Supreme Court Upholds Individual Mandate In The Affordable Care Act, But Medicaid Expansion Is In Question

The Supreme Court ruled today 5-4 that the Affordable Care Act is constitutional and upheld the individual mandate, requiring most Americans to maintain "minimum essential" health insurance coverage. The decision was written by Judge Roberts for the majority. The Court held that the argument relying on the Constitutional commerce clause would not support the Affordable Care Act, but then looked to the constitutional right of Congress to impose taxes. Noting that the enforcement and operational structure for the individual mandate compliance and penalties was administered through the Internal Revenue Service, the Court upheld the individual mandate as a valid exercise of the Taxing Clause of the U.S. Constitution.

A notable result of the decision also was the holding by the Court that the federal government could not penalize states by withholding or withdrawing Medicaid funding for those states which choose not to participate in the Medicaid expansion. The Court reasoned that the type of change contemplated to the Medicaid program by the Affordable Care Act was transformational and not contemplated previously and therefore was not subject to the prior statutory reservation of rights by the federal government that allowed the alteration or amendment of the Medicaid program.

Further analysis of the decision is required, but this holding may allow for states individually to choose not to support the Medicaid expansion program and to do so without fear of reprisal from the federal government. Put another way, the Supreme Court decision potentially removes the "stick" held by the federal government and therefore may require a shift by the federal...