Presidents and the Supreme Court: Barack Obama and The Affordable Care Act
Right from the beginning of his presidency, Barack Obama was focused on keeping the campaign promise that was the centerpiece of his campaign: a government health care program. He expended almost every ounce of his political capital in securing the passage of the Patient Protection and Affordable Care Act (abbreviated as the ACA, and referred to by many as "ObamaCare"). The bill narrowly got through Congress. Having secured the support of the Executive and Legislative beranchs of government, the law would also have to pass muster with the Judicial branch. The showdown on this issue came in a case argued before the United States Supreme Court called National Federation of Independent Business v. Sebelius. The decision is reported at 567 U.S. 519 (2012). At issue was whether or not Congress had the power to enact most provisions of the ACA, as well as the Health Care and Education Reconciliation Act (HCERA). Most contention the requirement for most Americans to have health insurance by 2014. The Acts represented a major set of changes to the American health care system and it had been the subject of highly contentious debate, one that was largely divided on political party lines.
President Obama signed the Patient Protection and Affordable Care Act into law in March of 2010. This was met with a spate of lawsuits including one begun by the National Federation of Independent Business. It was their position that the law was unconstitutional. The Supreme Court granted certiorari (meaning that the court agreed to hear argument and decide ) in three cases: National Federation of Independent Business v. Sebelius, Dept. of Health and Human Services v. Florida and Florida v. Dept. of Health and Human Services. The Defendant Sebelius was President Obama's Secretary of Health and Human Services, former Kansas Governor Kathleen Sebelius.
The state of Florida filed a lawsuit against the United States Department of Health and Human Services, challenging the constitutionality of the law. On January 31, 2011, Judge Roger Vinson ruled that the "individual mandate" (the provision of Internal Revenue Code section imposing a penalty on nearly all Americans who fail to purchase health insurance) was beyond the power of Congress. Vinson also held that the mandate could not be severed from the rest of the Affordable Care Act. He struck down the entire Act. The Department of Health and Human Services appealed to the 11th Circuit Court of Appeals. A three-judge panel heard the appeal. By a margin of 2 to 1, the court affirmed the Vinson's ruling that the individual mandate was unconstitutional, but held that the individual mandate could be severed, leaving the rest of the law intact.
Other federal courts heard cases related to the Affordable Care Act that were not directly considered by the Supreme Court, but left a climate of inconsistency about the constitutionality of the law. Generally, those judges appointed by President Bill Clinton upheld the individual mandate, while those appointed by George W. Bush did not, with some exceptions.
The Court agreed to hear approximately six hours of oral argumentation over a three-day period, from Monday, March 26, to Wednesday, March 28, 2012. Chief Justice John Roberts wrote the majority opinion. The majority upheld the Affordable Care Act generally, but severed a portion of it. Chief Justice Roberts was joined by Justices Ginsburg, Breyer, Sotomayor and Kagan. The majority upheld the individual mandate component of the ACA as a valid exercise of Congress's power to levy and collect taxes. Roberts, wrote:
"The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."
On the question of the expansion of Medicaid, a majority of the Court found the expansion to be unconstitutional and severed the provision from the act. Chief Justice Roberts, joined by Justices Breyer and Kagan, said that the Medicaid expansion could survive, but that states must be given the right to opt out of the expansion without losing their pre-existing Medicaid funding. Justice Ginsburg, joined by Justice Sotomayor, would have upheld the Medicaid expansion in its entirety. Justices Scalia, Kennedy, Thomas, and Alito would have struck down the Medicaid expansion completely, along with the entire Act.
The Court held that the federal government could not withhold existing Medicaid funding from states that choose not to participate the Act's extension of the Medicaid program. Justices Roberts, Breyer, and Kagan concluded that punishing states for failure to comply in the Medicaid expansion by withholding existing Medicaid funding is unconstitutional.
Chief Justice Roberts concluded:
"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. 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. As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer... The Federal Government does not have the power to order people to buy health insurance. Section 5000A [of the Internal Revenue Code] would therefore be unconstitutional if read as a command. The Federal Government does have the power to impose a tax on those without health insurance. Section 5000A is therefore constitutional, because it can reasonably be read as a tax."
Justices Scalia, Kennedy, Thomas, and Alito joined in a dissent that argued the individual mandate was unconstitutional because it represented an attempt by Congress to regulate beyond its power under the Commerce Clause. Further, they were of the opinion that reclassifying the Individual Mandate as a tax rather than a penalty in order to sustain its constitutionality was not to interpret the statute but to rewrite it.
The joint dissent argued that since the ACA exceeded its constitutional powers in both compelling the purchase of health insurance and in denying non-consenting States Medicaid funding, the whole statute should have been deemed inoperative because the two parts were central to the statute's design and operation.
The Court convened on the morning of June 28, 2012, to announce its decision. Many believe that the joint dissent was the original internal majority opinion, and that Chief Justice Roberts' vote changed some time between March and the public issuance of the decision. On July 1, 2012, CBS News, citing unnamed sources within the Court, said that over the course of internal deliberations Roberts changed his position from striking down the mandate to upholding it. On July 2, Adam Liptak of The New York Times reported he believed that this information was leaked to CBS News by Justice Thomas.
President Obama was understandably happy with the decision. Republicans criticized the majority decision and vowed to repeal the ACA. They had already attempted to do so starting in January 2011,but were unsuccessful in enacting a repeal. Republican presidential candidate Mitt Romney pledged that he would repeal the bill, and a spokesperson for the Romney campaign announced that they raised more than $3.2 million in the hours after the announcement of the decision. The American Medical Association, the National Physicians Alliance, the American Academy of Pediatrics, and the Association of American Medical Colleges all deemed the ruling a victory.
President Obama signed the Patient Protection and Affordable Care Act into law in March of 2010. This was met with a spate of lawsuits including one begun by the National Federation of Independent Business. It was their position that the law was unconstitutional. The Supreme Court granted certiorari (meaning that the court agreed to hear argument and decide ) in three cases: National Federation of Independent Business v. Sebelius, Dept. of Health and Human Services v. Florida and Florida v. Dept. of Health and Human Services. The Defendant Sebelius was President Obama's Secretary of Health and Human Services, former Kansas Governor Kathleen Sebelius.
The state of Florida filed a lawsuit against the United States Department of Health and Human Services, challenging the constitutionality of the law. On January 31, 2011, Judge Roger Vinson ruled that the "individual mandate" (the provision of Internal Revenue Code section imposing a penalty on nearly all Americans who fail to purchase health insurance) was beyond the power of Congress. Vinson also held that the mandate could not be severed from the rest of the Affordable Care Act. He struck down the entire Act. The Department of Health and Human Services appealed to the 11th Circuit Court of Appeals. A three-judge panel heard the appeal. By a margin of 2 to 1, the court affirmed the Vinson's ruling that the individual mandate was unconstitutional, but held that the individual mandate could be severed, leaving the rest of the law intact.
Other federal courts heard cases related to the Affordable Care Act that were not directly considered by the Supreme Court, but left a climate of inconsistency about the constitutionality of the law. Generally, those judges appointed by President Bill Clinton upheld the individual mandate, while those appointed by George W. Bush did not, with some exceptions.
The Court agreed to hear approximately six hours of oral argumentation over a three-day period, from Monday, March 26, to Wednesday, March 28, 2012. Chief Justice John Roberts wrote the majority opinion. The majority upheld the Affordable Care Act generally, but severed a portion of it. Chief Justice Roberts was joined by Justices Ginsburg, Breyer, Sotomayor and Kagan. The majority upheld the individual mandate component of the ACA as a valid exercise of Congress's power to levy and collect taxes. Roberts, wrote:
"The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."
On the question of the expansion of Medicaid, a majority of the Court found the expansion to be unconstitutional and severed the provision from the act. Chief Justice Roberts, joined by Justices Breyer and Kagan, said that the Medicaid expansion could survive, but that states must be given the right to opt out of the expansion without losing their pre-existing Medicaid funding. Justice Ginsburg, joined by Justice Sotomayor, would have upheld the Medicaid expansion in its entirety. Justices Scalia, Kennedy, Thomas, and Alito would have struck down the Medicaid expansion completely, along with the entire Act.
The Court held that the federal government could not withhold existing Medicaid funding from states that choose not to participate the Act's extension of the Medicaid program. Justices Roberts, Breyer, and Kagan concluded that punishing states for failure to comply in the Medicaid expansion by withholding existing Medicaid funding is unconstitutional.
Chief Justice Roberts concluded:
"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. 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. As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer... The Federal Government does not have the power to order people to buy health insurance. Section 5000A [of the Internal Revenue Code] would therefore be unconstitutional if read as a command. The Federal Government does have the power to impose a tax on those without health insurance. Section 5000A is therefore constitutional, because it can reasonably be read as a tax."
Justices Scalia, Kennedy, Thomas, and Alito joined in a dissent that argued the individual mandate was unconstitutional because it represented an attempt by Congress to regulate beyond its power under the Commerce Clause. Further, they were of the opinion that reclassifying the Individual Mandate as a tax rather than a penalty in order to sustain its constitutionality was not to interpret the statute but to rewrite it.
The joint dissent argued that since the ACA exceeded its constitutional powers in both compelling the purchase of health insurance and in denying non-consenting States Medicaid funding, the whole statute should have been deemed inoperative because the two parts were central to the statute's design and operation.
The Court convened on the morning of June 28, 2012, to announce its decision. Many believe that the joint dissent was the original internal majority opinion, and that Chief Justice Roberts' vote changed some time between March and the public issuance of the decision. On July 1, 2012, CBS News, citing unnamed sources within the Court, said that over the course of internal deliberations Roberts changed his position from striking down the mandate to upholding it. On July 2, Adam Liptak of The New York Times reported he believed that this information was leaked to CBS News by Justice Thomas.
President Obama was understandably happy with the decision. Republicans criticized the majority decision and vowed to repeal the ACA. They had already attempted to do so starting in January 2011,but were unsuccessful in enacting a repeal. Republican presidential candidate Mitt Romney pledged that he would repeal the bill, and a spokesperson for the Romney campaign announced that they raised more than $3.2 million in the hours after the announcement of the decision. The American Medical Association, the National Physicians Alliance, the American Academy of Pediatrics, and the Association of American Medical Colleges all deemed the ruling a victory.