Supreme Court’s Affordable Care Act decision will have massive, immediate impact

The Supreme Court will hear several states’ legal challenges to the Affordable Care Act, ensuring that the court — in late June 2012 — will deliver a momentous statement about the ever-contentious constitutional balance between federal and state power.


“The key element of the states’ lawsuits targets the act’s requirement that everyone in the country must purchase commercial health insurance,” says constitutional law expert Gregory P. Magarian, JD, professor of law at Washington University in St. Louis.

“From a policy standpoint, this individual mandate works much like Social Security taxation, ensuring that everyone has a stake in a system of public benefits. The challenger states, however, argue that the individual mandate exceeds the federal government’s authority by requiring people to buy a commercial product. The government maintains that Congress’ constitutional power to regulate commerce justifies the mandate.”

Magarian says that the legal dispute over the individual mandate implicates deep, perpetually controversial questions of constitutional federalism.

“In my view, the realities of modern economics and politics compel a generous reading of the federal government’s constitutional authority to regulate commerce,” he says.

“The court has acknowledged those realities in a series of decisions stretching back almost 75 years, consistently validating broad and ambitious federal regulations of crime, labor relations, the environment, and more. Based on these principles and precedents, I believe the court should uphold the act unequivocally.”

Magarian notes that no one, supporter or opponent of the act, can credibly claim that the Constitution’s text or history requires a particular result.

“Despite what we sometimes like to imagine, the court in constitutional cases makes law. It will do so in this case, and whatever law it makes will have massive and immediate practical impact,” he says.

“Constitutionally, however, the court’s decision will represent merely the latest movement in a controversy that will last as long as our Constitution does.”


Magarian says that one element of the Supreme Court’s decision to hear the case should worry supporters of the act.

“In addition to the individual mandate issue, the court agreed to consider the challenger states’ argument that the act’s extension of the Medicaid program coerces states by making them provide more services in exchange for federal funding,” he says.

“This argument makes little if any sense. The court has held that the Constitution places only negligible limits on the federal government’s power to attach conditions to its spending. Perhaps the court agreed to hear this issue simply out of attention to judicial efficiency.

“On the other hand, the opportunity to uphold the Medicaid extension could protect the court in the event it decided to strike down the individual mandate, creating an appearance of balance in what would really be a devastating loss for the government,” Magarian says.