HealthReformGPS is made possible through generous financial support from the RCHN Community Health Foundation. Visit them at

Supreme Court Issues Ruling in Landmark Health Reform Case

Posted on June 28, 2012 | Comment (1)

PDF Version
Implementation Briefs
Key Developments
Editor's Comment

The U.S. Supreme Court has released the highly anticipated decision regarding the issues raised by parties in two cases: Florida, et al. v. Department of Health and Human Services and National Federation of Independent Business v. Sebelius.

President Barack Obama signed the Affordable Care Act (ACA) into law in March 2010.  On March 26-28, 2012, the Supreme Court heard arguments regarding the following four issues:

1)      Anti-Injunction Act: Whether the Anti-Injunction Act bars consideration of the ACA’s minimum coverage provision before the mandate’s penalties take effect in 2015

2)      Minimum Coverage Provision: If the ACA’s minimum coverage provision exceeds Congress’ powers under Article I of the U.S. Constitution

3)      Severability: If the minimum coverage provision is invalidated, whether the remainder of the ACA must also be invalidated or if it is severable from the rest of the law

4)      Medicaid Expansion: Whether Congress exceeded its powers and violated the principles of federalism by conditioning a state’s receipt of any federal Medicaid funding on implementation of the ACA’s Medicaid expansion

The Court held that the minimum coverage provision is constitutional, and survives as a tax. The Medicaid expansion is also constitutional, but Congress’ enforcement power to compel states to comply with the new expansion is limited. Medicaid participation by states is voluntary and always has been.  And under today’s ruling, states that choose not to comply with the new expansion can only be subject to forfeiting the new expansion money; the federal government may not penalize them further by withholding all federal dollars for their entire Medicaid program.

Please continue checking for additional detailed analyses of the decision by experts and other thought leaders.

Comment (1)

One of a number of lawsuits filed in opposition to the ACA was Liberty University, Inc., et al. v. Geithner et al. Under this lawsuit in 2010, a private Christian university and a number of individual petitioners sued the government to block enforcement of the ACA’s employer requirement to provide health insurance coverage to employees, as well as the individual requirement to maintain health insurance coverage. The district court in the Western District of Virginia rejected all the plaintiffs’ claims, which included challenges based on the Commerce Clause, the Necessary and Proper Clause, the Tenth Amendment, the First Amendment, the Fifth Amendment, and the Religious Freedom Restoration Act (RFRA). On appeal, the Fourth Circuit held that the Anti-Injunction Act (AIA) barred federal courts...
In NFIB v Sebelius the United States Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA or the Act). At the same time, the decision adds a new dimension to the implementation of §2001(a) of the Act, which establishes expanded Medicaid eligibility for certain low-income people. This Implementation Brief begins with a discussion of exactly what the Court held in its Medicaid ruling. It then discusses the significance of the majority conclusion, as well as the key implementation questions that arise in the wake of this opinion.
The Supreme Court handed down its long-awaited ruling in the case of National Federation of Independent Businesses et al. v. Sebelius, Secretary of Health and Human Services, et al., upholding the individual requirement to maintain insurance coverage as a reasonable exercise of Congress’s taxing and spending authority and also upholding the constitutionality of the Medicaid coverage expansion. In a surprise coalition, Chief Justice Roberts was joined in his majority opinion by Justices Stephen Breyer, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. The summary below describes the majority opinion, the concurring opinion (authored by Justice Ginsburg), and the dissenting opinion (written by Justice Scalia). Because the Court upheld the individual mandate, it never reached...
Yesterday, Oklahoma's attorney general Scott Pruitt filed suit challenging the Affordable Care Act (ACA). The challenge focuses on the penalties that large employers would pay if they do not offer affordable health care coverage for employees, as mandated under the ACA. Oklahoma had previously joined 25 other states in arguing that ACA was unconstitutional due to the minimum coverage provision. However, the Supreme Court upheld the constitutionality of the individual mandate in its landmark June 28th decision. The new complaint focuses on...
HealthReformGPS Editor, Sara Rosenbaum, and frequent guest contributor to HealthReformGPS, Timothy Jost, authored two Health Affairs pieces analyzing the Supreme Court's Thursday decision regarding the Affordable Care Act (ACA). Jost's post provides an overview of the Court's decision regarding the individual mandate while Rosenbaum's examines the Court's surprising Medicaid expansion ruling.
Below find a table summarizing the United States Supreme Court decision regarding the Affordable Care Act (ACA)...