Health reform implementation

Roberts court upholds Obama health law

The Supreme Court upheld President Obama’s signature healthcare law Thursday in a 5-4 decision that vindicates Obama and helps define Chief Justice John Roberts.

The court said the health law’s individual mandate, which requires most taxpayers to either buy insurance or pay a penalty, is a tax and is constitutional. The court also altered the law’s Medicaid expansion without striking it down entirely.

The ruling is an enormous victory for President Obama and congressional Democrats, who had long insisted the healthcare law is constitutional.

The fact that Roberts — a bona fide conservative appointed by former President George W. Bush — wrote the majority opinion is a blow to Republicans who had claimed the mantle of the Constitution in opposing the individual mandate.

Republicans will press ahead with symbolic votes to repeal the Affordable Care Act, but they will have to make significant gains in November’s election to actually stop Obama’s signature domestic achievement from taking effect.

“Our mission is clear — if we want to get rid of ObamaCare, we’re going to have to get rid of President Obama,” GOP presidential candidate Mitt Romney said Thursday.

The GOP also signaled after the decision that it intends to make the question of taxes a centerpiece in its argument against Obama. Romney said the law would result in a huge tax increase, while Sen. Marco Rubio (R-Fla.) warned the decision could allow the IRS to come after the uninsured.

Roberts tacitly acknowledged the passionate opposition to the healthcare law, but he said policy decisions belong to the elected branches of government, not the court.

“It is not our job to save the people from the consequences of their political decisions,” he said.

The decision allows Roberts — whose legacy will rest in large part on this case — to avoid the severe repercussions that both sides of the case had feared. The court did not strike down the signature domestic achievement of a sitting president, nor did it give its approval to an expansion of Congress’s powers.

The ruling will also change the way the political left and right view Roberts, who with his majority opinion became a target for conservatives.

Roberts’ opinion on the mandate was joined by the court’s liberal members — Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan.

Democrats heralded the ruling even though the court took an unexpected route to uphold the law. The justices upheld the mandate as a use of Congress’ tax powers — not as a regulation of interstate commerce.

Obama argued repeatedly during the legislative debate that the mandate is not a tax, and the law would have been even more difficult to pass if Democrats had described the mandate as a tax.

But the Justice Department has consistently defended the mandate in court as both a use of Congress’ taxing power and a use of the Constitution’s Commerce Clause.

The five justices in the Supreme Court’s majority are the first judges in the country to side with the Obama administration’s tax argument. It was rejected in every lower court, even those that ultimately upheld the healthcare law.

Roberts’ majority opinion cited estimates that as many as 4 million people will choose to pay the penalty rather than buy insurance.

“That Congress regards such extensive failure to comply with the mandate as tolerable suggests that Congress did not think it was creating four million outlaws,” Roberts wrote. “It suggests instead that the shared responsibility payment merely imposes a tax citizens may lawfully choose to pay in lieu of buying health insurance.”

Politically, Democrats had insisted that the mandate is not a tax. But House Minority Leader Nancy Pelosi (D-Calif.) wasn’t concerned that the court upheld the mandate on tax grounds.

“Call it what you will, it is a step forward for America’s families. And you know what? Take ‘yes’ for an answer. This is a very good thing for the American people,” she said at a press conference.

Many of the law’s supporters thought before oral arguments that Roberts might vote to uphold the mandate, but on different grounds. After the arguments, conventional wisdom held that Roberts would vote to strike the mandate and Justice Anthony Kennedy would be the swing vote in the healthcare case, fulfilling his traditional role on the court.

Kennedy, though, not only sided with the court’s conservatives, he read a statement from the bench summarizing the strongly worded dissenting opinion.

“The majority rewrites the statute Congress wrote” by deciding the mandate is a tax, Kennedy said from the bench.

The dissenting justices said the mandate is unconstitutional and the entire law should have been struck down.

“The court regards its strained statutory interpretation as judicial modesty,” Kennedy said. “It is not. It amounts instead to a vast judicial overreaching.”

The court did chip away at the healthcare law’s Medicaid expansion without striking it down entirely. It said the federal government cannot withhold all Medicaid funding from states that choose not to take part in the expansion, but must give states a choice between participating in the expanded program or leaving it as is.

Twenty-six states and the National Federation of Independent Business (NFIB) filed the lawsuit as soon as Obama signed the Affordable Care Act into law.

NFIB executive director Karen Harned said she was “very disappointed” in the court’s ruling.

“There’s going to be a public outcry from our members. I can assure you of that,” Harned said, speaking just outside the Supreme Court.

The ruling was met with angry protests from conservatives, who said the court had paved the way for a single-payer healthcare system. One speaker rallied protesters to elect “conservatives — not Republicans, but conservatives” in the fall, to ensure that the law is overturned in Congress.

— Kevin Bogardus and Mike Lillis contributed

—This story was posted at 10:12 a.m. and last updated at 5:58 p.m.

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