The immediate significance of Thursday’s U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act, notes Stanford legal scholar Pamela S. Karlan, is dramatic for the large numbers of Americans who are assured of obtaining insured health coverage under various provisions of the law. Breaking news reports emphasized that the legislation mostly was upheld because the decisive vote came— unexpectedly—from Chief Justice John Roberts Jr., who settled the case with four more liberal justices.
But Karlan, a Stanford law school professor and co-director of the school’s Supreme Court Litigation Clinic, also foresees possible limitations on key Congressional powers based on the underlying considerations in the decision. Karlan, on record before the ruling in support of the constitutionality of the health care legislation, says the conclusions of a majority of justices “reveal some substantial shifts in the court’s approach to [Congress’s] commerce clause and spending clause.”
Excerpts from the decision showed the legislation survived because Roberts supplied the swing vote on the grounds that citizens can be required to carry insurance or pay a penalty (the individual mandate provision) as part of Congress’s taxing power. But Roberts aligned with the dissenting justices (Samuel Alito, Anthony Kennedy, ’58, Antonin Scalia and Clarence Thomas) in rejecting the individual mandate based on Congress’s ability to regulate interstate commerce. And the notable provision the court ruled unconstitutional—the underpinning of Medicaid expansion by penalizing states that do not comply—was overturned on grounds of exceeding legitimate Congressional spending authority that places conditions on the use of federal money.
“What you see is five members of the Supreme Court [who] would restrict the commerce clause,” says Karlan, noting they also represent a conservative majority in restricting the spending clause. “They’re laying down markers on two of Congress’s most important powers.”
By determining the health care outcome in conjunction with the liberal wing of the court (justices Stephen Breyer, ’59, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor), Roberts became the nexus of speculation, potentially redefining himself as a pivotal vote in sharply divided decisions. But Karlan says she’s not sure how much should be read into this particular ruling. “It’s very hard to draw a good line through just one data point,” she adds.
