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The Supreme Court Health Reform Decision: Our Upside-Down Constitution

June 28th, 2012

The one lesson that everyone should learn from reading the Supreme Court Affordable Care Act opinions is that we are all very poor seers when it comes to predicting the decisions of the United States Supreme Court.  No one thought that Justice Roberts would be the deciding vote for the mandate, or that the Medicaid extension, which was uniformly upheld by all the lower courts, would be struck down in the Supreme Court by a 7 to 2 majority for its coercive nature. Earlier precedents on the point had suggested that the coercion argument was dead for all purposes, and yet it was revived with a vengeance.

On the other side of the line, the individual mandate was found to pass muster under the taxing power, which again was an argument that commanded no support when the case was heard in the lower courts.  Yet the commerce clause argument, which was thought to be the stopper, was rejected by the Supreme Court on the now familiar grounds that Congress cannot require individuals to enter into an activity so that it could regulate it.

How this fits together no one can quite tell, but it is very clear that no one can harbor any illusions of a settled and coherent body of constitutional law.

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2 Responses to “The Supreme Court Health Reform Decision: Our Upside-Down Constitution”

  1. kholt16 Says:

    The Supreme Court correctly ruled that the the ACA’s expansion of Medicaid is coercive and that the States could not realistically turn down federal Medicaid funding while maintaining their existing levels of Medicaid coverage. American Action Forum President and former Director of the CBO, Douglas Holtz-Eakin stated in January of 2012:
    “Let’s be realistic, if a state was to forgo federal Medicaid funding while retaining the same level of coverage for its citizens, that state’s fiscal picture would become dramatically unrecognizable. Nationwide, federal Medicaid spending is the equivalent of one-third of all state taxes collected. It is clear that an abrupt 33 percent increase in state taxes across the board would be politically impossible.”
    Holtz-Eakin was one of 101 economists, including two Nobel laureates to sign an amicus brief arguing that the Medicaid expansion provision of the PPACA unconstitutionally coerces states to act. This brief can be found at:

  2. Michael D. Miller, MD Says:

    This ruling is completely consistent with what I’ve been explaining to people for many years – The Federal government has a very limited set of actions it can take: Give money, take money (e.g. taxes), imprison, make war, and talk at you (i.e. bully pulpit). The SCOTUS found that the requirement to have insurance (a.k.a. mandate) doesn’t itself fall under any of these powers – and Roberts apparently agreed that the mandate itself is unconstitutional under the Commerce Clause – BUT making people pay a tax for not complying with the requirement is completely fine…. so the Commerce Clause reasoning doesn’t matter. (Although it will very likely appear in Republic campaign rhetoric.)

    I find the Medicaid decision more confusing since Congress has expanded Medicaid via option/requirement ladder type changes over many years. Does this mean that any Federal program change involving paying states to run their programs can be politely declined by the States while they continue to operate under the prior rules? (I haven’t read the full decision, but that’s what I – and I’m sure others – will be trying to decipher.)

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