In a landmark 5-4 decision, with Chief Justice John Roberts writing the majority opinion, the U.S. Supreme Court upheld the Affordable Care Act (ACA), the signature legislation of the Obama Administration. Hastings Center experts comment on the Supreme Court ruling:
Karen Maschke, research scholar: Although the Supreme Court ruled that as a tax the ACA’s financial penalty is permissible under the U.S. Constitution, the Court did not address the “wisdom or fairness” of the Act. That decision the Court left to Congress. The ACA is not perfect, and opponents of the Act vow to repeal it. The crucial issue now is whether opponents have an alternative plan that is not shaped by the desire to win elections, but by the desire to be fair and wise in promoting and protecting the health of everyone.
Daniel Callahan, co-founder and president emeritus: Recent public opinion surveys have shown a serious public opinion decline in the reputation of the Supreme Court, mainly on the grounds of the apparent ideological and political character of its votes. The fact that Justice Roberts—who is said to be worried about that perception—voted with the majority in upholding the ACA is a triumph for the Court no less than for the legislation itself.
Michael Gusmano, research scholar: The Supreme Court’s 5-4 ruling to uphold the ACA is a victory for those who argued that the federal government has the authority to pool the risks associated with poor health across a life course. By requiring citizens to purchase health insurance or pay a penalty, the ACA seeks to protect those who already have health insurance from bearing in unfair share of health care costs and supports the idea of universal participation. The Court’s decision that the federal government may not take away all federal Medicaid funds if states refuse to participate in the ACA expansion of Medicaid may limit the number of people who receive health insurance coverage. If states decide not to participate in the Medicaid expansion, however, they will walk away from a great deal of federal money. The federal government will cover 100% of the Medicaid expansion for 2014 through 2016, with modest reductions until 2020, at which point the federal government will pay for 90% of the Medicaid expansion. States will be under great pressure from advocates and the health care industry to accept these funds.
The Court’s decision is not the end of the health care reform debate, but the beginning. Millions of Americans will remain uninsured after the full implementation of the ACA. The amount of revenue required to sustain the Medicare and Medicaid programs, along with the subsidies included in the ACA for people with lower incomes, will depend on the ability of the federal government to contain the cost of health care. The implementation of the ACA makes it more likely that the federal government will take responsibility for addressing these remaining challenges, rather than passing this off to another day and another generation.
Mary Crowley, director of public affairs and communications: The Supreme Court decision on the ACA was a legal and not an ethical ruling, based on the constitutionality of imposing a mandate via a tax. Ethics will come into play going forward in the court of public opinion, however, where supporters of the law will emphasize how expanding coverage appeals to values of justice and fairness, while opponents will focus on how the mandate and the ruling impede liberty (as Justice Scalia gestured to during oral argument in his comment about the mandate being akin to forcing people buy broccoli, and Justice Kennedy said when delivering the dissent). A robust concept of liberty can encompass the mandate (or tax) on the grounds that it frees both individuals and society from unsustainable burdens, and so makes possible the other inalienable rights enshrined in the Declaration of Independence, life and the pursuit of happiness.
Ross White, public policy associate: As a young adult currently benefiting from the ACA provision allowing me to stay on my parents’ health insurance—if even for only five more months—today’s SCOTUS decision is a triumph for the Millennial generation. Although many challenges remain ahead as implementation of the law moves forward, including how many states will choose not to expand Medicaid, the decision will expand health care coverage for upwards of 30 million Americans and set our nation on a more sustainable health care path. This is not only a political and policy victory, but also an affirmation of critical American values of justice, fairness, solidarity, and shared responsibility for the health and well-being of our fellow citizens. When Congress passed the Genetic Information and Nondiscrimination Act (GINA) in 2008, Senator Ted Kennedy called it the “first civil rights bill of the new century.” If Senator Kennedy were alive today, I'm sure he would agree that ACA is the greatest civil rights bill of my lifetime.