On June 28, the United States Supreme Court released its ruling in the National Federation of Independent Business, et al., v. Sebelius, Secretary of Health and Human Services, et al. finding the law to be constitutional. In the majority opinion, the constitutionality of the individual mandate section of the Patient Protection and Affordable Care Act (PPACA) — the centerpiece of the case — was upheld under the rationale that the constitutional power to levy taxes sufficiently extended to the law.
In his concluding opinion, Justice John Roberts summarized the ruling as follows:
"The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress’s power to tax."
Justice Roberts added, "The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that judgment is reserved to the people."
Ultimately this ruling means that the existing law and its accompanying rules and regulations remain intact, at least for the time being. It is important to note that the Supreme Court’s ruling does not necessarily end litigation over the PPACA. Several cases regarding different portions of the law remain pending such as rules governing physician-owned hospitals and the Independent Payment Advisory Board (IPAB).
Today’s ruling also touched on Medicaid. States had challenged the expanded coverage requirements. The Court found that state participation is optional and that states cannot be penalized for failing to participate in the expansion of coverage.
ASA President Jerry A. Cohen, M.D. offered the following remarks on the ruling:
"The Supreme Court’s ruling is anything but the last word on the debate surrounding this law. Congressional challenges to the implementation of the law and to policies included in law will continue. Indeed, this ruling will likely intensify efforts by opponents to repeal the reform law and to advance new approaches to affordable health care. ASA intends to vigorously participate in the ongoing debate to address the law’s shortcomings including those that weaken the physician-patient relationship and marginalize physician’s unique and indispensible role within the American health care system. As we did during the initial debate on health system reform and done subsequently, ASA will continue to be a voice for meaningful reforms that help patients and that preserve and strengthen the foundation our health care system – the American medical profession."
View the opinion here.