1. The Roberts Court and Health Care The Supreme Court as the arbiters of public policy? Upholding Obamacare - National Federation of Independent Business v. Sebelius (2012) The Patient Protection and Affordable Healthcare Act 2010

2. The Roberts Court and Health Care Health care an issue in US politics since 1912 when Theodore Roosevelt campaigns on introducing limited social provision Left out of New Deal legislation 1965 with Democratic controlled Congress, Johnson creates Medicare and Medicaid Ever since substantial health care reform has proved beyond all Presidents beyond some minor amendments

3. The Patient Protection and Affordable Healthcare Act 2010 Obama in 2008 promised health care reform Delivered in 2010 with historic legislation that, given the constraints imposed by both the US political and health systems is signature bill of Obama’s first term Greatly expands access to health insurance but still leaves up to 23million uninsured Takes steps to control costs Major coverage provisions do not kick in until 2014 Challenged in the courts

4. The Patient Protection and Affordable Healthcare Act 2010 All Republican Presidential candidates pledged to revoke ‘Obamacare’ Supreme heard constitutional challenges to the Bill – decided in June 2010 to uphold bill on 5-4 decision Individual mandate Upheld Bill as a Tax Obama re-elected – implementation of act in 2013

5. The Patient Protection and Affordable Healthcare Act 2010 Contains minimum coverage provision by amending the tax code Provides for individual mandate stipulating that individuals who fail to purchase and maintain a minimum level of health insurance must pay a tax penalty Contains expansion of Medicaid, which states must accept to receive Federal funds Contains an employer mandate to obtain health coverage for employees.

6. The Patient Protection and Affordable Healthcare Act 2010 Florida and 12 other states brought actions in the United States District Court seeking a declaration that the ACA was unconstitutional on several grounds Subsequently joined by 13 additional states, the National Federation of Independent businesses, and two individual plaintiffs Kaj Ahburg and Mary Brown.

7. The Roberts Court and Health Care Plaintiffs argued that: (1) the individual mandate exceeded Congress' enumerated powers under the Commerce Clause; (2) the Medicaid expansions were unconstitutionally coercive; (3) the employer mandate impermissibly interfered with state sovereignty.

8. The Roberts Court and Health Care Struck down in district and appeals court – Federal government appealed to the Supreme Court Key questions include: Does Congress have power under Article I, Section 8 of the Constitution, specifically under the Commerce Clause or the Taxing and Spending Clause, to require most Americans to purchase health insurance?

9. The Roberts Court and Health Care Did Congress exceed its enumerated powers and violate principles of federalism when it pressured States into accepting conditions that Congress could not impose directly by threatening to withhold all federal funding under Medicaid, the single largest grant-in-aid program? Could Act survive if the Court struck down the individual mandate?

10. The Roberts Court and Health Care By a vote of 5–4, individual mandate penalty is a tax for the purposes of the Constitution's Taxing and Spending Clause and is a valid exercise of Congressional authority – Art 1-8 The payment is not so severe as to be coercive, is not limited to wilful violations like fines for unlawful acts, and is collected by the Internal Revenue Service by normal means

11. The Roberts Court and Health Care Majority did not address the serverability question after concluding that the Individual Mandate was constitutional. Justices Scalia, Kennedy, Thomas, and Alito argued that the Individual Mandate and Medicaid expansion are inserverable, and that the entirety of the ACA is therefore unconstitutional

12. The Roberts Court and Health Care Court decided Medicaid expansion provisions was unconstitutionally coercive & Congress does not have authority to threaten the states with complete loss of Federal funding of Medicaid, if the states refuse to comply with the expansion. Remainder of the Medicaid expansion provision, without the unconstitutional threat to completely withdraw Medicaid funding, could stand

13. The Roberts Court and Health Care Decision was in essence a split along ideological grounds except for Roberts Speculation he changed his vote to uphold court’s prestige and reputation View that his philosophy of judicial restraint or lack of Supreme Court precedents available “to say the individual mandate crossed a constitutional line” played a part in his decision

14. The Roberts Court and Health Care Did Roberts buckle to liberal or even presidential pressure? Conservative bloc refused to join any aspect of his opinion, including sections with which they agreed A divided court

16. The Roberts Court