[Updated at 12:34 p.m.]
The Supreme Court has ruled. Health care reform lives.
The decision was actually three separate rulings, with the justices taking different positions on different parts of the law. But it means that the Affordable Care Act can take effect, unless lawmakers decide to repeal it, as Mitt Romey and congressional Republicans have vowed to do.
If fully implemented, thirty million people who might otherwise be uninsured will get coverage. Tens of millions more will get better insurance than they might have had, whether it’s seniors getting additional drug coverage or purchasers of private insurance getting the right to appeal insurer treatment decisions. Nearly all Americans will gain new peace of mind—the knowledge that comprehensive coverage will always be there, no matter what their medical or financial status.
Speaking at the White House moment ago, President Obama hailed the ruling and what it means for average Americans:
Whatever the politics, today's decision was victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it.
Here's how the opinions broke down:
The four liberals effectively embraced the government's arguments in defense of the mandate.
Four conservative dissenters rejected the government's arguments. Justice Anthony Kennedy wrote the dissent, saying that he would have invalidated the entire law.
The third opinion, somewhat surprisingly, came from Chief Justice John Roberts alone, although other justices signed onto parts. He joined the conservatives in rejecting arguments that the mandate was a permissible use of federal authority to regulate interstate commerce. But he said that the mandate was effectively the same as a tax and, as a result, passed constitutional muster.
Roberts' opinion gave the Affordable Care Act the critical fifth vote it needed. In the key passage, he wrote
The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may be reasonably characterized as a tax. Because the constitutionl permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.
Part of Roberts' decision, joined by the dissenters and two of the liberal justices, limited the federal government’s ability to dictate how states use Medicaid funds. This makes the expansion of Medicaid essentially voluntary. And while that may not have much practical effect, given that generous federal matching funds make the expansion a sweetheart deal for states, that part of the ruling could limit the federal government's leverage over states in the future.
Samuel Bagenstos, a constitutional law professor at the University of Michigan, explained why via e-mail:
The Medicaid holding -- adding up Chief Justice Roberts's lead opinion (joined on this point, perhaps surprisingly by Justices Breyer and Kagan) and the Scalia/Kennedy/Thomas/Alito opinion -- does make the expansion entirely voluntary. The expansion is still a really good financial deal for states, though, so the question *for the ACA* is whether and which states will decide to forego the expansion. The holding has potentially serious implications for cooperative federal spending programs generally, though. I would expect lots of new Spending Clause challenges to those programs to be brought after this opinion.
Conservatives can (and should) take heart in that development. They can also celebrate vindication of a key constitutional argument: That neither the Commerce Clause nor the "Necessary and Proper" Clause justify the mandate. Roberts and the four conservative justices endorsed that view and, again, that could have long-term effects on the extent of federal regulatory authority, depending on how broadly future justices read the provision.
But the immediate result is a win—a huge win—for those who support health care reform. Via SCOTUSblog, which was (I think) the first to report the result accurately:
Bottom line: The entire ACA upheld, with the exception that the federal govenrment’s power to terminate states’ Medicaid funds in narrowly limited.
In issuing this ruling, the Court has not only validated the Affordable Care Act. It has also validated its own reputation. The vast majority of legal experts have said, all along, that the law is constitutional under any reasonable reading of past decisions. The only way for the justices to overturn the law would have been to rewrite decades of constitutional law, if not more, and to substitute their own judgment about legislation in a way the Court has not done in nearly a century.
Instead, five justices demonstrated that judges should act with caution and humility, overturning major federal legislation only in cases where such legislation represents clear violations of the Constitution.
Roberts and the four Republican appointees put down markers that could, over the long term, seriously limit federal power. But they did so in a way that interferes minimally with laws that today's lawmakers have enacted.
Note: I will be updating this item throughout the day.