Musings on the Supreme Court’s Affordable Care Act Ruling

While I originally intended for this post to singularly focus on Chief Justice John Roberts’ surprising role as the swing vote in today’s Supreme Court ruling on the Affordable Care Act (ACA), I changed my mind. Like the Affordable Care Act, a gargantuan law that addresses so many aspects of the health care industry, any response to it would have be multi-layered. Thus, it is unsurprising that the law itself is 906 pages long while today’s ACA ruling was 193 pages. As a result, I decided on a four-part assortment of thoughts on the ruling specifically as well as healthcare in general.

With this type of complexity, it is no surprise that there were (and still are) debates about the law’s constitutionality as well as debates about its provisions. Contrary to popular belief, the law does not solely focus on the individual mandate, but also contains guidelines regarding things like public health research and the transparency of the insurance industry as well as programs like Medicare and Medicaid. But it was the individual mandate that had people nervously bitting their nails as they nervously awaited details of the final ruling.

Now, my attempt to explore my reactions to the ruling as well as criticisms of Obamacare.

I. Is it a tax?

In the Oxford American Dictionary, the definition of tax reads as follows: “a compulsory contribution to state revenue, levied by the government on workers’ income and business profits or added to the cost of some goods, services, and transactions." 

Keeping that definition in mind, we must look to our nation’s governing document - The Constitution of the United States. Article I, section 8 reads: "The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises to pay the Debts and provide for the common Defense and general Welfare of the United States.”

By that logic alone, we can argue that the ACA constitutes a tax. As it was never designed for 100% compliance, there will always be those that will choose to pay the tax instead of purchasing the mandated insurance. In short, there will always be a group that is contributing to state revenue. Additionally, the Congressional Budget Office has estimated that the law will raise over $17 billion by 2019.

Some arguing against the tax logic of the Justice Department have said that the government is simply forcing people to buy insurance. However, this is not exactly true as it is illness that forces people to purchase insurance and engage in the health care market. The government, through enacting Obamacare, is simply regulating the market. 

In any case, although the price may initially be high, health care prices should eventually decrease as the problem of adverse selection is solved. With “the U.S.spend[ing] more on healthcare than any other country in the world but [possessing] higher rates of infant mortality, diabetes and other ills than many other developed countries”, spiraling health costs needed - and still need - to be addressed. Expensive health care prevents millions of Americans from receiving critical treatment. And in that light, the law obviously improves the general welfare of the state.

Additionally, I personally believe that those kind of statistics are embarrassing. America cannot claim to be a leader in the world while neglecting our people at home. 

Despite critics bemoaning the high costs of Obamacare, in the long run, it will save us money.

On a more trivial note - Obama was a constitutional law professor. I highly doubt that he would propose a law without considering all of the legal implications behind it.

II. Back to Romney

Considering that Obama openly based the ACA on reforms that Romney enacted in Massachusetts, it’s fairly obvious that it is somewhat hypocritical for Romney to reject the ACA’s provisions. While I expect him to make a small statement regarding the ruling, his advisers will no doubt try to minimize the coverage connecting Romney to healthcare as it makes him seem like a flip-flopper - a label that proved to be politically fatal for Kerry in 2004. 

III. What this means for minorities and women


Women go to the doctor more often. Therefore they cost more to insurance companies, but Obamacare has eliminated the gender rating that allows insurance companies to charge women higher rates. Other provisions that help women include complete coverage without co-pay for contraception as well as life-saving tests like mammograms and Pap smears. 

Minorities make up a whopping 69.6% of uninsured people. The news that the ACA has been upheld will surely be welcome among many people in those communities.

However, as I look to statistics of how women and minorities are largely affected by the ACA, I can’t help but think about how their minimal representation in government may have something to do with some of the pushback that the law has received. 

IV. Societal Implications of Healthcare

Legislators appear to easily forget the promises that they make to work on behalf of the people. In the words of Cornel West, “if your success is defined as being well-adjusted to injustice and well-adapted to indifference, then we don’t want successful leaders." 

I want legislators who care about all their constituents instead of just a few. And that means legislators that care about the general welfare of their people. Yes, we have the right to preserve our individual interests as guaranteed by the Constitution, but that does require us to be callous in ignoring the needs of our fellow citizens? Why do you think that so many of the poor and middle class seem to be flocking to the Democratic party?

For those who have seen and engaged with poverty and desparation, ignoring the needs of a population that cries out for help is not an option. The idea of letting a system that allows 72 Americans die each day, 500 Americans die every week and approximately Americans 2,175 die each month, due to lack of health insurance continue breaks my heart. That is why I am so thankful that Obamacare will make some headway in bridging this gap and making sure that America is a leader again in all senses of the word. 

In my Bioethics and Law class at Yale, we addressed the topic of justice and access to healthcare. One argument in particular struck me as particularly sound - that of the Rawlsian framework for healthcare. If we consider Rawls’ theory of a just society, we must set the conditions of justice in a good society while wearing a veil of ignorance. There should be shared equality of opportunity while adhering to the difference principle (differences in wealth should only be permitted to the extent that they benefit people who are the least well-off).

While Rawls did not discuss healthcare, philosopher Norman Daniels placed healthcare within a Rawlsian framework by asserting that health insurance is necessary in a just society in order secure fair equality of opportunity. 

If politicians wore the veil of ignorance and put themselves in the shoes of their fellow citizens, I doubt that the health care debate would be as vicious. Now, we must simply hope that there is no additional congressional and state-level pushback on the law to prevent measures from being taken to improve the lives on American citizens.