Today, the Supreme Court announced one of the most anticipated decisions in the past decade, National Federation of Independent Business v. Sebelius. This case challenged the constitutionality of the Patient Protection and Affordable Care Act. In a split decision of 5-4, the High Court struck down the Act’s Medicaid expansion, but upheld its “Individual Mandate.”
The decision written by Chief Justice Roberts laid out the progression of Medicaid since its enactment in the Social Security Act of 1965. The court declined to uphold the new provision, which would have expanded Medicaid by 40%. In order for the states to continue receiving their funding for Medicaid, the states would have been required to expand the rosters of Medicaid to include all individuals under the age of 65 who are under 133% percent of the poverty limit.
Chief Justice Roberts likened Congress increasing Medicaid while placing all of the states’ Medicaid funding in jeopardy as a “gun to the head.” The court refused to close the door to future expansions of Medicaid by allowing financial “encouragement,” but not to the level in which Congress attempted in the Patient Protection and Affordable Care Act. The court upheld the “Individual Mandate” as within Congress’s Tax Power. The “Individual Mandate” would require most Americans to purchase insurance or be assessed a “penalty” on their taxes.
The court identified the “penalty” that would be assessed to most individuals as a tax and refused to expand Congress’s Commerce Clause Power to allow regulation of inactivity in the health care market as a viable reason for regulation. Chief Justice Roberts made it clear that he was not upholding the ability of Congress to demand that individuals purchase a product. He interpreted the “Individual Mandate” as a tax imposed on individuals who do not have insurance. The court upheld the remainder of the Act while excising the Medicaid expansion.