The U.S. Supreme Court yesterday issued its decision regarding legal challenges to President Obama’s 2010 Patient Protection and and Affordable Care Act.

The court ruled 5 to 4 to uphold virtually the entire law with some limits placed on the expansion of Medicaid.  Chief Justice John G. Roberts Jr., in the deciding vote, joined the Supreme Court’s liberals agreeing that the requirement for nearly all Americans to secure insurance is permissible under Congress’s taxing authority.  The court’s decision keeps in place one of the most sweeping pieces of domestic policy legislation in a generation that could extend coverage to as much as 32 million uninsured Americans when most of the law is set to take place in 2014.

The Democratic-controlled House and Senate passed the law without a single Republican vote in March 2010.  The legal battles over the health-care legislation began almost immediately after President Obama signed it into law and dozens of lawsuits were filed nationwide to  challenge the law.  The Supreme Court agreed to hear a suit brought by twenty-six states as well as a challenge by the National Federation of Independent Business.   These lawsuits culminated in three days of oral arguments before the Supreme Court in March.

At the core of the legislation is the mandate that Americans obtain health insurance by 2014 or face a tax penalty.  Those opposed to the law argued that Congress overreached its authority to regulate interstate commerce and impose taxes when it approved the insurance mandate and was thus unconstitutional.  States also challenged an expansion of Medicaid.

The court rejected the argument of the Obama administration that the individual mandate is constitutional under the commerce clause of the Constitution.  Roberts, who wrote the majority opinion, was joined by the court’s four liberal justices–Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor, and Elana Kagan. Roberts upheld the provision on the administration’s secondary, fallback argument that the penalty for refusing to buy health coverage amounts to a tax and thus is permitted.

Roberts summed up the decision:  “The federal government does not have the power to order people to buy health insurance,” he wrote.  “The federal government does have the power to impose a tax on those without health insurance.”  The law “is therefore constitutional because it can reasonably be read as a a tax.”  Roberts appeared to set limits on the size of the tax.  “The payment is not so high that there is really no choice but to buy health insurance, he wrote.  “The mandate need not be read to declare that failing to purchase health insurance is unlawful…beyond requiring a payment to the IRS.” Roberts legal reasoning was unanticipated by almost all following the political and legal

Justice Anthony M. Kennedy said the law is an affront to individual liberty and should have been rejected in its entirety.  “The values that should have determined our course today are caution, minimalism, and the understanding that the federal government is one of limited powers,” he said, speaking for Justices Antonin Scalia, Clarence Thomas, and Samuel A. Alito Jr.  “The court’s ruling undermines those values in every turn.”

The court’s ruling did limit the expansion of Medicaid to cover more poor and disabled people.  The program is a joint federal-state effort, and the court said the law’s requirement that states rapidly extend coverage to new beneficiaries or loose existing federal payments was unduly coercive.

Roberts said Congress crossed a line in threatening states with the loss of existing funding if they did not comply with the new requirements even if the federal government for now was footing the bill.  He said Congress may offer money to entice the states, but may not withdraw funding as a threat.  “What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding.” The court left intact provisions that require insurers to cover people with pre-existing condidtions, keep adult children on their parents’ health plans until age 26, and remove lifetime caps form policies.

House Majority Leader Eric Cantor (R-VA) has announced that the Republican-controlled chamber would vote again July 11 to repeal the law upheld by the court.  However, whatever repeal efforts House Republicans make will clearly die in the Senate, where Democrats have control, and President Obama has the ability to veto such a bill if it somehow passed in both the House and Senate.  Therefore, the health care act will be a pivotal issue in the upcoming presidential election.  “What the court did not do on its last day in session, I will do on my first day as president,” Mike Romney, the presumptive GOP nominee said.  However, if elected, Romney would still need the help of Congress, including a Senate in Democratic hands.  Because it is a tax provision, Senate passage requires 51 votes, rather than the usual 60 super majority.

An Associated Press Poll taken before the Supreme Court vote showed that 47 percent of respondents opposed the health-care law and 33 percent supported it, with only 21 percent of political independents backing the measure.  The survey of 1,007 adults, taken June 14-18, had a margin of error of plus or minus 4 percentage points.