There is the no two ways about it, President Obama received a huge victory today, and got it from an unexpected source. Chief Justice John Roberts was the deciding vote that upheld the individual mandate for the Affordable Care Act.

Here is the walk-through. The United States Supreme Court was deciding four major things in today’s ruling.

  • Did the Federal government under the Commerce Clause of the Constitution have the authority to mandate individuals’ purchase of health insurance?
  • Was the mandate necessary for the entire law to be upheld? The idea of Severability. If you got rid of the mandate, would it invalidate the whole law?
  • Did the Federal government have the ability to withhold a state’s Medicaid funding, IF they did not enact the Affordable Care Act, and not place more people under their Medicaid health care plans?
  • Is the penalty a tax?

The Individual Mandate

From the start, the primary fight against the ACA or Obamacare law was the idea that the law forced people to buy health insurance. That was the primary issue that people have been discussing for the last two years. Does the Commerce Clause give the federal government that power? In a 5 to 4 vote the court said that no, the federal government does not have that power. And when that was announced on the news, a million plus sighs and cries of €œYES!€ could be felt from conservatives around the United States. It was short lived.

Although the court said it was unconstitutional under the Commerce Clause it was upheld as constitutional as a tax. Not only that, but the deciding vote for the law was Conservative judge John Roberts. To call this a crushing blow is an understatement, and underscores how Presidents can never know how their appointees will decide. President Bush appointed John Roberts, and he has been a frequent attack subject by the political left. Yet, he voted their way today. And the man who was supposed to be the deciding vote Justice Kennedy had this to say in his dissent, “In our view, the entire Act before us is invalid in its entirety.”

The total opinion is 200 hundred pages long and will take time to digest, but in the law itself, there is not a single mention of the word €œtax.€ This could be because President Obama and the Democrats knew they could not sell it, if it were called a tax. That, however, did not stop the lawyers of the government from calling it that in the briefs and oral arguments. It was persuasive, as the Court upheld the idea that under Congress’s power to tax, the mandate, and the penalty charged for not getting health insurance falls under that umbrella, even if it were not called that in the law itself. Lastly, because the mandate was upheld as a tax there was no reason to even discuss severability.

The Issue of Medicaid

This is one issue that was central to the 26 states that brought suit against the Obamacare law, but not necessarily followed by most U.S. Citizens. In this area the Supreme Court, also in a 5-4 vote, held that is was unconstitutional for the federal government to withhold a state’s federal Medicaid funding, if the state did not create the exchanges and add the millions of new people onto their Medicaid rolls. The states position was that it was too expensive, and that the federal government could not force them to expand their Medicaid rolls.

While this question did not receive much attention before it will now. The segment of the population that Obamacare was created to give insurance coverage to was the poor, and the working middle-class. However, the way in which they would be getting this coverage was through an expansion of the Medicaid rolls in each state. Now, the states can refuse to do it. This means one primary purpose of the act has been nullified. This will have huge implications for the practical working of the law and goes back to the issue nonpartisan evaluations of Obamacare have always maintained. That the law tried to do too much, too fast, and was not crafted well.

Twenty-six states sued over both the mandate and the Medicaid requirements. Presumably all 26 will refuse to set up the exchanges. That means the millions who were supposed to be getting the new benefits will not, and that also means that one of the funding apparatus’s; namely, premiums for the policies, will not be forthcoming. That adds another financial burden to a law that was financially fraught from conception. In today’s news, and from now to election day, this aspect may be out shined by the huge win for President Obama. However, the practical measures of getting the law started in terms of the health care policies, could rear its ugly head soon after the election.

What now?

What happens next is anyone’s guess. One possible consequence is the independent and conservative bases that fueled the 2010 midterm elections could rise again. If that happens, Obama loses in a landslide, and the Republicans take the Senate and the House. Spending, the threat of taxes, and Obamacare fueled the 2010 election outcomes. This ruling has put all those items squarely back in play.

But, President Obama can campaign on making sure he is reelected so that he can preserve his law, a law that has been ruled constitutional. Republicans would be making a mistake to think Democrats cannot be rallied to the polls to keep that from happening. Presidential election cycles always have a higher turn out than midterm elections. Thinking that the conservative and independent base will overwhelm the Democratic base would be a mistake.

Still, one problem with the law has always been that did it not address health care costs, just access. So how to pay for it still remains a big question. The mandate leaves one funding avenue open, but the state not having to make the exchanges closes down another. The Congressional Budget Office and the Medicaid Department have both released studies showing that the law does not reduce health care costs or the costs of insurance. The bottom line from these two nonpartisan agencies was even if everyone followed the mandate and bought health insurance, it still was too expensive. Now, you add in some states not even creating the exchange, and you have a bigger mess. Further complicating this is that you can bet the Court will shortly have another case related to this from religious organizations that do not want to pay for a woman’s choice to use birth control pills.

Today is a historic, and for me, ironic day. According to the Supreme Court, conservatives were correct in their assertion that it is unconstitutional under the commerce clause, but lost because of the government’s ability to tax is broader than the commerce clause. Ironic that they won, but lost. Ironic that President Obama wins via a tax, yet he has never called it a tax. Ironic indeed.



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