Supreme Court Upholds Affordable Care Act

UPDATED (3:11 p.m.)—The Supreme Court, in a split decision, has upheld the individual mandate that requires the purchase of insurance as a tax.

The announcement allows the Affordable Care Act championed by President Barack Obama to move forward. It's expected that the law would offer health care to more than 30 million Americans, according to the Huffington Post.

In a 5-4 opinion, Chief Justice John Roberts wrote that the majority of the court rejected arguments that the law violated the Constitution's interstate commerce clause.

"The individual mandate forces individuals into commerce precisely because they elected to refrain from commercial activity," Roberts wrote. "Such a law cannot be sustained under a clause authorizing Congress to “regulate Commerce.”

But the court allowed the individual mandate to survive, saying it was with Congress' power to lay a penalty on those who choose not to buy insurance. The court said that penalty was essentially a tax.

Roberts wrote that the federal government "does not have the power to order people to buy health insurance" but that it did "have the power to impose a tax on those without health insurance.

"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," Roberts wrote. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."

In statement, Ron Pollack, Executive Director of Families USA praised the 193-page court decision.

"Today’s Supreme Court ruling is a clear, unambiguous, and complete victory for long-overdue health care reform. It sends an unmistakable message that the building of a better, fairer health care system will continue to move forward," Pollack said in the statement. "Implementing health reform will provide peace of mind for our families – the peace of mind that only comes when our loved ones are sure to receive the health care they need when they need it."

Douglas Hough, an associate professor at Johns Hopkins University’s Carrey Business School, argued the court’s decision to up hold the law is a positive for the health care industry.

He said that by adding or giving access to health care to about 26 million people it will increase demand for those services. 

"From a supply side you have physicians and hospitals getting more business, but also they’re going to get paid for care previously given, but either given on a pro-bono basis or a very reduced fee basis," Hough said.    

Hough, who has a book coming out titled Keep Your Government Hands Off My Medicare: What Behavioral Economics Can Tell Us About Health Care and Health Care Reform, said people make decisions in hot and cold states. The decision to buy or not to buy health insurance is made in a cold state, where they may be able to rationalize not buying health care. But when they need it they’re in a hot state and would do just about anything to have insurance.

“This was jaw dropping ruling. I don’t think anyone expected the Supreme Court would rule this way, this is a unique and amazing day in American jurisprudence,” Hough said

Richard Vatz, a professor of political rhetoric at Towson University, said his initial reaction was that the court’s decision validated fears that the judges make decisions first and then find a Constitutional rationale defending their stance.  However, he said Roberts’ vote in this instance was a case of upholding the Constitution over personal political ideals.

"It is indisputable in my mind that politically Chief Justice Roberts dislikes the individual mandate, but found it Constitutional," Vatz said. "This is an honorable, if impractical, vote but, again, the court’s mandate is to rule on the Constitutionality of laws."

Vatz questioned the motives of other judges regarding the ruling.

"The other justices whose votes reflects their policy preferences could have coincidentally found their politics and Constitutional adjudication identical, but it could not be the case for all eight of them," he said.

Joel Grossman, who teaches about the Supreme Court, American law and politics at , said the split of the justices was the most surprising element of the 5-4 decision. 

He said he expected Justice Anthony Kennedy and Justice John Roberts to come down on the same side of the issue, particularly because Roberts wanted to write the decision.

"Well, I think that [Roberts’s] decision to join the liberals, and uphold the law, reflects his view that it would be a terrible mistake for the court to invalidate the law,” Grossman said.

He also doubted the decision would be a landmark one, with a lasting impact on how future courts will interpret cases in relation to the Constitution. He said the split decision and plethora of opinions on the court will make it hard to determine what the decision means.

"I would say it’s an important decision, the impact politically is a blockbuster, but constitutionally it isn’t quite that," Grossman said.

Local Government Reaction

• In Howard County, Health Officer Dr. Peter Beilenson said Thursday that now that health insurance is mandatory, Howard County’s program to provide health services to uninsured residents would expire in January of 2014, according to a story on .

Beilenson also said that the nonprofit would now increase its focus on explaining how the health care law works for residents. 

“The … [law] is complex,” he said. “Because it’s been bandied about as a political football, nobody knows quite what it is. Now that the Supreme Court has ruled this is the law of the land, we can start explaining it to the average citizen what it means. 

“We will be both the educator and the navigator for enrollment.”

• Montgomery County officials enthusiastically supported the Supreme Court's decision to uphold the Affordable Care Act, according to a

Dr. Ulder Tillman, Montgomery County health officer, said shortly after the decision, "This is very exciting news for us."

, Dist. 39, Germantown, said, "I am thrilled."

Rachel Baye, Montgomery County reporter for the DC Examiner, tweeted from a meeting of the county Health and Human Services Committee:

"MoCo Council Health and Human Services committee just cheered ‪#scotus‬  decision on healthcare."

"Now the MoCo Council Health and Human Services committee is having a hard time getting back to their discussion. (Montgomery County Council President Roger) Berliner looks giddy."

• In Baltimore City Mayor Stephanie Rawlings-Blake sent a message to the media celebrating the court's decision.

"This morning, our nation’s highest court upheld President Obama’s Affordable Care Act. This decision is a victory for the American people and allows us to move forward, enacting vital reforms that will expand coverage for tens of thousands of Marylanders. I want to once again thank President Obama for his support of meaningful health care reform and his commitment to the needs of vulnerable and underserved citizens.”

Maryland's Congress members and Senators Comment

Elected officials from around Maryland also weighed in on the decision:

• Sen. Ben Cardin called the decision "a win for the American people.

"Before this law, every responsible American with health insurance was subsidizing the health care needs of the rest," Cardin said in a statement. "That unfair arrangement will be coming to an end soon, as all Americans become part of a more efficient, more cost-effective health care system.”  

Cardin also on the decision on Patch.

• Republican Rep. Andy Harris, who is also a physician, said in a statement he was disappointed in the court's ruling and said he believes the bill is poor public policy.

“The Supreme Court’s decision determined the law’s constitutionality, not whether the law is good policy," Harris said in his statement. "Americans have already made up their mind on that issue.  A majority favor repealing the law."

Harris called for Congress to repeal the law.

"Today’s decision does not change the overwhelming opposition of the American public to Obamacare,"Harris said in his statement.

• Rep. Dutch Ruppersberger, a Democrat, issued a statement saying the ruling "is not about a victory for Democrats or a loss for Republicans. It’s about providing all Americans with access to quality, affordable healthcare."

"The idea behind the individual mandate is to be responsible for your own health needs instead of burdening others, to make it easier for those who can’t afford insurance to find options in the private market and to help employers offer health benefits to workers," Ruppersberger said in the statement. "The Supreme Court has spoken and we now need to work together to implement the law of the land and achieve these goals.”

Did the court get it right? .

Stay with Patch throughout the day for updates and local reaction.

Local Editor Nayana Davis contributed to this story.