The Supreme Court upheld the 2010 health care reform, but the decision may not change voters’ minds in the November elections.

The Supreme Court ruled June 28 that the Patient Protection and Affordable Care Act, including a mandate that individuals purchase health insurance or pay a fine, was constitutional. The decision will affect millions of Americans who may be compelled to purchase health insurance, as well as those who will benefit from protections against insurance discrimination and the extension of coverage for youth on their parents’ health care plans.

“It has metastasized into one of the culture wars, like abortion,” said Neil Siegel, Duke U. professor of law and political science. “I hope the court avoids being partisan and fractured like American politics.”

The reach of the Supreme Court’s ruling, however, may not significantly affect voters’ attitudes toward the presidential candidates, because voters will be more concerned about the economy than about constitutional arguments when they head to the polls, said Michael Munger, professor of political science and economics.

The Supreme Court examined the ACA and specifically the mandate provision, which would require all Americans to obtain health insurance or be penalized $95. It determined in a 5-4 decision that the mandate was constitutional under congressional authority to levy a tax. Among its many provisions, the Act will expand Medicaid to 16 million more Americans, raising the number of insured Americans by 32 million by 2020, said Frank Sloan, J. Alexander McMahon professor of health policy and management and professor of economics.

The health care reform will also prohibit insurance companies from charging women higher rates for coverage than men and refusing coverage to those with preexisting conditions, said Walton Robinson, communications director for the North Carolina Democratic Party.

Neither President Barack Obama nor Republican nominee Mitt Romney, however, are planning to emphasize the health care issue during the presidential campaign, Munger said.

“Voters don’t care about the decision,” Munger said. “It’s a constitutional issue, not a partisan issue. This election is about the economy—if unemployment doesn’t improve, Obama will lose anyway.”

Obama will likely focus on Congress in his campaign, attributing the lack of accomplishments during his first term to the partisan divide, Munger said. Romney cannot criticize the health care reform because he implemented a similar program in Massachusetts.

“Obamacare is just the national version of Romneycare,” Munger said.

But young adults who stand to benefit from the legislation may respond politically. Sophomore David Winegar, co-president of Duke Democrats, said the provision allowing young adults to remain on their parents’ health insurance until age 26 will drive the youth vote to support Obama.

This provision has already benefitted 95,000 young adults in the state, Robinson said.

The candidates may also avoid the health care issue because both parties have expanded the power of the federal government under the Commerce Clause—the provision of the constitution that allows Congress to regulate interstate commerce—Munger noted.

Despite widespread anticipation that the court would base its ruling on the commerce clause, Chief Justice John Roberts argued that the commerce clause was not applicable because Congress cannot regulate inactivity.

Legal ramifications

Although the political consequences of the ruling are uncertain, the legal ramifications are monumental, Siegel said.

Since the Great Depression, the Supreme Court has maintained a deferential position to Congress in cases where federal laws are accused of being unconstitutional, Siegel said. The health care reform act, which determines the federal government’s power to enforce multi-state regulations, presents one of the most significant Supreme Court rulings since the 1930s in terms of defining Congress’s enumerated powers.

Despite the significant political involvement in the case, the Court will remain objective and impervious to external pressures in making its decision, Munger said.

“They do not perceive political pressure, they perceive disapproval,” Munger said. “The paradox of the Supreme Court is that the less power they use, the more power they have.”

Yet the Court’s decision could still be perceived as partisan, especially given the political tendencies of the nine justices, Siegel said. Four of the sitting justices are liberal and five are conservative.

Any decrease in the Court’s legitimacy, if the decision is perceived to be partisan, will be neutralized by the widespread public desire to overturn the legislation and the ambiguity of the law, Siegel added.

“No matter what the court does it will always have support and critics,” Siegel said. “The law and the provisions of the law are sufficiently controversial—the court’s legitimacy is not at stake.”

For the past two years, legal commentators from both parties have maintained a broad consensus that the health care reform act is constitutionally sound, Siegel said. Not all the justices seem to share this opinion, however.

“The Libertarian objection to the mandate seems to have captured the conservative imagination, including that of Justice Kennedy,” Siegel said. “But the overwhelming majority of legal commentators, including conservatives, still think the law is constitutional in every regard.”