HONORS PRECEDENT: Chief Justice John Roberts vote for mandate was the key in health law affirmation.

  • HONORS PRECEDENT: Chief Justice John Roberts vote for mandate was the key in health law affirmation.

Damn. Early word from the scotusblog on health care ruling. It says the U.S. Supreme Court has preserved the mandate in the Affordable Care Act as a tax.

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But the ruling is complicated and there’s much more to come. Still, the mandate was the most unpopular feature of the legislation and the key to providing the money to make the larger plan work. Here’s the text of the opinion.



The bottom line: the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.

… The money quote from the section on the mandate: “Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.”

The second part of that statement sounds as if it gives states leeway to ratchet down their own support of Medicaid, which can have punishing implications in the states least likely to help the poor. (See: Texas.) But, existing Medicaid funds can’t be reduced, the court said, according to scotusblog coverage.

More analysis from scotusblog, this described as a “plain English” summary:


The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

There will be a torrent of coverage today, full of fist pumping, chest beating, lamentations, wailing, gnashing of teeth and more.

NOTED: Anthony Kennedy, writing for the dissenters (Thomas, Scalia, Alito), said they’d have struck the whole thing down in its entirety. Good Republicans that they are.

The Republican message machine’s instantaneous response: The fight for repeal will continue. Arkansas Republicans, led by Lt. Gov. Mark Darr, will decry this outrage at a 2 p.m. news conference. Others think this will turbocharge the Romney campaign and those of other candidates. Maybe. Or maybe people might start thinking end of pre-existing conditions, coverage of kids, low-cost options for the poor, end of the “doughnut hole,” end of insurance company profiteering and more are good things now that the court option is off the table.

U.S. Rep. Rick Crawford, who has on occasion said there were good things in Obamacare, today whips out a video saying he’ll work to repeal the whole thing. His Democratic opponent Scott Ellington listed the important provisions of the law and urged Crawford “to reject his leader’s pointless and hyper-political vote to repeal the ACA. It’s not helpful. Instead, the Congressman should use his office to help our families, friends and neighbors understand the basic facts and learn what exactly is provided by the Act.”


Total mush from Rep. Mike Ross. Similar from Sen. Mark Pryor — law’s not perfect, has many benefits, will work in bipartisan way to improve. More mush from the guv, who is now on the frontline of the Republicans’ redeclared war on health care:

“We will study the impact the Court’s ruling will have on health care in Arkansas going forward. In the mean time, our separate initiative to create cost savings and improve health care in Arkansas continues. Our aim is to set an example other states can follow, regardless of what transpires next in Washington, D.C.” – Governor Mike Beebe

The legislators who resisted health exchanges because of the court hadn’t ruled now will move on them, right? Uh, if I know Nate Bell and the rest of the Perry Posse, wrong. Massive resistance will continue to be the order of the day. Too bad they forget this is about helping children and families, which they supposedly value so much. Link is to Arkansas Advocates’ recitation of the help law provides.

Heh. I was reminded that U.S. Rep. Tim Griffin helped with political organizing of the campaign to confirm Chief Justice Roberts to the bench.

ALTHOUGH: The developing analysis is that Roberts pulled a fast one. While giving Obama a short-term victory, he gave conservatives complete victory in organic, long-term legal questions. He agreed with the four Repubs on everything except striking down the mandate, which isn’t as big a thing long-term as it might seem. Particularly since every Republican at every level vows to ignore it, not fund it, obstruct it and otherwise massively resist.

My instant reaction:

1) Has it only been two years ago since Obama won a political fight many other presidents had lost? Seems like a 100-year war.

2) A loss today wouldn’t have returned the status quo. It would have made us worse off. Some of the tangible benefits offered to people in need of health coverage are in place. Here’s a reminder of what Arkansas received.

3) If the Republicans leverage this into control of Congress and the White House, it won’t be long before the public really IS worse off. The Ryan budget, approved by all Arkansas Republicans, would wreck Medicare as a universal health care coverage for older people. Medicaid spending would be slashed. The same in Arkansas from Republican control, but perhaps worse, where more people live in poverty and more people have depended on Medicaid benefits to insure children. The fight isn’t over, that’s for sure.

4) If you’re not sick, don’t have kids, have a good job and have health insurance, you were always going to be fine. But as insurance costs (and insurance company profits) increased, that number had decreased.


5) Instant Arkansas reaction: Republicans appear to have been deprived of giving a thunderous I-told-you-so to Attorney General Dustin McDaniel for refusal to join the Republican court challenge. In two years, when he runs for governor, that’s a decision that might be easier to defend if the broader benefits remain and expand.

6) I was wrong. Linda Greenhouse was right in putting Chief Justice John Roberts in the majority. He was the key. This will stem a tide of utter and deserved cynicism about politicization of the court and his abuse of precedent after swearing in his confirmation proceeding that he honored it. But it shouldn’t be taken as a political conversion by a very shifty political player.

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