Title: The Constitutionality of the Affordable Care Act: An Update | Journal of Ethics | American Medical Association
Headings: The Constitutionality of the Affordable Care Act: An Update
The Constitutionality of the Affordable Care Act: An Update
The Court’s Holding
The Aftermath of the Ruling
References
Author Information

Content: 10.1001/virtualmentor.2012.14.11.hlaw1-1211. On June 28, 2012, the U.S. Supreme Court upheld key provisions of the Patient Protection and Affordable Care Act (ACA) after 26 states had challenged its constitutionality in lower courts. In last November’s Virtual Mentor health law column, we summarized some of the key legal issues the court would consider in the ACA case, and now we examine their ruling, including the basis for the court’s decision and relevant legal considerations as the ACA is implemented [1]. The Court’s Holding
The Supreme Court’s 5-4 decision determined the constitutionality of two key substantive provisions in the ACA: the individual mandate and a requirement that states expand eligibility criteria for Medicaid coverage [2]. Individual mandate. The most legally and politically controversial aspect of the ACA, the individual mandate requires Americans to purchase health insurance or face a government penalty, with some exceptions—particularly for low-income individuals who cannot afford to buy insurance [3]. The individual mandate has been considered necessary to cover the cost of U.S. health care. Without a mandate, fewer healthy people would pay into the system to counterbalance the cost associated with care for the sick. The healthy, mostly younger people would be able to “free ride,“ purchasing health insurance only when they got sick, after paying little or nothing up front when their use of services was lower [4, 5].