Earlier this morning, the Supreme Court affirmed the constitutionality of the Affordable Care Act. We will provide a more complete summary this afternoon, but here are the essential holdings.
First, by a 5-4 vote, the individual mandate requiring most Americans to maintain "minimum essential" health insurance coverage, 26 U.S.C. 5000A, is affirmed as an exercise of Congress's taxing power. Chief Justice Roberts wrote the opinion on this point, joined by Justices Ginsburg, Breyer, Sotomayor, and Kagan.
Second, although it did not affect the outcome, five Justices concluded that the individual mandate could not be justified as an exercise of Congress's power to regulate commerce. The Chief Justice wrote separately on this point. Justice Scalia also addressed this point in an opinion joined by Justices Kennedy, Thomas, and Alito.
Third, the Court held that the expansion of the Medicaid program is affirmed as an exercise of Congress's spending power, but that Congress cannot punish states for refusing to participate in the expansion by withholding all of the Medicaid funds. No opinion commanded a majority on this point. Chief Justice Roberts' opinion, joined by Justices Breyer and Kagan, contains the narrowest rationale and is thus controlling. Justice Ginsburg, joined by Justice Sotomayor, would have affirmed the expansion on a broader ground.