Health Affairs

Health Reform and the Supreme Court

Bethesda, MD -- A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation analyzes the groundbreaking June 2012 Supreme Court decision on the constitutionality of the Affordable Care Act. In a narrow 5-4 majority, the court upheld the constitutionality of the individual mandate, under which most people must have health insurance or pay a tax penalty. In the process, the court thereby rejected arguments that the rest of the law needed to fall. At the same time, the court in effect made the expansion of Medicaid optional for states by unexpectedly declaring that it was unconstitutional for the federal government to cut off all Medicaid funding if states declined to go along with the expansion.

This policy brief reviews the highlights of the majority and dissenting opinions and assesses their implications, particularly for future federal-state programs. Topics covered in the brief include:

• What's in the ruling? The brief details the decision, authored by Chief Justice John Roberts, that the individual mandate was constitutional under the Constitution's taxing power and describes why the court rejected the separate argument that the mandate was constitutional under the Commerce Clause. It also explains the views expressed by some of the justices in the separate 7-2 decision (also written by the chief justice) on the Medicaid expansion.
  
  
• What's the impact of the Medicaid provision? The brief explains how the ruling leaves unanswered questions, both about how states will proceed in expanding Medicaid and whether the Department of Health and Human Services will devise an alternative option for states, such as a partial expansion by a state. The brief notes the precedent set by the Medicaid decision in that, for the first time, the court limited the federal government's ability to attach strings to its grants to states.
  
  
• Future litigation. A number of other Affordable Care Act cases that had been moving through the judicial system are now moot in the wake of the court's decision. However, several other cases are challenging provisions of the law on different grounds than those argued before the Supreme Court. Some contend that the law violates individual rights of liberty, privacy, and freedom of association. These cases are likely to continue to move through the courts even as implementation of the Affordable Care Act proceeds.

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.