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Key excerpts from the Supreme Court’s health care opinions


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The Supreme Court largely upheld the Affordable Care Act — known more widely as Obamacare — in a 5-4 ruling Thursday morning, deeming constitutional the individual mandate for Americans to buy health insurance.


Chief Justice John Roberts, nominated to the high court by former President George W. Bush, voted with left-leaning justices Ruth Bader Ginsburg, Stephen Breyer,  Sonia Sotomayor and Elana Kagan creating a majority to maintain the law. The landmark ruling labeled the mandate is constitutional, in accordance with Congress’s power to tax.


The highly-debated mandate is, most simply put, a command for individuals to purchase insurance, Roberts wrote, and non-compliant Americans would face the consequence of a tax.

“Rather, it makes going without insurance just another thing the Government taxes, like buying gasoline or earning income,” the chief justice wrote. “And if the mandate is in effect just a tax hike on certain taxpayers who do not have health insurance, it may be within Congress’s constitutional power to tax.”

The noted conservative’s opinion offered lines almost mirroring a disclaimer that the high court’s sole line of authority is constitutionality — not whether the hyper-politicized bill known as Obamacare is sound policy.

He called the act part-constitutional, part-unconstitutional.
“The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to con­strue what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Con­gress’s power to tax,” Roberts wrote.

Ginsburg moved a step further than Roberts in her legal grounds for upholding the health care mandate, saying the commerce clause of the Constitution also gives Congress the authority to enact requirements for minimum health care coverage.

The effect of individuals’ failure to obtain health insurance on their own has “deleterious effects on the health-care market,” Ginsburg wrote, adding that states cannot alone solve the “problem of the uninsured.”
“In sum, Congress passed the minimum coverage provi­sion as a key component of the ACA to address an econom­ic and social problem that has plagued the Nation for decades: the large number of U. S. residents who are unable or unwilling to obtain health insurance. Whatever  one thinks of the policy decision Congress made, it was Congress’ prerogative to make it.”
The court also gave the green light to the act’s provisions expanding Medicaid but took issue with the idea that Congress could penalize states that chose not to comply with expansion by taking away their existing funding under the program.
Dissenting with the majority opinion, Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito wrote that the act overstepped Congress’s authority.

The majority’s “vast judicial overreaching” leads to “a debilitated, inoperable version of health-care regulation that Congress did not enact and the public does not expect.”


Kennedy wrote in the dissent that if faced with the choice between expanding Medicaid or paying large tax sums, “we do not doubt that states are capable of making decisions when put in a tight spot. We do doubt the authority of this Court to put them there.”

The court’s ruling “undermines” the values it should have protected “at every turn” — caution, minimalism, and the understanding that the federal government has limited power, the dissenters wrote.

Priya Anand