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As It Happened: Supreme Court Upholds Health Care Law

Supporters of President Obama's health care legislation celebrated outside after hearing that the Supreme Court upheld the constitutionality of the Affordable Care Act.
Saul Loeb
AFP/Getty Images
Supporters of President Obama's health care legislation celebrated outside after hearing that the Supreme Court upheld the constitutionality of the Affordable Care Act.

The Supreme Court ruled today that the 2010 Affordable Care Act is constitutional — giving the Obama administration a big election year win over conservative critics who argue that the health care overhaul is a step on the way toward socialized medicine.

Republican leaders immediately vowed to renew their efforts to repeal the controversial act. Presidential contender Mitt Romney said that while the court may have found the act constitutional, it didn't say "that Obamacare is good law and good policy."

"Obamacare was bad policy yesterday, it's bad policy today," Romney said. "Obamacare was bad law yesterday, it's bad law today."

President Obama, meanwhile, said that debates over the political repercussions of the decision miss the point. He declared that "today's decision was a victory for people all over this country whose lives will be more secure because of this law" and the court's decision.

The decision virtually ensures that the health care act will remain a huge topic of debate in the presidential campaign.

In a 5-4 decision that was unusual because conservative Chief Justice John Roberts joined the court's four liberals and became the deciding vote, the justices ruled that the so-called individual mandate is a tax that Congress can impose on Americans. That undercut the challenge to that provision's constitutionality for allegedly violating the Commerce Clause.

From there, upholding the mandate meant that the rest of the act was judged constitutional as well.

We live blogged as the news developed and as key lawmakers reacted. We'll watch for more news of note as the day continues, but for more coverage you might also want to check NPR's Shots and It's All Politics blogs, as well as today's edition of All Things Considered. Click here to find an NPR station that broadcasts or streams the show.

Our coverage:

Update at 12:20 p.m. ET. I Didn't Do This Because It's Good Politics, Obama Says.

"I respect the very real concerns that millions of Americans have shared" about the act, the president just said. Then, he added that "it should be pretty clear by now that I didn't do this because it's good politics." Instead, he said, the act was passed because it is "good for the country ... good for the American people."

Update at 12:17 p.m. ET. Obama Says It's A Victory "For People All Over This Country":

Saying that debates over the political repercussions of the decision miss the point, President Obama just declared that "today's decision was a victory for people all over this country whose lives will be more secure because of this law" and the court's decision.

Update at 12:05 p.m. ET. Roberts Avoided "The Abyss":

On SCOTUSBlog, UCLA constitutional law professor Adam Winkler writes that:

"With this deft ruling, Roberts avoided what was certain to be a cascade of criticism of the high court. No Supreme Court has struck down a president's signature piece of legislation in over 75 years. Had Obamacare been voided, it would have inevitably led to charges of aggressive judicial activism. Roberts peered over the abyss and decided he didn't want to go there."

Richard Garnett, founding director of Notre Dame Law School's program in Church, State and Society, tells NPR's Liz Halloran that the decision confirms what Roberts "told us during his confirmation hearings."

"He's a guy trying to find the right constitutional arguments," Garnett said. "He's able to confirm his commitment to federalism, and to look really closely at a piece of federal legislation, regardless of the party that produced it, and see if it is constitutional. That's to be admired, no matter what you think of the decision."

Update at 11:54 a.m. ET. Romney Says It's Important To Repeal "Obamacare":

Calling the act a "job killer" that will have the federal government getting involved in "choosing your doctor," Republican presidential candidate Mitt Romney just renewed his call to repeal the act.

The court, he said, ruled that the act is constitutional. But "what the court did not say is that Obamacare is good law and good policy," Romney said. "Obamacare is bad law" and bad policy, he added.

Update at 11:47 a.m. ET. On Medicaid:

The one part of the Affordable Care Act that was found unconstitutional was the sanction imposed on states if they fail to expand Medicaid to the poor.

Essentially, the chief justice writes in the opinion, the federal government does have the ability to give states grants with strings attached. But in this case, the federal government was telling states that they had to expand Medicaid or lose funding for the whole program.

"Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer. The States are given no such choice in this case," Roberts writes.

The court decided the expansion can proceed, but the sanction against states that decide not to take part is struck down.

Update at 11:36 a.m. ET. Coverage On The Shots Blog:

Our colleagues on the Shots health blog are covering the decision here.

Reminder: Not only will there be substantial coverage on All Things Considered, but NPR will be broadcasting and streaming special coverage at 7 p.m. ET. Click here to find an NPR member station.

Update at 11:33 a.m. ET. Justice Ginsburg Would Have Upheld Mandate Regardless:

Justice Ruth Bader Ginsburg agreed with the majority that the individual mandate was constitutional under Congress' taxing authority.

But Ginsburg goes further, saying she would have upheld the individual mandate based on the Commerce Clause. She criticizes Roberts on his reading of the clause, which she called "stunningly retrogressive."

Here's a key paragraph from Ginsburg's concurring opinion:

"The provision of health care is today a concern of na­tional dimension, just as the provision of old-age and survivors' benefits was in the 1930's. In the Social Security Act, Congress installed a federal system to provide monthly benefits to retired wage earners and, eventually, to their survivors. Beyond question, Congress could have adopted a similar scheme for health care. Congress chose, instead, to preserve a central role for private insurers and state governments. According to the chief justice, the Commerce Clause does not permit that preservation. This rigid reading of the Clause makes scant sense and is stunningly retrogressive."

Update at 11:27 a.m. ET. What The Dissenters Said:

Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito dissented from the majority.

They aren't buying Roberts' argument that the individual mandate is also a tax: "We cannot rewrite the statute to be what it is not. Although this court will often strain to construe legislation so as to save it against constitutional attack, it must not and will not carry this to the point of perverting the purpose of a statute ... or judicially rewriting it."

And they agree with the other justices that the Commerce Clause simply didn't support the health care law. Citing a 1942 case, Wickard v. Filburn, the four justices note that government can regulate "the economic activity of growing wheat, even for one's own consumption." But they're astonished that someone could be punished for failing to grow wheat or in this case for failing to purchase health insurance. That failure isn't "an economic activity, or any activity at all." They warn that if the government can regulate the failure to act, this will "make mere breathing in and out the basis for federal prescription."

Update 11:20 a.m. ET. Romney, Then Obama To Speak:

Republican presidential candidate Mitt Romney's campaign says he will be making a statement at 11:45 a.m. ET. The White House says President Obama will speak at 12:15 p.m. ET.

Update at 11:17 a.m. ET. Roberts' Quest For Modesty:

The chief justice, NPR's Nina Totenberg just said on Morning Edition, has "always wanted to be painted" as modest in his judicial aspirations. This decision would seem to help him in that effort.

Update at 11:15 a.m. ET. "It Quacks Like A Tax."

On Morning Edition a moment ago, NPR's Nina Totenberg summed up the court's thinking on why the individual mandate is a tax this way:

"It looks like a tax, it walks like a tax, it quacks like a tax."

Update at 11:10 a.m. ET. Why The Mandate Is A Tax:

In the majority opinion written by Chief Justice Roberts, he lays out his case for considering the penalty a tax.

"Under the mandate, if an individual does not maintain health insurance, the only consequence is that he must make an additional payment to the IRS when he pays his taxes," Roberts explains. "That, according to the Government, means the mandate can be regarded as establishing a condition — not owning health insurance — that triggers a tax — the required payment to the IRS. Under that theory, the mandate is not a legal command to buy insurance."

Roberts admits that this may not be a natural reading of the mandate. But that doesn't matter, according to precedent.

"The question is not whether that is the most natural interpretation of the mandate, but only whether it is a 'fairly possible' one," Roberts writes.

Roberts also makes the case that "exactions not labeled taxes nonetheless were authorized by Congress's power to tax."

"In the License Tax Cases, for example, we held that federal licenses to sell liquor and lottery tickets — for which the licensee had to pay a fee — could be sustained as exercises of the taxing power," Robert writes.

Update at 10:44 a.m. ET. What Others Are Saying:

-- "HEALTH LAW STANDS." (The New York Times)

-- "Court Upholds Health Mandate As Tax." (The Wall Street Journal)

-- "ObamaCare SURVIVES." (Fox News)

Update at 10:40 a.m. ET. The Decision Itself:

Want to read the court's opinion? It's posted here.

Update at 10:38 a.m. ET. Boehner Reacts, Renews Push For Repeal:

This tweet just showed up on House Speaker John Boehner's page. It's one of the first reactions from Republicans:

"Today's ruling by the Supreme Court underscores the urgency of #fullrepeal of #ObamaCare j.mp/LFJTni #4jobs"

Update at 10:33 a.m. ET. The Key Points In "Plain English."

From SCOTUSBlog:

"In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters.

"Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding."

Update at 10:30 a.m. ET. Tax Issue "Saved" The Act:

On Morning Edition, NPR's Ari Shapiro just explained that the individual mandate was upheld as a tax.

The Obama administration had argued that mandating that everyone in the country have insurance was constitutional under the Commerce Clause of the Constitution. That was the administration's "A argument," as Ari explained. The "B" argument was that the individual mandate was constitutional under the federal government's ability to tax. During debate in Congress and in the law itself, the mandate is called a "penalty." It was up to the Supreme Court to decide whether the penalty was indeed a tax.

It appears, Ari said, that the "tax argument is what saved President Obama's signature law."

Update at 10:28 a.m. ET. Chief Justice Was The Deciding Vote:

According to SCOTUSBlog's Tom Goldstein, it was Chief Justice John Roberts who was the deciding vote on the key issue of whether the so-called individual mandate would survive. The vote was 5-4, says Goldstein, and Justice Anthony Kennedy sided with the "conservatives" while Roberts shifted to the "liberal" side.

Update at 10:24 a.m. ET. The Lede:

"The Supreme Court has upheld President Obama's signature health care law," NPR's Carrie Johnson writes. "Chief Justice John Roberts says the individual mandate survives because the penalty it imposes for not having insurance is considered a tax."

Also, NPR reports, "on the issue of the Medicaid expansion, a majority of the court said Congress can expand Medicaid, but can't strip states of all their Medicaid funds if they fail to do the expansion."

Update at 10:21 a.m. ET. "Yes We Did!":

Supporters of President Obama broke out in chants of "Yes We Did!" outside the court building as word came that the law has been upheld.

Update at 10:19 a.m. ET. The "Money Quote":

According to SCOTUSBlog, "the money quote from the section on the mandate is: 'Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it."

Update at 10:14 a.m. ET. "Entire ACA Is Upheld:"

According to SCOTUSBlog, "the bottom line [is that] the entire ACA [Affordable Care Act] is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read."

Update at 10:10 a.m. ET. Individual Mandate Is Constitutional:

In a dramatic conclusion to the year's most divisive legal debate, SCOTUSBlog says the U.S. Supreme Court has just ruled that the so-called individual mandate in the 2010 Affordable Care Act is constitutional — a decision that it's believed means the entire law passed by President Obama survives.

Update at 10:07 a.m. ET. Health Care Opinion Being Released:

About 10 minutes earlier than expected, the health care opinion is now being released.

Update at 10:02 a.m. ET. "Stolen Valor" Act Is Unconstitutional:

In the day's first decision, as SCOTUSBlog reports, the court affirms a Ninth Circuit decision that ruled the so-called Stolen Valor act is unconstitutional. The act made it a crime to lie about being the recipient of military medals. The justices voted 6-3 to affirm the lower court.

Update at 10 a.m. ET. Court Is In Session:

The justices have come to the bench, according to reporters at the court.

Update at 9:55 a.m. ET. On The Timing:

It's most likely, court watchers say, that the health care decision will be released around 10:15 a.m. ET. It will come after some less notable cases.

Meanwhile, NPR's Arnie Seipel reports that outside the court building "the sidewalks are packed." He reports "the strangest sight so far has been a pair of belly dancers with a small band who support single-payer."

Update at 9:50 a.m. ET. There Are Four Issues.

As SCOTUSBlog's Lyle Denniston says, there are really four issues confronting the justices:

-- Does the court have the authority to decide the constitutionality of the so-called individual mandate?

-- If so, is that mandate constitutional?

-- If the mandate isn't constitutional, do some or all parts of the act go down with it?

-- Is the act's expansion of Medicaid constitutional?

SCOTUSBlog, by the way, is also live blogging.

Our Original Post:

If everything goes as expected, sometime between 10 a.m. ET and 10:30 a.m. ET we should get word about the Supreme Court's most-anticipated decision of the year — on the constitutionality of the Affordable Care Act; the health care overhaul enacted in 2010.

Every U.S. news outlet, including NPR, has exhaustively previewed the decision, so we won't go over that ground yet again, except to point to the post we did Wednesday called "Here's How To Learn What The Supreme Court Says About Health Care." It has background and links you may find useful.

We'll use this post to cover the news as it comes in, so as decision time draws near be sure to hit your "refresh" button to see our latest updates.

NPR's Ari Shapiro, Carrie Johnson and Nina Totenberg will be reporting on the NPR Newcast and Morning Edition once the decision is released, and on All Things Considered later in the day. At 7 p.m. ET, NPR will be broadcasting and streaming special coverage of the decision and what it means. Click here to find an NPR member station.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Mark Memmott is NPR's supervising senior editor for Standards & Practices. In that role, he's a resource for NPR's journalists – helping them raise the right questions as they do their work and uphold the organization's standards.
Eyder Peralta is NPR's East Africa correspondent based in Nairobi, Kenya.
Korva Coleman is a newscaster for NPR.