The mandate is the centerpiece of Mr. Obama’s Affordable Care Act (ACA) – the signature legislative accomplishment of his presidency, which aims to set the nation on a path to universal health-care coverage. With the court's 5-to-4 decision, Obama is vindicated in his insistence that the law is constitutional. Never mind that the court upheld the mandate in a manner few had expected: that the penalty for failing to buy insurance is a tax, which Congress has the right to levy.
As a former teacher of constitutional law, Obama would have faced embarrassment had the mandate been struck down.
But Obama’s victory could come at a political cost. The mandate is unpopular with the public, and the president will have to defend it in his reelection campaign. At the same time, the high court has handed his challenger, Mitt Romney, and the GOP a pungent election-year issue. Republicans, particularly those with a libertarian, tea party bent, assert that the mandate represents an overreach of federal power and an affront to individual liberty.
At press time, both Obama and Mr. Romney were due to deliver statements shortly.
In Congress, Republicans have pledged to repeal the law they derisively call “Obamacare.” But with Democrats in charge of the Senate, and Obama still president, such efforts will go nowhere. That raises the stakes for the fall election. Romney has pledged to issue “Obamacare” waivers to all 50 states on his first day in office, and then sign repeal legislation as soon as it reaches his desk.
For his part, Obama is likely to keep emphasizing aspects of the law that are popular: the guarantee that insurance companies accept new patients despite preexisting health conditions; the ban on “community rating,” which requires the same price for coverage regardless of gender and health status; the provision that allows adult children up to the age of 26 to be covered on their parents’ plan; the filling in of the “donut hole,” the gap in coverage for prescription drugs under Medicare.
And lest Republicans think Obama got everything he wanted from the Supreme Court, they can take comfort in the court’s ruling on the law’s expansion of Medicaid. Under the law, Medicaid would have become available in 2014 to anyone whose income is less than 138 percent of the federal poverty line. Because Medicaid is a joint federal-state program, states argued that the expansion would have posed an undue financial burden. The court ruled that states can opt into the Medicaid expansion but are not required to.