The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional, ruled the Supreme Court today by a vote of 5-4. The Act was upheld on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance.  However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters.

Because the “individual mandate” survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding.  On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

As we are finding out now in Massachusetts, extending health care coverage without comprehensive cost controls on medical services is, ultimately, unworkable.  Beyond this, the impact on the ratification of the Affordable Care Act and the November election is anyone’s guess.

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