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Questions about chief justice's health-care ruling could have lasting impact

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The Supreme Court upheld the Patient Protection and Affordable Care Act last Thursday.

The decision surprised many conservative analysts who expected the chief justice to side with the court’s conservative wing to strike down the centerpiece of the law, the individual mandate requiring Americans to buy health insurance or pay a penalty.

How Roberts ruled

At issue in the case was whether Congress overstepped its authority under the Commerce Clause by ordering Americans to engage in commercial transactions (buying insurance), which Congress would then regulate.

Roberts and four other conservative justices concluded that the so-called individual mandate exceeded limits on congressional power. Those five votes would have been enough to invalidate the mandate and establish a clear limit on the expansion of federal power under the Commerce Clause.

That alone could have resolved the case and would have qualified as a landmark decision.

Instead, Roberts sided with the court’s four liberal justices to uphold the health-care reform law as a valid exercise of Congress’s power to raise and collect taxes. In effect, Roberts and the liberal justices concluded that the penalty required in the individual mandate was not a penalty at all, but a tax.

Even though the law was unconstitutional under the Commerce Clause, it could still stand because Congress had full authority to enact it as a tax, Roberts announced.

The chief justice also joined with the court’s liberal wing to uphold a major expansion of Medicaid, provided the administration dropped its threat to withdraw all existing Medicaid funding from states that choose to opt out of the Medicaid expansion.

The federal government must give the states a genuine choice of whether to participate in the federal expansion or not, the justices said.

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