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Supreme Court Scorecard: The Health Care Vote

The U.S. Supreme Court delivered its much-anticipated ruling on the constitutionality of the Affordable Care Act Thursday. In a 5 to 4 vote, the court said that the individual mandate is constitutional. It also agreed to the expansion of Medicaid, with some changes.

Speculation about the fate of President Barack Obama's landmark health care law has been frenzied. Most of it is  focused on three key questions:

1. Is the so-called individual mandate constitutional? This is the provision in the Affordable Care Act that requires most Americans to buy health insurance.

ANSWER: Yes, in a 5 to 4 vote. Justices John Roberts, Stephen Bryer, Ruth Bader Ginsburg, Elena Kagan, and Sonia Sotomayor ruled in favor of its constitutionality. The dissenting votes came from Justices Samuel Alito, Anthony Kennedy, Antonin Scalia, and Clarence Thomas.

2. If the individual mandate is found to be unconstitutational, can the rest of the provisions remain intact?

ANSWER: Not applicable.

3. Is the expansion of Medicaid constitutional?

ANSWER: Sort of. The court did not rule the expansion unconstitutional, but it said states should be able to choose to participate in the expansion of Medicaid. Two justices - Ginsburg and Sotomayor - ruled firmly in favor of its constitutionality. Four justices - Scalia, Kennedy, Thomas, and Alito - dissented. Meanwhile, Roberts, Kagan and Bryer said it is unconstitutional to take away all of a state’s Medicade money if it doesn’t agree to an expansion. But they agreed the provision could remain intact if a state was only denied the newly expanded Medicaid funds, not existing funds.


The Scorecard graphic has been updated to correctly identify the president who appointed Justice Samuel Alito.

About the author

Matt Berger is the former Digital Director at Marketplace.
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I feel like this scorecard really misunderstands the ACA ruling. Although the majority backed the individual mandate, they backed it for very different reasons. The 4 liberals argued that it fell under the Interstate Commerce Clause, while Roberts argued it came under taxing authority. That nuance will have a lot of implications. Roberts checkbox deserves an asterisk along with the Full court ruling.

Same goes for the Medicaid Expansion. The court ruled with the same asterisk that the scorecard gives to the findings of Roberts + Breyer + Kagan, ie the Feds can't deny all Medicaid funding to states that refuse to expand coverage.

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