Chief Justice Roberts’ health reform ruling analysis: A win-win?

The decision is in – and it is likely to have a substantial impact on this year’s elections, the Congress, the Court, the healthcare industry, and all Americans.

Of all the commentary I’ve read in the wake of the recent Supreme Court decision, Time Magazine‘s “Special Report: The Health Care Decision” struck me as the most balanced and comprehensive.

In the lead article, “Roberts Rules,” author David Von Drehle skillfully dissected the legal gymnastics that turned a potential zero-sum game into a win-win situation.

The controversies will persist, but two things are certain:

  1. Healthcare reform as formulated in the hotly debated Patient Protection and Affordable Care Act (ACA) is constitutional, and
  2. Congress cannot force states to adopt the Medicaid expansion provision, a key element in attaining the goal of universal coverage.

There is now not a single doubt that Chief Justice Roberts does indeed rule.

Sharp as the horns were on this dilemma, Roberts was sharper — and, whatever one’s political leaning, his performance was sheer artistry!

His interpretation of the law allowed liberals to realize their long sought (and fought-for) dream of government-led reform and simultaneously aided conservatives in their quest for limits on congressional power over states.

Here is how it went down: Roberts began by stating that the conservative position on the “individual mandate” was indeed correct – i.e., the Constitution does not give Congress the power to require citizens to buy health insurance if they don’t want it.

Predictably, this part of the ruling was supported by the four Republican appointees on the Court.

Roberts went on to say that Congress is empowered by the Constitution to levy taxes and that the mandate is, in essence, a tax on citizens who decide not to buy health insurance.

Just as predictably, the Democratic appointees sided with Roberts on this part of the ruling. Neither side got exactly what it wanted, but both “won” something.

The 5-4 split was not unusual, but the fact that the Chief Justice took the reins rather than the perennial swing voter, Anthony Kennedy, made jaws drop across the country.

From a political standpoint, Roberts’ ruling guarded the Court against charges of partisanship while protecting Obama from accusations that he wasted the first year of his term “fiddling over an unconstitutional overreach” while the economy was burning.

I particularly liked Von Drehle’s keen observation that what Roberts managed to do with the ACA “vindicated the virtue of compromise in an era of Occupiers, Tea Partyers, and litmus-testing special interests” and positioned him above the “toxic cloud of partisan rancor.”

One question that remains is why Roberts decided to take the lead.

Von Drehle consulted John Q. Barrett, professor of law at St. John’s University, who saw it as a classic example of a cautious Chief Justice who feels that “for public credibility and independence of the court, major legislation should not be struck down by a 5-4 vote on the grounds that Congress lacks the power.”

In this context, “cautious” was far from wimpy!

In fact, the limits the decision imposes on Congress’ power to regulate commerce and use its spending power to coerce states will undoubtedly spur conservatives to pursue even greater limitations.

So, was it a “sober compromise” or a “clever ruse” to facilitate the conservative agenda?

Barrett pointed out that the relatively young Chief Justice might not have wanted his tenure to be defined in terms of the opposite ruling, which would have been a “permanently controversial landmark.”

For the time being, only Justice Roberts knows — but the answer will surely become obvious to all of us over the next few years.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

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