Supreme Court upholds individual mandate in President Obama's health care overhaul

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The U.S. Supreme Court has upheld the individual mandate of the Patient Protection and Affordable Care Act, often referred to as ACA or Obamacare, with a 5-4 decision. That means that individuals will be required to buy health insurance or face financial penalties. The court struck down part of the expansion of Medicaid.

The court said the individual mandate was the equivalent of a tax and it was not its role to strike down imposition of a tax. The expansion extended Medicaid coverage to more low-income parents and adults without children. The majority held that the Medicaid expansion is constitutional, but said only the expansion money could be withheld from states that did not want to participate; the federal government could not withhold other Medicaid funding.

That leaves the Medicaid expansion on "shaky ground," according to Judi Hilman of the Utah Health Policy Project.

ACA was passed by Congress along party lines in 2010. Not long after, 26 states challenged the law. This March, the Supreme Court justices listened to three days of oral arguments.

Among other things, the act contains the now-affirmed individual mandate to buy insurance or face fines. It eliminates lifetime caps on insurance coverage, discrimination in pricing and denial of coverage based on pre-existing conditions. Adult children are allowed to stay on a parent's insurance policy until age 26. It also says some preventive health services must be provided at no cost to the insured. And it expanded Medicaid to cover more low-income people.

In the moments following release of the decision, Twitter was buzzing with contrary reports of what happened, some major outlets reporting incorrectly that the individual mandate was overturned.

Reaction to announcement of the decision was swift.

The ruling surprised some watchers, who'd predicted that Chief Justice John Roberts and Associate Justice Anthony Kennedy would side together on the issue. Instead, Roberts, who wrote the majority opinion, sided with the more liberal view of the law, "although it was pretty clear Roberts didn't much like the law," said Robert Bennett, former U.S. Senator from Utah and now a fellow at George Washington University's School of Media and Public Affairs.

In voting that way, said Bennett, Roberts countered critics of the Supreme Court who have said the justices are too political and would not set aside personal beliefs and decide cases on the basis of the law. His position on health care reform "drove a major stake in that argument," Bennett told the Deseret News.

But Bennett believes the decision, while upholding the individual mandate, also weakens it. It is possible people will choose to ignore the mandate and pay the tax penalty instead, he noted. That would change the depth of the risk pool, which has to be big enough to afford the costs associated with all that the ACA provides. And the ruling on the Medicaid expansion "takes away the stick with which to beat the states" for not complying, but leaves the carrot.