Supreme Court upholds individual insurance requirement

WASHINGTON — In a surprising ruling in which Chief Justice John Roberts emerged as the Supreme Court's dominant voice, a split court approved most of the new health care law that has deeply divided Americans, extending coverage to millions and re-establishing health care as a major battleground in the presidential election race.

The justices concluded that while Congress does not have the power to force people to buy health insurance policies as called for in the law, it can constitutionally tax those who refuse to purchase insurance.

A majority of the justices joined Roberts’ opinion to reject a major feature of the law — the Medicaid provision.

That provision had allowed the federal government to financially punish any state that refused to add millions of people to its Medicaid rolls.

The ruling, while a partial victory for President Barack Obama who pushed the law through Congress in 2010, also was a major victory for the states, many of which feared the new and more generous Medicaid eligibility standards would have imposed new financial burdens on them.

For Obama, the ruling clears the way for the administration to continue implementing the law, which does not go completely into effect until 2014. But states such as Ohio can refuse to adopt the new Medicaid eligibility standards, which state officials said would have cost the taxpayers $675 million a year in 2018.

The new law expanded eligibility for Medicaid, a program financed jointly by the states and the federal government to provide health coverage for low-income people. But the law also permitted the federal government to withhold its contribution for all Medicaid programs if a state chose not to cover additional people.

“Nothing in our opinion precludes Congress from offering funds under (the health law) to expand the availability of health care and requiring that states accepting such funds comply with the conditions on their use,’’ Roberts wrote. “What Congress is not free to do is penalize states that choose not to participate in that new program by taking away existing Medicaid funding.’’

In the East Room of the White House, Obama called the decision “a victory for people all over this country whose lives will be more secure.’’ He also warned congressional Republicans against trying to repeal the rest of the law, saying that “what the country can’t afford to do’’ is to “refight the political battles of two years ago or go back to the way things were.’’

House Speaker John Boehner, R-West Chester Twp., brushed that warning aside and vowed to repeal “this entire law in its entirety … Republicans stand ready to work with a president who will listen to the American people and not repeat the mistakes that gave us this harmful law.’’

Presumed Republican presidential nominee Mitt Romney made clear that health care would emerge as a central issue in the November election. In a statement, he said he disagreed with the ruling, adding that “what the court did not do on its last day in session, I will do on my first day if elected president of the United States. And that is I will act to repeal Obamacare.’’

Roberts decided vote

The law was designed to extend health coverage to 32 million of the 46 million Americans currently without any coverage. Because the Medicaid section was modified by justices, it is unlikely that many people will be covered.

The outcome was almost entirely due to Roberts, a conservative federal appeals court judge nominated to the high court by former President George W. Bush.

Because the court’s four most liberal justices did not have the votes to uphold the law in its entirety and the four most conservative justices lacked the votes to strike it down completely, Roberts became the fifth and deciding vote on the law.

The most contentious section of the law called for all Americans to buy insurance or face a fine. Roberts made clear under the Commerce Clause of the Constitution that “the federal government does not have the power to order people to buy health insurance.’’

Instead, Roberts accepted an argument advanced by the Justice Department that the penalty was in reality a tax, which is constitutional. Roberts wrote that the government has “the power to impose a tax on those without insurance.’’

As a result, Roberts broke with conservative justices Anthony Kennedy, Clarence Thomas, Antonin Scalia and Samuel Alito . But he then darted away from liberal Justices Ruth Bader Ginsburg and Sonia Sotomayor to rule that the Medicaid punishment was unconstitutional. Even as justices grudgingly joined parts of Roberts’ opinion, they criticized his reasoning. Ginsburg wrote that Roberts relied “on a newly minted constitutional doctrine,” complaining of his “novel constraint” of congressional powers under the Commerce Clause.

By contrast, conservatives Kennedy, Thomas, Scalia and Alito wrote that “the court today decides to save a statute Congress did not write. It rules that what the statute declares to be a requirement with a penalty is instead an option subject to a tax. And it changes the intentionally coercive sanctions of a total cut-off of Medicaid funds to a supposedly non-coercive cut-off of only the incremental funds … .”

The ruling had its share of irony: Roberts rescued major parts of a law championed by Obama, who as a member of the Senate in 2005 opposed Roberts’ confirmation.

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