The U.S. Supreme Court’s landmark ruling on Thursday to uphold key provisions of the Affordable Care Act has sent shock waves through the public psyche. In a 5-4 decision, with Chief Justice John Roberts surprisingly siding with the Court’s four liberal justices, the majority supported the constitutionality of the law’s individual mandate, but limited the government’s ability to cut off Medicaid funding to states that do not comply with new eligibility requirements. Whatever the political implications, the Court has settled the ideological score by implicitly accepting the central premise of the Affordable Care Act — that all Americans are entitled to health care as a fundamental right. On that note, today we are proud to call ourselves Americans.
By choosing to uphold the individual mandate, the Court subscribed to the government’s secondary line of reasoning — that the penalty imposed for not adhering to the mandate is the sort of tax that Congress can legally implement. This decision carries great significance for our generation of Americans.
In the legal battle preceding the decision, the argument against the law’s legitimacy focused on the act as commercial regulation. It is this view of the mandate as a tax that makes the decision so noteworthy.
In his majority opinion, Roberts stated that the individual mandate receives no legal protection from the commerce clause because the mandate does not regulate existing commercial activity, but rather forces individuals to become active in commerce. Roberts’ choice to justify the law’s constitutionality in the context of a tax seems to have affirmed the government’s ability to control behavior through taxation, but has also curtailed the breadth of the commerce clause. Indeed, Ruth Bader Ginsburg penned a dissent on behalf of the Court’s liberal faction decrying the perceived harm done to the commerce clause and the Court’s apparent loss of jurisprudence over commerce and spending.
Ginsberg’s protest speaks to a broader point: From a legal and social perspective, the nuances of this decision will be hugely important in contextualizing future battles over government intervention. Roberts’ majority opinion is somewhat paradoxical in that it simultaneously supports a historically unprecedented expansion of government power yet leaves the Commerce Clause, a mighty and traditionally flexible portion of the Constitution, rather toothless. As with any landmark case, the real question lies in the precedent that has been set by the majority opinion. The health care debate is only the tip of the iceberg in discussions of the government’s proper role in society.
With the mandate intact, we should be especially proud of our country’s achievement, given the immediate and tangible benefits to our society from the gradual implementation of the Affordable Care Act. Among its most notable accomplishments is curtailing insurance companies’ ability to deny coverage to those with pre-existing conditions and expanding the security of coverage afforded to young adults, like the vast majority of Dartmouth students, until they reach age 26. For now, it seems that the Court has adequately balanced the proper use of government power with the understanding that health care will remain one of the nation’s leading public policy concerns as we move forward. For that, the justices must be commended.
However, as the weight of this case reverberates through American society, we must wonder how the nation will react. Will future politicians be more inclined to justify policy change in the context of socially conscious taxation? How might organized interest try to leverage the government’s ability to impose taxes for noncompliance? Particularly with respect to the Commerce Clause, we can envision a later instance in which the government’s ability to regulate commerce, perhaps regarding a macro-level issue like climate change, will be hindered by the Roberts Court’s specific interpretation of this statute. Only time will tell, but what we know today is that it would be difficult to understate the impact of this ruling on the country.