Decade in review: The court upholds Obamacare

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law. The law was almost immediately challenged in federal court, leading to three days of oral argument at the Supreme Court in March of 2012. And as if the stakes weren’t already high enough, the justices were expected to issue their decision in the middle of the presidential campaign.

One crucial question before the justices involved the constitutionality of the “individual mandate,” the requirement that virtually all Americans either buy health insurance by 2014 or pay a penalty. Defending the law, the Obama administration argued that the Constitution’s commerce clause gave Congress the power to enact the mandate, because an individual’s decision not to buy health insurance affects interstate commerce. The challengers countered that the mandate was unconstitutional because Congress was trying to regulate inactivity – that is, the refusal to buy health insurance.

The other main question stemmed from the part of the ACA that made more people eligible for Medicaid. In the ACA, Congress gave the states a choice: Comply with all the new Medicaid rules or risk losing all their federal funding for the program. The challengers argued that Congress had overstepped its authority, because it could not use the threat of cutting off the funding to force the states to expand eligibility for Medicaid.

After the oral argument, the future of the individual mandate appeared to be in real doubt. And when Chief Justice John Roberts read the summary of his opinion on June 27, he took spectators at the court on a roller-coaster ride. Roberts and his four conservative colleagues rejected the government’s commerce clause argument. But in a surprising turn of events, Roberts’ four more liberal colleagues joined him in upholding the mandate on a basis that had gotten relatively little attention: The penalty imposed on individuals who did not buy health insurance was a tax, which the Constitution allows Congress to impose. However, by a vote of 7-2, the justices agreed with the challengers that the Medicaid expansion provision exceeded Congress’ authority.

Interest in the ruling ran so high that the court’s website crashed, temporarily limiting access to the ruling to the hard copies distributed by the court’s Public Information Office. And confusion briefly reigned when some television networks erroneously reported that the mandate had been struck down.

A few days later, Jan Crawford of CBS News reported that Roberts had originally voted to strike down the mandate before changing his mind. Crawford’s story only fueled the sense that Roberts was “squishy” – so much so that, when conservatives prepared to fill vacancies on the Supreme Court in 2017 and 2018, they specifically mentioned wanting to avoid another pick like Roberts.