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: The penalty, though not labeled a tax in the ACA, is similar in several ways to other taxes. Its amount is determined by income, number of dependents, and filing status, and it is paid into the treasury when filing income tax. It is not a punishment for an illegal action: failure to purchase health insurance is not illegal, the penalty for refusing to purchase health insurance is less than the cost of paying for actual insurance, and there are no criminal sanctions attached. ( The Congressional Budget Office has predicted that approximately 4 million people will opt to pay the IRS instead of an insurance company [10].) Moreover, while the individual mandate is clearly intended as an incentive to purchase health insurance, many other taxes are also in place to promote certain behaviors—for example, the government taxes cigarettes to reduce nicotine consumption. Thus the Court found the mandate well within Congress’s power to tax. While Congress doesn’t have the power to require individuals to purchase health insurance, it does have the power to tax those individuals who do not. Medicaid expansion. The second provision challenged by the states required them to expand their Medicaid programs to cover adults with incomes up to 33 percent above the poverty level by 2014 or to face a penalty (including withdrawal of all federal Medicaid funds) [11].