[JURIST] The US Supreme Court [official website] on Thursday ruled 5-4 [opinion, PDF] that the Patient Protection and Affordable Care Act (PPACA) [text; JURIST backgrounder] does not violate the constitution. The case centered on the “individual mandate” provision [text] of the act, which requires every person, with some exceptions for religious and other reasons, to purchase some form of health insurance by January 1, 2014, or be subject to a fee equal to either a percent of that individual’s income or flat rate of $695. In his opinion, Chief Justice John Roberts held that individual mandate is not a requirement that Americans buy insurance, since individuals who choose to pay the flat-rate fee are in full compliance with the law. Instead, the Court accepted the federal government’s argument that the fee is appropriately classified as a tax:

While the individual mandate clearly aims to induce the purchase of health insurance, it need not be read to declare that failing to do so is unlawful. Neither the Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS. The Government agrees with that reading, confirming that if someone chooses to pay rather than obtain health insurance, they have fully complied with the law. Indeed, it is estimated that four million people each year will choose to pay the IRS rather than buy insurance. We would expect Congress to be troubled by that prospect if such conduct were unlawful. That Congress apparently regards such extensive failure to comply with the mandate as tolerable suggests that Congress did not think it was creating four million outlaws. It suggests instead that the shared responsibility payment merely imposes a tax citizens may lawfully choose to pay in lieu of buying health insurance.

The court’s decision limited the law’s new Medicaid requirements, preventing the federal government from withholding existing funds from states who choose not to opt-in to the expanded coverage. Justice Ruth Bader Ginsburg filed a concurring opinion joined by Justices Sonia Sotomayor, Stephen Breyer and Elena Kagan. In the concurrence, the justices said they would have upheld the PPACA under the power of Congress in the Commerce Clause [Cornell LII backgrounder], regardless of the individual mandate.

Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito entered a dissenting opinion concluding that the PPACA should be struck down in its entirety. The dissenting justices found that the individual mandate was an unconstitutional invasion into the private lives of citizens. In their dissenting opinion, the justices found that the individual mandate provision of the PPACA is not a tax, and is not supported under the Commerce Power:

The Court today decides to save a statute Congress did not write. It rules that what the statute declares to be a requirement with a penalty is instead an option subject to a tax. And it changes the intentionally coercive sanction of a total cut-off of Medicaid funds to a supposedly noncoercive cut-off of only the incremental funds that the Act makes available. The Court regards its strained statutory interpretation as judicial modesty. It is not. It amounts instead to a vast judicial overreaching. It creates a debilitated, inoperable version of health-care regulation that Congress did not enact and the public does not expect. … The Court’s disposition, invented and atextual as it is, does not even have the merit of avoiding constitutional difficulties. It creates them.

Thomas wrote a separate opinion objecting to the court’s interpretation of the Commerce Clause. The court’s decision Thursday resolves the four consolidated cases accepted by the court [JURIST report] in November 2011. Oral arguments [JURIST report] were heard by the court in March.