguments before the court on the case in March, many observers predicted that the individual mandate would be struck down, noting that a majority of the justices, including Roberts and Kennedy, were extremely skeptical of the argument that the federal government could require Americans to purchase a product.

Although the court’s decision settles the question of the law’s constitutionality, political wrangling over it will continue. Likely Republican presidential nominee Mitt Romney supports a repeal of the entire law, and in the wake of today’s decision, Republican congressional leaders vowed to push for full repeal as well.

Read our previous coverage of health care reform:

  • The Supreme Court Considers Health Care Reform: A Day-by-Day Guide
  • Health Care Reform: 2012 and Beyond
  • The Role of Pharmacists in Health Care Reform (Video)
  • Health Care Reform...Disruptive Changes?
  • Health Insurance Exchanges: A Boom or a Bust for Specialty Pharmacy?

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