The Court’s Ruling: ACA Upheld Under Tax Clause (So, the Battle Will Remain)

It’s interesting being at New Staff Training when a ruling like this is announced. When CNN announced that the Affordable Care Act was declared unconstitutional, the entire cafeteria cheered, and promptly prayed a Glory Be. Then, all were confused to find out, the court had actually, in fact upheld the mandate under the tax clause.

The next question almost every missionary is asking: “What does that mean?” Which in this atmosphere really means, “How does this affect the freedom of conscience that is under attack?”

Well, not a whole lot. The battle is still going on. They are just using more constitutionally pleasing weapons. Or, at least more linguistically pleasing terms.

A good summary of what the court really decided this morning: (from

Reports are out that the individual mandate has been upheld by a 5-4 ruling, with Chief Justice John Roberts joining the four liberal members of the court in upholding the mandate under Congress’ power to tax. I’m not shocked by this. The law was written that way on purpose, enforcing the mandate through the tax code because the Constitution explicitly grants the power to tax to Congress. No link to the ruling yet.

Amy Howe at SCOTUSblog offers this key quote from the ruling:

Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.

The ruling is now available on the Supreme Court website. Get it before the server crashes. Here’s the key section from the syllabus:

Such an analysis suggests that the shared responsibilitypayment may for constitutional purposes be considered a tax. The payment is not so high that there is really no choice but to buy healthinsurance; the payment is not limited to willful violations, as penalties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation. None of this is to say that payment is not intended to induce the purchase of health insurance. But the mandate need not be read to declare that failing to do so is unlawful. Neither the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS. And Congress’s choice of language—stating that individuals “shall” obtain insurance or pay a “penalty”—does not require reading §5000A as punishing unlawful conduct. It may also be read as imposing a tax on those who go without insurance.

The most frustrating part about all of this is that lowering the cost of healthcare, and making it available to all people is a really, really good goal. However, because of a few details, this particular means has really, really twisted the whole idea.

A CNN blog this morning offered a great clip from the Conference of Bishops explaining why, while we desire more affordable and available healthcare, we cannot support this particular mandate.

[Updated at 11:49 a.m. ET] The U.S. Conference of Catholic Bishops said it is for comprehensive healthcare reform, especially for the poor, but it opposes the Supreme Court decision for three reasons.

“First, ACA allows use of federal funds to pay for elective abortions and for plans that cover such abortions, contradicting longstanding federal policy. The risk we identified in this area has already materialized, particularly in the initial approval by the Department of Health and Human Services (HHS) of “high risk” insurance pools that would have covered abortion.

Second, the Act fails to include necessary language to provide essential conscience protection, both within and beyond the abortion context. We have provided extensive analyses of ACA’s defects with respect to both abortion and conscience. The lack of statutory conscience protections applicable to ACA’s new mandates has been illustrated in dramatic fashion by HHS’s “preventive services” mandate, which forces religious and other employers to cover sterilization and contraception, including abortifacient drugs.

Third, ACA fails to treat immigrant workers and their families fairly. ACA leaves them worse off by not allowing them to purchase health coverage in the new exchanges created under the law, even if they use their own money. This undermines the Act’s stated goal of promoting access to basic life-affirming health care for everyone, especially for those most in need.”

We shouldn’t oppose the end goal, but we shouldn’t support the mandate that’s being used to achieve it.


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