Editorials

The US Supreme Court’s ruling on the Patient Protection and Affordable Care Act

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4503 (Published 29 June 2012) Cite this as: BMJ 2012;344:e4503
  1. Robert Steinbrook, professor adjunct
  1. 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
  1. robert.steinbrook{at}yale.edu

Declares most of the 2010 law constitutional, but a political challenge is coming

The implementation of the Patient Protection and Affordable Care Act in the United States will continue. In a 5-4 decision, issued on 28 June 2012, the US Supreme Court ruled constitutional the requirement that by 2014 most Americans must buy a health insurance policy that provides at least minimum coverage or pay a tax penalty to the federal government.1 The requirement, known as the individual mandate, is a signature feature of the mammoth 2010 law that President Barack Obama championed and the US Congress enacted.2 The law’s goals include increasing the number of people who are covered by health insurance, slowing the rate of increase in medical costs, and overhauling many facets of healthcare.

The majority opinion delivered by Chief Justice John Roberts, although legally complex, has two straightforward outcomes. Firstly, the individual mandate stands. The Supreme Court rejected the Obama administration’s preferred legal argument in support of the mandate—that it was constitutional because of the power of Congress to regulate interstate commerce. But the court accepted the government’s related …

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