Affordable Care Act Ruling


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The U.S Supreme Court on 28th June 2012 submitted its decision in the cases that were challenging the Affordable Care Act by Patient Protection and Affordable Care Act (PPACA). The two parts that were facing scrutiny were the individual mandate that required all Americans to buy health insurance or else they face a penalty, and Medicaid expansion. After the law was passed several people perceived it as a violation of the Constitution’s commerce clause that mandates the government to control trade among different states. However, in its ruling, the court maintained that it was not possible to uphold the individual mandate under the commerce clause. However, the court supported that the order was a tax and therefore, a constitutional exercise under the taxation authorities. The interpretation of the ruling was that the individual mandate was provided with two options; purchase of the health insurance or pay for a penalty to the IRS. Additionally, the court narrowly ruled that the expansion of PPACA’s Medicaid expansion was constitutional provided that all the states had access to government funds if they did not comply with the Medicaid expansion provisions. To mention, the court also stated that the Congress threat to withhold Medicaid funds for all the states that were not willing to support Medicaid expansion was above its powers (FRH, 2012).

The final decision was made by Judge Justice Robert who presented the deciding vote of the mandate as a tax. All through his presentation he regularly mentioned that the Supreme Court of the United States (SCOTUS) had no power to pass any practical, personal or political judgment of this law. In his opinion from the first to the last paragraph, Justice Robert reminds us that despite the PPACA’s justices, political or personal views the only job they had was to judge the law against the constitution and the powers given to the federal government. Therefore, this distinguishes that as much as the decision to affirm the mandate may be subjected to political implications, the ruling itself was not political.

The mandate was not upheld under the commerce clause because, as much as it is a great power given to the Congress, it has its limits. The decisive issue of the mandated about commerce clause is that could inactivate commercial activities. Implementing this would lead to the expansion of the already broad interpretation of the provision beyond the predetermined limit. On the other hand, the mandate was upheld as a tax under IRS. This was considered constitutionally acceptable by the Supreme Court and was enforced as a penalty but not a tax. This was not a subject to Anti-Injunction Act, which indicates that taxes are not challengeable until they are paid or charged. Nevertheless, this does not exclude it from being used for determination of the constitutional validity of bills. This was a right decision as it helped keep alive the insurance mandate of PPACA. Politically, it gave Obama recognition through its legislation.  Nevertheless, this might not be the end of it. It could also contribute to the formation of movements against the law and as a result, could have led to the removal of Obama from the presidency. As much he had continually stated that the mandate was not a tax the Supreme Court confirmed it as a tax. This decision would have led to debates that would overturn the bill and remove President Obama from the state house.

For the Medicaid Expansion, all states were expected to a bind with the new regulations, or they would lose their existing Medicaid funding. The case was overturned under the constitutional microscope on a 5-4 vote. Practically, threatening the states of withdrawing Medicaid funds to force them to comply was not permitted. The decision also gave the federal government limited power to govern the nations.

The law provides that all persons have the right to life, property, and liberty and the state should not deprive their citizens these rights without facing the wrath of the law. There are no duties that have been imposed by the constitution to the government to protect, act or intervene against personal invasions. The position of the Supreme Court is therefore to follow the law and is not responsible for protecting the health and safety of the public (ACEP, 2011).

All policymakers need to familiarize themselves with all the legal policy tools since the law is an agent of societal change. Nevertheless, it limits the roles of public policy. Thus, policymakers must be ready to handle the social, legal and ethical challenges that may arise. The court can interfere with the individuals’ privacy through surveillance. However, with US supreme caught upholding the state’s power to report disease incidences; it also insisted that the health agencies should adequately protect the privacy of the individuals. Although this decision can be a critical disease control measure, there is no adequate assurance that the confidentiality of the individuals will be protected.



Focus on Health Reforms (FHR), (2012). A Guide to the Supreme Court’s Affordable Care Act Ruling.

American College of Emergency Physicians (ACEP), (2011). The ethics of health care reform: issues in emergency medicine—an information paper.


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