In a 5 to 4 ruling with
Chief Justice Roberts being the deciding vote, most of the Affordable Care Act (ACA)
was upheld. The court ruled that the act's individual mandate was
constitutional under congressional tax powers. The ruling largely ignores the
argument that the individual mandate is a violation of the commerce clause.
The primary argument for opponents of the ACA focused on the
individual mandate to purchase health insurance. They held that congress had
overstepped its authority by requiring instead of regulating commerce.
Opponents also argued that the purchase of health insurance was a personal choice.
Proponents of the ACA pointed to the right of congress to levy
taxes and enforce commerce. Examples of which varied from the individual income
tax to the EPA.
However, It did curtail a provision to sanction states that did
not expand their Medicaid programs to include the poor under the ACA. In effect
creating a toothless mandate since the federal government is prohibited from
taking punitive measures against states who refuse to comply.
With this ruling, individuals without medical coverage,
(beginning in 2014) can be assessed a tax that begins at $95 and increases every year until 2016 where a
formula indexed to inflation is used.
What isn't addressed in the court's ruling were core structural
issues with the ACA. Specifically, the Medicaid expansion provisions of the act
now effectively void and the vague language concerning required coverage
features.
Core to the argument of opponents of the ACA is the government
requirement of an individual to be compelled to engage in commerce with a
private commercial entity. Today's ruling ignores that argument in favor of the
stronger argument of congress' right to tax. The language of the ACA mandate
does treat the penalty as a tax and not a transaction.
Even proponents of the ACA admit the program is flawed but like
the Medicare part D prescription program from a decade ago they claim it's
better than the alternative.
It's not inconceivable that the future may hold low cost minimum
coverage health plans with few if any benefits under the current ACA language.
Such plans would not be unlike the minimum coverage auto insurance policies
commonly seen in states that require auto insurance to register a vehicle.
Little attention has been given to what constitutes the minimum
coverage outside of actuarial values
concerning deductible and out of pocket expenses based on income. While
pre-existing conditions are largely curtailed specifics of what constitutes the
features of an effective health plan are vague at best. Likely part of the
compromise made to garner insurance industry support, such concerns appear to be
left to the insurer.
Proponents of the ACA have called today's ruling a victory
for the President while the opposition has vowed to defeat it using legislative
measures.
Obamacare as the ACA is commonly referred to by detractors will
continue to be hotly debated in the coming months and is likely to be the major
political issue of the coming Presidential election.
