http://www.nytimes.com/2012/06/29/us/supreme-court-lets-health-law-largely-stand.html


Supreme Court Upholds Health Care Law, 5-4, in Victory for Obama

By ADAM 
LIPTAK<http://topics.nytimes.com/top/reference/timestopics/people/l/adam_liptak/index.html>Published:
June 28, 2012
WASHINGTON — The Supreme
Court<http://topics.nytimes.com/top/reference/timestopics/organizations/s/supreme_court/index.html?inline=nyt-org>
on
Thursday upheldPresident
Obama<http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per>
’s health care 
overhaul<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html?inline=nyt-classifier>
law,
saying its requirement that most Americans obtain insurance or pay a
penalty was authorized by Congress’s power to levy taxes. The vote was 5 to
4, with Chief Justice John G. Roberts Jr. joining the court’s four more
liberal members.

The 
decision<http://www.nytimes.com/interactive/2012/06/29/us/29healthcare-scotus-docs.html>
was
a victory for Mr. Obama and Congressional Democrats, affirming the central
legislative achievement of Mr. Obama’s presidency.

“The Affordable Care Act’s requirement that certain individuals pay a
financial penalty for not obtaining health insurance may reasonably be
characterized as a tax,” Chief Justice Roberts wrote in the majority
opinion. “Because the Constitution permits such a tax, it is not our role
to forbid it, or to pass upon its wisdom or fairness.”

At the same time, the court rejected the argument that the administration
had pressed most vigorously in support of the law, that its individual
mandate was justified by Congress’s power to regulate interstate commerce.
The vote was again 5 to 4, but in this instance Chief Justice Roberts and
the court’s four more conservative members were in agreement.

The court also substantially limited the law’s expansion
ofMedicaid<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier>,
the joint federal-state program that provides health care to poor and
disabled people. Seven justices agreed that Congress had exceeded its
constitutional authority by coercing states into participating in the
expansion by threatening them with the loss of existing federal payments.

Justice Anthony M. Kennedy, who had been thought to be the administration’s
best hope to provide a fifth vote to uphold the law, joined three more
conservative members in an unusual jointly written dissent that said the
court should have struck down the entire law. The majority’s approach, he
said from the bench, “amounts to a vast judicial overreaching.”

The court’s ruling was the most significant federalism decision since the
New Deal and the most closely watched case since Bush v. Gore in 2000. It
was a crucial milestone for the law, the Patient Protection and Affordable
Care Act of 2010, allowing almost all — and perhaps, in the end, all — of
its far-reaching changes to roll forward.

Mr. Obama welcomed the court’s decision on the health care law, which has
inspired fierce protests, legal challenges and vows of repeal since it was
passed. “Whatever the politics, today’s decision was a victory for people
all over this country whose lives are more secure because of this law,” he
said at the White House.

Republicans, though, used the occasion to attack it again.

“Obamacare was bad policy yesterday; it’s bad policy today,” Mitt Romney,
the presumptive Republican presidential nominee, said in remarks near the
Capitol. “Obamacare was bad law yesterday; it’s bad law today.” He, like
Congressional Republicans, renewed his pledge to undo the law.

The historic decision, coming after three days of lively oral arguments in
March and in the midst of a presidential campaign, drew intense attention
across the nation. Outside the court, more than 1,000 people gathered —
packing the sidewalk, playing music, chanting slogans — and a loud cheer
went up as word spread that the law had been largely upheld. Chants of “Yes
we can!” rang out, but the ruling also provoked disappointment among Tea
Party<http://topics.nytimes.com/top/reference/timestopics/subjects/t/tea_party_movement/index.html?inline=nyt-classifier>supporters.


In Loudoun County, Va., Angela Laws, 58, the owner of a cleaning service,
said she and her fiancé were relieved at the news. “We laughed, and we
shouted with joy and hugged each other,” she said, explaining that she had
been unable to get insurance because of her diabetes and back problems
until a provision in the health care law went into effect.

After months of uncertainty about the law’s fate, the court’s ruling
provides some clarity — and perhaps an alert — to states, insurers,
employers and consumers about what they are required to do by 2014, when
much of the law comes into force.

The Obama administration had argued that the mandate was necessary because
it allowed other provisions of the law to function: those overhauling the
way insurance is sold and those preventing sick people from being denied or
charged extra for insurance. The mandate’s supporters had said it was
necessary to ensure that not only sick people but also healthy individuals
would sign up for coverage, keeping insurance premiums more affordable.
Conservatives took comfort from two parts of the decision: the new limits
it placed on federal regulation of commerce and on the conditions the
federal government may impose on money it gives the states.

Five justices accepted the argument that had been at the heart of the
challenges brought by 26 states and other plaintiffs: that the federal
government is not permitted to force individuals not engaged in commercial
activities to buy services they do not want. That was a stunning victory
for a theory pressed by a small band of conservative and libertarian
lawyers. Most members of the legal academy view the theory as misguided,if
not frivolous.

“To an economist, perhaps, there is no difference between activity and
inactivity; both have measurable economic effects on commerce,” Chief
Justice Roberts wrote. “But the distinction between doing something and
doing nothing would not have been lost on the framers, who were practical
statesmen, not metaphysical philosophers.”

Justice Ruth Bader Ginsburg, in an opinion joined by Justices Stephen G.
Breyer, Sonia Sotomayor and Elena Kagan, dissented on this point, calling
the view “stunningly retrogressive.” She wondered why Chief Justice Roberts
had seen fit to address it at all in light of his vote to uphold the
mandate under the tax power.

Akhil Reed Amar, a Yale law professor and a champion of the health care
law, said that it was “important to look at the dark cloud behind the
silver lining.”

“Federal power has more restrictions on it,” he said, referring to the new
limits on regulating commerce. “Going forward, there may even be laws on
the books that have to be re-examined.”

The restrictions placed on the Medicaid expansion may also have significant
ripple effects. A splintered group of justices effectively revised the law
to allow states to choose between participating in the expansion while
receiving additional payments or forgoing the expansion and retaining the
existing payments. The law had called for an all-or-nothing choice.

The expansion had been designed to provide coverage to 17 million
Americans. While some states have indicated that they will participate in
the expansion, others may be resistant, leaving more people outside the
safety net than the Obama administration had intended.

Although the decision did not turn on it, the back-and-forth between
Justice Ginsburg’s opinion for the four liberals and the joint opinion by
the four conservatives — Justice Kennedy and Justices Antonin Scalia,
Clarence Thomas and Samuel A. Alito Jr. — revisited the by-now-familiar
arguments. Broccoli made a dozen appearances.

“Although an individual might buy a car or a crown of broccoli one day,
there is no certainty she will ever do so,” Justice Ginsburg wrote. “And if
she eventually wants a car or has a craving for broccoli, she will be
obliged to pay at the counter before receiving the vehicle or nourishment.
She will get no free ride or food, at the expense of another consumer
forced to pay an inflated price.”

The conservative dissenters responded that “one day the failure of some of
the public to purchase American cars may endanger the existence of domestic
automobile manufacturers; or the failure of some to eat broccoli may be
found to deprive them of a newly discovered cancer-fighting chemical which
only that food contains, producing health care costs that are a burden on
the rest of us.”

All of the justices agreed that their review of the health care law was not
barred by the Anti-Injunction Act, which allows suits over some sorts of
taxes only after they become due. That could have delayed the health care
challenge to 2015. The conservative dissenters said that the majority could
not have it both ways by calling the mandate a tax for some purposes but
not others.

“That carries verbal wizardry too far, deep into the forbidden land of
sophists,” they said.

As a general matter, Chief Justice Roberts wrote that the decision in the
case, National Federation of Independent Business v. Sebelius, No. 11-393,
offered no endorsement of the law’s wisdom.

Some decisions, the chief justice said, “are entrusted to our nation’s
elected leaders, who can be thrown out of office if the people disagree
with them.”

Justice Ginsburg, speaking to a crowded courtroom that sat rapt for the
better part of an hour, drew a different conclusion.

“In the end,” she said, “the Affordable Care Act survives largely
unscathed.”
Reporting was contributed by John H. Cushman Jr., Robert Pear, John
Schwartz, Ethan Bronner and Sabrina Tavernise

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