The U.S. Supreme Court decision upholding the Affordable Care Act was a victory, even for advocates of limited government.
It was, of course, a victory for people with pre-existing conditions who could not get health insurance coverage. It was a victory for the millions of people who, lacking insurance coverage, have almost no access to health care. It was a victory for hospitals that, under current law, have to treat uninsured people in emergency rooms.
It was a victory for all insured Americans who pay about $1,000 a year in extra premiums to cover the costs of those who decline to buy health insurance.
Here’s the surprise, though: It was a victory for those who fear that the federal government’s power over individuals and the states is out of control.
The Commerce Clause of the U.S. Constitution has been the enumerated power through which federal control of the individual has ballooned. Because interstate commerce is far more extensive than the Founding Fathers could have imagined, what they thought was a narrow power had become an all-consuming one.
The Supreme Court on Thursday drew a line in the sand when it held that the Commerce Clause did not authorize an individual mandate. Writing for the majority, Chief Justice Roberts basically said, “Enough is enough.”
The conservative justice also pointed out that the “individual mandate” is not a mandate. The ACA gives people a choice: Buy health insurance or pay a tax. For many people, that tax will be less than the cost of health insurance. By law, the tax cannot exceed the cost of insurance. Using taxes to encourage wise decisions is nothing new. We impose extra taxes on tobacco and alcohol to discourage their use. Tax incentives already encourage people to buy homes, attend college and give to charities. This tax encourages people to buy health insurance.
Roberts made clear that if Congress makes the tax so high that it effectively forces people to buy health insurance, it will have exceeded its taxing authority.
Not only did the court impose the first significant limit on the federal government’s power under the Commerce Clause, it also placed a new limit on Congress’ ability to mandate state activity.
The court ruled the ACA went too far when it threatened to eliminate Medicaid funding for those states who decline to expand Medicaid coverage.
Everyone knew that U.S. health care had serious problems. For most, the fear of Obamacare was that it would expand federal control over the individual even more.
In a wise decision, the court both upheld a desperately needed change to our health care system and placed new limits on the power of the federal government.
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