Chief Justice Roberts wrote the majority opinion, who held that the law was a valid exercise of Congress’s power to tax. Congress, he said, is “increasing taxes” on those who choose to go uninsured.
The law requires non-exempted individuals to maintain a minimum level of health insurance or pay a tax penalty. Why certain individuals are exempt while others are not remains an issue of contention for many.
The essence of Roberts’s ruling was:
• “The Affordable Care Act is constitutional in part and unconstitutional in part,”.
• “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.”
• But “it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but (who) choose to go without health insurance. Such legislation is within Congress’s power to tax.”
The law, Roberts wrote, “makes going without insurance just another thing the Government taxes, like buying gasoline or earning income 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.”
He said “The question is not whether that is the most natural interpretation of the mandate, but only whether it is a ‘fairly possible’ one and that the Supreme Court precedent is that “every reasonable construction” of a law passed by Congress “must be resorted to, in order to save a statute from unconstitutionality.”
In 2005, then Senator Obama voted against confirming Roberts as chief justice, saying that Roberts lacked empathy for underdogs and “he has far more often used his formidable skills on behalf of the strong in opposition to the weak.”
Vice President Biden also voted against Roberts when he was a senator.
The four justices joining Roberts in upholding the law were Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan.
The dissenting justices were Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito.
Individuals who choose to or can not afford health insurance, and are not eligible for subsidies, will be penalized by the government increasingly year after year starting at $95 in 2014, rising to $325 in 2015, and up to $695 in 2016. After 2016, that $695 amount is indexed to the consumer price index.
Congress specifically did not allow the use of liens and seizures of property as methods of enforcing the penalty nor is non-compliance with the mandate subject to criminal or civil penalties under the Tax Code. Interest does not accrue for failure to pay the penalty in a timely manner, according to the congressional Joint Committee on Taxation.
The court said that the Obama administration cannot coerce states to go along with the Medicaid insurance program for low-income people.
The financial pressure which the federal government puts on the states in the expansion of Medicaid “is a gun to the head,” Roberts wrote.
“A State that opts out of the Affordable Care Act’s expansion in health care coverage thus stands to lose not merely ‘a relatively small percentage’ of its existing Medicaid funding, but all of it,” Roberts said.
Congress cannot “penalize States that choose not to participate in that new program by taking away their existing Medicaid funding,” Roberts said.
The Medicaid provision is projected to add nearly 30 million more people to the insurance program for low-income Americans — but the court’s decision left states free to opt out of the expansion if they choose.