Supreme Court upholds most of health-care law

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• What to expect as health-care law phases in

WASHINGTON — The Supreme Court upheld nearly all of President Obama’s health-care law Thursday, ratifying the signature domestic achievement of his presidency and affirming the broad overhaul that Democrats had sought for more than six decades.

The decision ensured that the law will continue to take effect — barring an unexpected repeal — extending coverage to the uninsured, providing new protections such as coverage for pre-existing medical conditions and imposing new taxes to finance it all.

In a ruling that’s politically far-reaching but legally restrained, the court said in a 5-4 decision that Congress had acted within its taxing power when it mandated that people buy health insurance or pay a penalty. The rest of the health-care law likewise survived, save for tinkers with a provision that directs states to expand Medicaid coverage.

“It is reasonable to construe what Congress has done as increasing taxes on those who … choose to go without health insurance,” Chief Justice John Roberts Jr. wrote for the majority. “Such is within Congress’ power to tax.”

Roberts, a 57-year-old conservative nominated by former President George W. Bush, formed an intriguing alliance with the court’s four Democratic-appointed justices to control the decision. In essence, they reached the same conclusions by different routes. The liberals wanted a more expansive ruling. Instead, they ended up providing most of the votes while Roberts narrowed the reasoning as much as he could.

Congressional Republicans, who voted en masse against the Patient Protection and Affordable Care Act in 2010, vowed to kill it if they could. The House of Representatives will vote on a repeal bill July 11, Majority Leader Eric Cantor, R-Va., announced Thursday. Though the repeal is likely to pass the House, it almost certainly will fail in the Senate, where Democrats hold the majority.

Passed on party-line votes in Congress, the law includes hundreds of provisions that are being phased in over several years. Many are politically popular across party lines, such as one allowing parents to keep their children on family insurance policies until age 26. The centerpiece, though, is a government mandate on individual Americans that alarms conservatives.

The mandate requires that taxpayers obtain a minimum level of health insurance coverage by 2014. With some exceptions, those who don’t get insurance must pay annual fees that start at $95 in 2015 and rise to $695 by 2016.

The court’s conservatives, including Roberts, agreed that the individual mandate violated the Constitution’s Commerce Clause. The Commerce Clause authorizes Congress to regulate commerce “among the several states.” Since the New Deal era of the 1930s, this has justified many expansions of the federal government on the basis that the activity substantially affects commerce.

“It is no surprise that Congress has employed the commerce power in a wide variety of ways to address the pressing needs of the time,” Roberts wrote, “but Congress has never attempted to rely on that power to compel individuals not engaged in commerce to purchase an unwanted product.”

The court’s four liberal justices contended that the Commerce Clause empowered Congress to impose the mandate, with Justice Ruth Bader Ginsburg arguing in dissent that while “the insurance-purchase mandate is novel … novelty is no reason to reject it.” This reasoning, had it prevailed, would have been much more sweeping than Roberts wanted. It also would have encouraged more congressional efforts to build laws atop the Commerce Clause.

Justices Sonia Sotomayor, Elena Kagan and Stephen Breyer joined Ginsburg.

Roberts tied approval of the individual mandate to the power of Congress to “lay and collect taxes.” Though Obama and congressional Democrats denied that the individual-mandate penalty was a tax, Roberts reasoned that it effectively serves as a tax. That saved the mandate, but it set a less-aggressive precedent.

Conservative justices Antonin Scalia, Samuel Alito and Clarence Thomas joined Justice Anthony Kennedy in saying the tax-powers reasoning gave Congress too much benefit of the doubt.

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