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Supreme Court Rules On Health Care Law


The Supreme Court has just wrapped up its term with one of the most consequential cases in decades.


The justices have ruled that the landmark health care law that has become a signature of Barack Obama's presidency is largely upheld. The opinions run hundreds of pages. We're looking at all those pages now and we'll bring you detailed news and analysis all morning.

MONTAGNE: And we have with us in the studio NPR's Ari Shapiro to talk about what we do know at this moment, and really just minutes after this ruling has been made public. Ari, welcome. Good morning.

ARI SHAPIRO, BYLINE: Thank you. Nice to be with you.

MONTAGNE: On this...

SHAPIRO: Eventful day.

MONTAGNE: Momentous morning, yeah. The Supreme Court has functionally upheld the mandate, that is the individual mandate, the requirement that every American buy health insurance - not exactly as one might have expected.


MONTAGNE: Tell us what happens here.

SHAPIRO: So the key part of this law is the requirement that everybody have health insurance, whether it's provided through their employer or on the individual market. And the government, in front of the Supreme Court, basically made two arguments that this was constitutional. Their A argument was: the commerce clause allows the federal government to regulate interstate commerce, which includes this requirement that everyone have health insurance.

Well, it looks to us right now, at least on an initial reading, like the justices did not buy that commerce clause argument. And they said, under that argument, the mandate might not have been constitutional. But the government also had a B argument, which was: this is basically a tax. The penalty for not having health insurance is a tax and the federal government is allowed to levy taxes. And so if you don't buy our commerce clause argument, well, then the tax argument should stand.

You didn't hear a lot about the tax argument in the early days of this law because, for understandable reasons, the Obama White House did not want to be portrayed as raising taxes on anyone. But it looks this morning like that tax argument is what saved President Obama's landmark health care law in the Supreme Court.

WERTHEIMER: And the thing that I think is most remarkable about this decision, Ari, is that the deciding vote appears to have been cast by the chief, John Roberts.

SHAPIRO: Chief Justice John Roberts. And it looks right now as though the narrow way in which they tailor this opinion, upholding the mandate and therefore most of the rest of the law while making it a tax rather than under the commerce clause, in some ways, gives a victory to both the court's conservative leader, John Roberts, the chief justice, and also President Obama, the Democratic head of state who championed this law in the first place.

WERTHEIMER: Now there is one element. We should say that it looks as though this is a fairly broad endorsement of the constitutionality of the Affordable Care Act, but there are some exceptions but they're in the Medicaid area.


WERTHEIMER: And that was a relatively unrelated section of the act which expanded the coverage of Medicaid.

SHAPIRO: Right. So you remember that there were three big days of arguments. And the last day of arguments was about the legality of the expansion of Medicaid, in which the federal government basically said, states, you have to cover more people under Medicaid than you did before, and we'll cover most of the cost of that, but not all. And if you decide not to expand Medicaid coverage, then we pull away all of our federal funding for your Medicaid coverage.

So the states said that's not legitimate. That is an overreach of the federal government. The federal government said, look, take the money or leave it. But if you're going to take it, we're allowed to attach these conditions. It looks as though the Supreme Court has limited the scope of the federal government's ability to expand Medicaid in this way, though they haven't thrown it out altogether. That's something we're still parsing as I and my colleagues pore through these hundreds of pages of opinions.

MONTAGNE: Those two areas of this law are really the heart of the law, in terms of how many people will get covered and, you know, how they will get covered. What else so far do we know, or do we not know really, yet, quite what the other details are?

SHAPIRO: Well, just to take a step back to look at the big picture of this case. There were basically four questions before the court. The first question boils down to, does the court have a right to decide this case at all? And clearly they said, yes, we do. The second question was, if you've got the right to decide this case, then is the individual mandate constitutional, which, as we just discussed, the court said it is constitutional, but under this taxing provision, not under the commerce clause.

This third question was, if the individual mandate is not constitutional, does the rest of the law stand or fail? Since they upheld the individual mandate, that third question becomes relatively moot. And then the fourth question was about the expansion of Medicaid, which we just discussed, appears to have been narrowed but not struck down.

WERTHEIMER: Now, there were some question about if - that the court might divide this law up in various ways, find some of it OK, some of it not OK. The fact that it's a five-four decision upholding the mandate, that ends all questions of severing parts of the law.

SHAPIRO: You know, I think we're still parsing who sided with whom in what. And so, it's possible, I'm just not prepared to say that there is a concurring opinion, a majority opinion, a preponderance of the judges who are siding with this and that. Obviously, the fact that there are hundreds of pages means there's a whole lot of nuance we're going to get to as we peel back the layers of this onion. But for now, it does look like, given that the centerpiece of the law is intact, most of the rest of it may well be OK as well.

WERTHEIMER: Now one of the things that I think is interesting, we're getting this, I'm reading this right off of SCOTUS blog - which is one of the things that we rely on for analysis of opinions - that you cannot - you might be able to wiggle out of a mandated ruling that you had to buy health insurance, but you can't wiggle out of a tax.


WERTHEIMER: A tax is a tax.

SHAPIRO: Right. There is this quote here from Chief Justice Roberts' majority opinion. It says, "Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power." Just to translate, that's the fee or the penalty that people pay for not having health insurance. So, according to Roberts, Congress had the power to impose that exaction and that Section 5000A, that penalty, need not be read to do more than impose a tax. This is sufficient to sustain it, to sustain the law, says Chief Justice Roberts.

In other words, Congress had the right to levy this penalty. And given that they had that right to levy the penalty on people who do not have health insurance, the rest is kind of moot.

MONTAGNE: Would it be fair, then, to say at this moment in time - a lot of details yet to come - but that the Affordable Care Act has been, for all intents and purposes, upheld?

SHAPIRO: That's the headline. And the political implications of this cannot be overstated. Health care for everyone has been a dream of the Democratic Party for at least the last half-century. It was the preeminent accomplishment of President Obama in his term and it was the number one goal of Republicans to undo this. The fact that the law has largely been upheld means it will continue to be a rallying cry for conservatives and Republicans in the upcoming elections. And it will continue to be an accomplishment that President Obama can trumpet on the campaign trail and in his legacy going forward.

WERTHEIMER: Now according to what I'm reading on my, you know - as we watch information sort of scroll up, the liberals on the court decided that it should be upheld, both on the commerce clause and as a tax.

SHAPIRO: Right. And so Roberts was the reason we have a narrow opinion rather than a broad one.

MONTAGNE: So as you can see, plenty to talk about. We'll be talking about this all morning and throughout the day at NPR News. Ari, thank you very much. This is MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.

As NPR's senior national correspondent, Linda Wertheimer travels the country and the globe for NPR News, bringing her unique insights and wealth of experience to bear on the day's top news stories.
Renee Montagne, one of the best-known names in public radio, is a special correspondent and host for NPR News.
Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.