June 29, 2012 |
Forget all the spin and analysis you are reading this morning about how
much of a political moderate Supreme Court Chief Justice John Roberts
is for siding with the Court’s left-leaning wing and saving the
Affordable Care Act from the judicial firing squad.
Roberts'
opinion
for the majority is radical and dangerous—and sets alarming precedents
because it ignores decades of established Court doctrine, which
associate Justice Ruth Bader Ginsberg noted out in exquisite detail in a
lengthy dissent trashing the ruling. (See page 66.) Moreover, Robert’s
opinion suggests that there is a majority on the Court that would vote
to take the country back to the pre-Constitution days, when there was no
clear authority to regulate interstate commercial activity or for the
states to obey Congress.
The Chief Justice’s “rigid reading of the Commerce Clause makes scant
sense and is stunningly retrogressive,” Ginsberg said, in a
dissent
joined by Associate Justices Elena Kagan, Sonia Sotomayor and Stephen
Breyer. Indeed, her dissent, like that of retired Justice John Paul
Stevens in the
Citizens United ruling that accused the
ideological conservative majority of inventing facts to fit its
politicized conclusion, will likely emerge as the most prescient and
memorable aspect of the ACA ruling.
Health Insurance Is Not An Interstate Activity?
Roberts’ majority
opinion
said that the health insurance coverage mandate of the Act was
permissible, but not under the Constitution’s Commerce Clause, which
gives Congress power to regulate interstate business, nor under the
Necessary and Proper Clause, which gives Congress power to legislate to
address genuine problems.
As Ginsberg’s dissent and the ACA’s defenders noted in Court,
healthcare costs account for more than one-sixth of the U.S. economy,
and when uninsured people walk into hospitals seeking medical care, it’s
other insurance policyholders—not the insurance companies—who end up
paying for their medical bills.
Instead, Roberts offered a convoluted analysis ignoring that basic
fact. He said that the law’s insurance-buying requirement was not a
requirement at all, because all the law did was impose a tax on people
who didn’t buy a health plan after January 2014. Roberts said that not
buying a health plan was not an economic activity and had no
consequences. But he then went on to say that not having a plan was
something that could be subject to a federal income tax penalty. And
that taxing power was constitutional, he said.
“The mandate is not a legal command to buy insurance. Rather, it makes
going without insurance just another thing the Government taxes, like
buying gasoline or earning income,” he wrote. “And if the mandate is in
effect just a tax hike on certain taxpayers who do not have health
insurance, it may be within Congress’s constitutional power.”
Robert’s twisted reasoning was a reflection of an argument made by
right-wing think-tanks and commentators such as George Will that want
the Supreme Court to resurrect the so-called
Lochner Era, where in 1905 the Court started issuing decisions
reversing
progressive healthcare and labor reforms, holding an individual’s
freedom to have a "contract" with their employer was more deserving of
constitutional protection than societal concerns.
“The Chief Justice’s limitation of the commerce power to the regulation
of those actively engaged in commerce finds no home in the text of the
Constitution or our decisions,” Ginsberg wrote. “In the early 20th
century, this Court regularly struck down economic regulation enacted by
the peoples’ representatives in both the States and the Federal
Government... The Chief Justice’s Commerce Clause opinion, and even more
so the joint dissenters’ reasoning… bear a disquieting resemblance to
those long-overruled decisions.”
The problem for progressives with Roberts’ finding that there is no
basis in the Commerce Clause, or Necessary and Proper Clause, is that
this legal viewpoint—on top of the four other right-wing justices who
said they would have thrown out the ACA as congressional
overreach—suggests that in the future there could be a Supreme Court
majority that would invalidate other laws regulating the national
economy— such as a carbon tax to combat climate change, or new national
energy strategy.
These so-called constitutional "originalists" seem intent on not just
upholding their extremely pro-business vision of how Congress should
address national issues—by providing more customers for the private
sector—but they seem intent on taking the country back in time to before
the Constitution was even written.
That would sound like an extreme interpretation of the ACA ruling, were
it not for the other big piece of the ACA decision, which tells states
that they can ignore Congress’ directions to expand state-run Medicaid
programs providing medical care for the poor, which disproportionately
are single mothers and children.
The Outrageous Medicaid Ruling
Roberts told states that they did not have to implement the state
government section of the law, which would open up Medicaid programs to
everyone under age 65 whose income was under 133 percent of the poverty
line. (Seniors 65 and older can get healthcare under the federal
Medicare program.)
Roberts decreed that states that did not want to implement the ACA
would not face the fiscal penalty of losing all of their federal
Medicaid funds—as envisioned by the law. Instead they would only lose
funds for the Medicaid expansion, such as for covering more poor people
and creating medical clinics in underserved areas.
“The Court today limits the financial pressure the Secretary [of Health
and Human Services] may apply to induce States to accept the terms of
the Medicaid expansion,” Roberts wrote. “As a practical matter, that
means States may now choose to reject the expansion; that is the whole
point.”
That option for states—which scholars say may be the first time the
Court has found a congressional spending requirement to be
unconstitutionally coercive—gives the GOP license to use healthcare for
the poor as a political pawn. That tactic is hardly new—and already on
Thursday right-wing Republicans signaled they were ready to sacrifice
healthcare for the poor to score political points.
“Today’s ruling crystallizes all that’s at stake in November’s
election,” said Virginia Gov. Bob McDonnell, Republican Governors
Association chairman. “The only way to stop Barack Obama’s
budget-busting healthcare takeover is by electing a new president.”
“We are very concerned that a sudden, dramatic increase in Medicaid
spending could threaten Ohio’s ability to pursue needed reforms in other
areas, such as education,” Ohio’s GOP Gov. John Kasich said in a
quickly issued statement Thursday.
Never mind that Ohio will be raking in millions of dollars from natural
gas fracking well fees by the time its share of ACA Medicaid payments
would begin in three years. There are a handful of red state governors
that previously rejected congressional economic stimulus funds—as they
came from a Democratic-majority Congress and Obama.
Texas, South Carolina, Louisiana and Mississippi refused to accept
federal dollars to extend unemployment benefits in 2009. Florida also
rejected $2 billion for a high-speed rail line between Orlando and Tampa
last year. The open question is will red-state Republicans also reject
the ACA’s new federal Medicaid subsidies?
“It will be their option,” answered Stan Dorn, a senior health policy
fellow with the Washington-based Urban Institute. “The federal
government will not compel states to do it by threatening to withhold
money or taking them to court.”
GOP politicians’ beating up on the poor is neither new nor radical.
What’s radical about this part of the ACA ruling is the potential impact
on public sector—not private sector—healthcare, because that may slow
the creation of a uniform nationwide public system that could one day
lead to universal government-delivered healthcare.
Having a patchwork of different state systems and services would hamper
creation of a national public option—which progressives have long
desired. In this respect, the Court’s ruling upholding the requirement
that everyone have a health plan (private or public) and allowing states
to opt out of Medicaid expansion is exceptionally pro-business.
Moreover, the Medicaid precedent also raises the question of what other
costly federal programs states may object to—and refuse to implement if
they forego the funding that comes with it? During the Court’s hearing
on the ACA, Justices Sonia Sotomayor and Elena Kagan both noted that
limiting Congress’ spending authority—as the Court majority did in this
case—could limit Congress’s responses in national crises.
“When future Spending Clause challenges arrive, as they likely will in
the wake of today’s decision, how will litigants and judges assess
whether “a State has a legitimate choice whether to accept the federal
conditions in exchange for federal funds”?” wrote Ginsberg, quoting
Roberts. “Are courts to measure the number of dollars the Federal
Government might withhold for noncompliance?”
“The portion of the State’s budget at stake? And which State’s—or
States’— budget is determinative: the lead plaintiff, all challenging
States (26 in this case, many with quite different fiscal situations),
or some national median? Does it matter that Florida, unlike most
States, imposes no state income tax, and therefore might be able to
replace foregone federal funds with new state revenue? Or that the
coercion state officials in fact fear is punishment at the ballot box
for turning down a politically popular federal grant?
“The coercion inquiry, therefore, appears to involve political judgments that defy judicial calculation.”
Ginsberg said the majority’s Medicaid analysis was exactly the opposite
of how the Constitution envisioned the separation of powers between
Congress and the states.
“At bottom, my colleagues’ position is that the States’ reliance on
federal funds limits Congress’ authority to alter its spending
programs,” she wrote. “This gets things backwards: Congress, not the
States, is tasked with spending federal money in service of the general
welfare. And each successive Congress is empowered to appropriate funds
as it sees fit.”
While many commentators praised the decision for not overturning the
ACA, and lauded the Chief Justice for siding with the Court’s moderates,
they are overlooking how pro-business, radical and politicized the ACA
ruling is. Those politics will not just play out in the presidential
campaign, where Mitt Romney on Thursday again vowed to overturn the law
if elected, but inside red states as anti-Obama GOP leaders will use
Medicaid as a political pawn.
Looking further down the road, the Medicaid precedent will tempt other
states’ rights rebellions to rise, and also curtail Congress’s ability
to respond—as a nation of 50 states—in a national emergency. Not only is
the Roberts' ruling entirely pro-business, by sending tens of millions
of new customers to insurers while limiting state expansion of public
care, it is based on a right-wing vision of a shrunken Constitution and
diminished congressional powers.
That is as radical a reshaping of congressional powers to regulate economic issues as the
Citizens United was
a radical reshaping of the campaign finance landscape. If you are
reading media accounts praising Roberts, read Ginsberg’s dissent. It
reveals just how pro-business, ideological and ahistorical the Court
under Roberts truly is.
Steven Rosenfeld covers democracy issues
for AlterNet and is the author of "Count My Vote: A Citizen's Guide to
Voting" (AlterNet Books, 2008).
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