By voting to uphold the Patient Protection and Affordable Care Act, Chief Justice
The implications for the nation's health care system and for the American people are enormous. Had Chief Justice Roberts sided instead with the court's conservative wing, the entire act would have been thrown out — and with it, protections for Americans with chronic diseases and pre-existing conditions, the expansion of health insurance to millions who now lack it, and provisions to control the spiraling cost of health care in the United States. A rejection of the model for universal health care embodied in the Affordable Care Act would have left little other option besides a single-payer system, which is for the foreseeable future a political impossibility.
The 5-4 decision is not a complete validation of the Affordable Care Act. It narrows a provision related to the expansion of
Speculation before the decision centered on whether the conservative majority on the court would reject the notion that the individual mandate was authorized by the Commerce Clause and, in the process, overturn precedents for Congress' ability to regulate the economy dating to the New Deal. Without that mandate, insurance companies would not be able to cover pre-existing conditions or provide many other benefits without raising premiums drastically. Interestingly, a majority of justices did conclude that the mandate was not a permissible regulation of interstate commerce — which, at first glance, would seem to present a real limitation on Congress' ability to address problems that the states can't handle on their own. After all, granting greater deference to Congress' authority to levy taxes is of little use in an era when approximately half of Congress has signed a pledge never to raise taxes under any circumstances.
But the way Chief Justice Roberts (who was joined in his opinion by Associate Justices
This ruling comes in the middle of a hotly contested presidential race, and it is bound to be debated fiercely between now and November. But its electoral implications are unclear. Health care reform is the signature accomplishment of President Obama's first term, and this ruling validates its constitutionality. However, despite the popularity of many individual elements of the act —