Most glaringly, the court struck down the sanction that faced any state that didn't agree to expand its Medicaid program, ruling such a bargain as tantamount to coercion. No other court, not even the District Court judge in Pensacola, Fla., who struck down the entire act and launched the case that went to Washington, found the Medicaid provisions unconstitutional.
With the insurance mandate, Roberts and the liberal-leaning justices upheld it on the grounds that it was an exercise of Congress' power to tax under the Constitution. Neither of the federal appeals courts in Cincinnati or Washington that ruled the mandate legal did so on those grounds.
But observers said that by ruling that way on the mandate, Roberts achieved two goals. First, he avoided a party-line split on a major national controversy, while also not granting the expansion of congressional power that many conservatives and libertarians have railed against.
“Even if Congress lacks the power to direct individuals to buy insurance, the only effect of the individual mandate is to raise taxes on those who do not do so, and thus the law may be upheld as a tax,” Roberts' wrote for the majority.
M. Miller Baker, a constitutional law and appellate court attorney with McDermott Will & Emery in Washington, said virtually no one could have foreseen Roberts' ruling.
“The shocker here is that there were five votes to sustain this on the taxing power,” Baker said. “Congress over and over went out of its way to say this is not a tax, and the president himself said it wasn't a tax. And now it's being upheld as a tax.”
Indeed, staunch reform law opponent Ken Cuccinelli, the attorney general of Virginia who filed his own unsuccessful court challenge, noted that as a political “silver lining” of the ruling.
“Those who support this law and who voted for it are now and forever on record for supporting this tax increase—a position they refused to admit when passing the bill,” Cuccinelli said in a written statement.
Cuccinelli also said the opinion represented the first time since the 1930s-era New Deal that the court had imposed any limit on congressional power under the Constitution's commerce clause.
Indeed, Roberts' opinion opened with a preamble describing a kind of deep national and institutional soul-searching that the healthcare law had provoked, framing the ruling's constitutional context in terms of the sweeping powers of states to police their citizens, as compared to the limited powers of the federal government enumerated in the Constitution.
Yet the decision reached a conclusion that is anathema to many proponents of individual liberties and limited federal powers: that the federal government has the power to cajole some people to buy a private product.
“Simply put, Congress may tax and spend,” Roberts wrote. “This grant gives the federal government considerable influence even in areas where it cannot directly regulate."