President Obama’s signature legislative achievement, the 2010 Patient Protection and Affordable Care Act, has now passed two major challenges in the Supreme Court. In each, Chief Justice John Roberts wrote the decisions upholding disputed aspects of “Obamacare.” The latest came down Thursday in favor of Mr. Obama, saying the federal government can run a marketplace for individuals to buy a range of health insurance policies in the 34 states that currently do not offer such an “exchange.”
While Chief Justice Roberts had to read much into the presumed intent of Congress on whether states alone should run an exchange, he nonetheless continued an important theme that runs through these rulings. Indeed his theme runs through both the Constitution and parts of the Affordable Care Act itself. It is an emphasis on protecting freedom of choice.
In a 2012 ruling on the act, Roberts said Congress cannot impose a mandate on individuals to buy health insurance under the threat of a penalty in the form of a fine. Federal powers do not extend to such a control over an individual’s choice not to participate in a market. But, he stated, Congress can use its constitutional power to tax in order to “encourage” an individual to purchase health insurance.
He said a fine would have had the potential to “destroy” individual welfare whereas a tax can be subject to limitations. The high court could someday decide the law's provision for taking 2.5 percent of a person’s income for not buying health insurance is too burdensome.
In the same ruling, he also upheld the right of states to opt out of the law’s coercive measure in forcing an expansion of Medicaid for lower-income Americans.
In a similar vein, his latest decision endorses the free market aspects of the law, noting that the individual insurance exchanges are meant to allow “people to compare and purchase insurance plans.” And each state remains free not to set up an exchange.
In his penultimate point, he states: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”
In these decisions, the chief justice has helped bring a necessary balance between the right to health and a right to choose one’s method of health care. The two need not be incompatible. Future court rulings and another Congress might adjust that balance. For now, Roberts and the other justices who have supported him are helping find that balance.