By now, you've heard the news and seen the headlines: the Supreme Court of the United States has upheld the Patient Protection and Affordable Care Act. The Court’s decision reflected three of the four possible questions it could consider on the case: Will the Court rule on this issue? Yes. Is the Individual Mandate constitutional? As a tax, yes. Can the federal government implore the expansion of Medicaid across states? Yes, but in a narrowly interpreted, limited sense.
The final question of “severability” – what parts of the law survive if the individual mandate must go — was not considered. Chief Justice John Roberts sided with the left-leaning members of the bench to affirm health care reform.
The majority opinion recognizes the constitutional difficulty of the infamous Individual Mandate under the Commerce Clause, and so noted that an agreement by five justices could not be reached on that basis. But taken under the taxing power of Congress, Justices Roberts, Ginsburg, Kagan, Breyer, and Sotomayor found the Individual Mandate for all Americans to buy health insurance constitutional.
This is the first successful attempt at health care reform in history, and President Obama and Congress have changed the health care game. Last week, the Department of Health and Human Services released data that 3.1 million Americans aged 19-25 have gained health insurance under the ACA. Previously, the largest blind spot in health insurance coverage (so much so that they had a name for it — the ‘young invincibles’), now over 74 percent of this demographic has got it covered. By 2014, 30 million of the 50 million currently uninsured will have health insurance.
While the decision came largely as a surprise (Intrade, the prediction market for current events wagers, had odds that the individual mandate would be struck down at about 70 percent moments before the ruling.), what will surprise no one are the political consequences. This ruling is certain to energize both bases in the upcoming election. Governor Romney will use the decision to continue sounding the alarm for repealing the law, and President Obama will continue trumpeting its on-the-ground success.
While the results in this sense are predictable, it’s clear that the present advantage goes to President Obama, who, by Governor Romney’s own words, staked the political capital of his first term on the success of this legislation. The tested and sustained success of a landmark law strongly signals the President’s ability to manifest change. The hope his campaign seeks to proffer on the looming issues of comprehensive immigration reform for rest safely for now.
However, this case is unlikely to swing the election. The conventional wisdom inside and outside the beltway holds that economics will sway this vote in November. But this ruling will shape the discourse of the coming weeks. It will mold the campaign strategy, the fundraising pleas, the pot shots and grandstanding on both sides. The most this decision will do is “activate” more voters. It becomes a rallying point.
Also worth considering is the popular import of this decision. Court-watchers outside the building today noted the sprawling crowds. Perhaps more than the Citizens United decision, which gained notoriety in its aftermath, this case has drawn the most attention in over a decade. Indeed, the Supreme Court, aware of this, held some of the longest oral arguments in recent history, giving access to daily recordings of the hearings in lieu of public access to the physical chamber. In a polarized political climate, no estate is left unturned.