LAST WEEK’S US supreme court decision upholding President Barack Obama’s healthcare reform is as welcome as it was unexpected. The ruling clears the way for the extension of health coverage to more than 30 million Americans who are uninsured and for new rules to stop insurance companies refusing coverage to people with pre-existing medical conditions.
Most commentators had predicted that the nine-judge court would either reject the legislation completely or declare unconstitutional a central element of it, the individual mandate – an obligation on all citizens to take out health insurance. Instead, the judges voted by a margin of five to four that, because any penalty imposed on citizens who failed to take out insurance could be identified as a tax, Congress was acting within its rights. Chief justice John Roberts, until now regarded as one of the court’s most solid conservatives, joined the four liberal judges to make up the majority and became overnight a hate figure for many of his former admirers on the right.
A closer reading of the decision offers some consolation to conservatives and suggests that liberals have less cause for celebration than they may think.
The court upheld the constitutionality of the individual mandate but rejected the argument that it was covered by the power of Congress to regulate commerce between the federal states. “Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. ... Allowing Congress to justify federal regulation by pointing to the effect of inaction on commerce would bring countless decisions an individual could potentially make within the scope of federal regulation, and under the government’s theory, empower Congress to make those decisions for him,” the chief justice said.
The commerce clause has been key to congressional power, providing the legal basis for legislation on everything from environmental protection to civil rights. The long-term impact on the clause of last week’s ruling is unpredictable but it is likely to raise the “legitimacy barrier” for action by the federal government.
Healthcare reform remains unpopular, even if Republican presidential candidate Mitt Romney’s threat to repeal it is an empty one and Mr Obama still faces a tough battle for re-election. But the supreme court’s decision has ensured that he will achieve what none of his predecessors managed – the introduction of universal healthcare in the richest country on Earth.