The decision keeps in place the largest new social program in a generation, a major overhaul of the health-care system that could extend coverage to about 30 million Americans. It creates state-run insurance exchanges and eliminates what have been some of the most unpopular insurance practices.
The ruling did limit one significant portion of the law, which sought to expand Medicaid to cover millions more poor and disabled people. The program is a joint federal-state effort, and the court said the law’s requirement that states rapidly extend coverage to new beneficiaries or lose existing federal payments was unduly coercive.
Obama welcomed the justices’ decision, which he called “a victory for people all over this country whose lives will be more secure.”
At the core of the legislation is the mandate that Americans obtain health insurance by 2014.
The high court rejected the argument, advanced by the Obama administration, that the individual mandate is constitutional under the Commerce Clause of the Constitution. Before Thursday, the court for decades had said it gave Congress latitude to enact economic legislation.
But Roberts found another way to rescue it. Joined by the court’s four liberal justices — Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan — he agreed with the government’s alternative argument, that the penalty for refusing to buy health coverage amounts to a tax and thus is permitted.
Roberts summed up the split-the-difference decision: “The federal government does not have the power to order people to buy health insurance,” he wrote. “The federal government does have the power to impose a tax on those without health insurance.”
The chief justice went out of his way several times to portray the court as a neutral arbiter of the facts, adjudicating matters of law, not passing judgment on the wisdom of the health-care legislation.
“Those decisions are entrusted to our nation’s elected leaders, who can be thrown out of office if the people disagree with them,” Roberts said. “It is not our job to protect the people from the consequences of their political choices.”
It was a mark of the tightrope Roberts walked that, after announcing the court’s decision, he sat impassively while representatives of the court’s conservative and liberal wings read forceful criticisms of his work.
Justice Anthony M. Kennedy, most often the pivotal vote in the court’s ideological battles, said the law is an affront to individual liberty and should have been rejected in its entirety.