(CN) – A five-justice majority of the Supreme Court upheld health care reform Thursday, but division in the ranks contributed to 127 pages in separate opinions.
The four colleagues who joined the majority opinion of Chief Justice John Roberts banded together for an equally lengthy argument that defended the law’s power under the commerce clause and the necessary-and-proper clause of the U.S. Constitution.
Roberts had said that taxing powers supported the so-called individual mandate of the Patient Protection and Affordable Care Act, but said the government’s attempt to apply commerce powers was akin to mandating that all Americans eat a healthy diet.
The health care mandate, otherwise known as the minimum-coverage provision, imposes penalties on eligible citizens who choose not to purchase health insurance. It is set to take effect in 2014, empowering the Internal Revenue Service to collect the penalty with an individual’s taxes, just as it would collect a penalty against those who overstate their income tax refunds.
Roberts’ colleagues in the majority said that high cost of health care activates the commerce clause.
There were 50 million uninsured Americans in 2009, but at least half still visit doctors or emergency rooms every year. This group consumes more than $100 billion in health care services, nearly 5 percent of the nation’s total, according to statistics cited by the court.
Hospitals, physicians and other medical professionals received no compensation for $43 billion worth of the $116 billion in care they administered to those without insurance in 2008, the opinion states.
The cost-shifting that results from providers passing these debts along has caused family insurance premiums to increase by an average of $1,000 a year, the judges added.
“In sum, Congress passed the minimum coverage provision as a key component of the ACA to address an economic and social problem that has plagued the nation for decades: the large number of U. S. residents who are unable or unwilling to obtain health insurance,” Justice Ruth Bader Ginsburg wrote, joined by Justices Sonia Sotomayor, Stephen Breyer and Elena Kagan. “Whatever one thinks of the policy decision Congress made, it was Congress’ prerogative to make it. Reviewed with appropriate deference, the minimum coverage provision, allied to the guaranteed-issue and community-rating prescriptions, should survive measurement under the commerce and necessary and proper clauses.”
Sotomayor joined this opinion in full, but Breyer and Kagan did not agree with its fifth and final section, which looked at Medicaid expansion under the new health care law.
Ginsburg and Sotomayor said they sided with the limits Roberts applied to this section.
Roberts took pains to note that invalidating an application of a statute does not rewrite it, thus preserving the rest of the act.
This issue and others sparked a 65-page dissent from the court’s right-leaning justices.
“The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying nonconsenting states all Medicaid funding,” according to the dissent joined from Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito. “These parts of the act are central to its design and operation, and all the act’s other provisions would not have been enacted without them. In our view it must follow that the entire statute is inoperative.”
Thomas followed up with a separate, one-paragraph dissent in which he argued that court precedent has improperly empowered Congress to regulate economic activity that “substantially affects interstate commerce.”
“As I have explained, the court’s continued use of that test ‘has encouraged the federal government to persist in its view that the commerce clause has virtually no limits,'” Thomas wrote, quoting a concurring opinion he authored in 2000. “The government’s unprecedented claim in this suit that it may regulate not only economic activity but also inactivity that substantially affects interstate commerce is a case in point.” (Emphasis in original.)