Dramatic ruling adopts new view of mandate

Opponents of the national health care law won two major battles Thursday, but in the end they lost the war.

In what can only be described as an unexpected — and perhaps even shocking — ruling, a bare majority of the U.S. Supreme Court allowed the core of what has become commonly known as Obamacare to continue, including the “individual mandate” under a different name.

The decision — written by the key “deciding” justice on the issue, Chief Justice John Roberts — transformed what even supporters had called a mandate to buy health insurance into a tax. It was a critical transformation.

It had always been recognized that the government has full power to tax individuals for whatever reason it chooses, including health care.

The question was whether the government had the power to mandate individuals to buy health insurance under the Commerce Clause in the Constitution. Supporters of Obamacare said it did, but opponents said it did not.

The court ruled that indeed the government could not mandate that consumers buy something, a major victory for those seeking to limit the ability of the federal government to expand use of the Commerce Clause.

But Roberts and four other justices said Congress really meant for the mandate to be a tax because a tax penalty was the only punishment for not buying insurance. In effect, you can go without insurance if you want, but you have to pay a tax to do so.

In another important ruling for opponents of the law, the court said it is unconstitutional to require states to participate in a key element of the law involving an expansion of the Medicaid program. This expansion in the health program for the poor (called AHCCCS in Arizona) was one way the law helped those who could not afford health insurance to receive needed care.

The court ruled it is unconstitutional to force states to participate in the expansion by taking away all of their Medicaid funding, even the funds that were not part of the expansion. In effect, it was a victory for states' rights advocates. Participation in the program by states has to be voluntary, the majority of justices ruled.

Despite the two victories for Constitution advocates, the reality is the overall health care law will go forward and dramatically change the scope and availability of health care in our nation, assuming it survives the inevitable political battles to come.

One day, it could be looked on as having the same significance as the creation of Medicare for the elderly.

And for many Americans, that is the important thing — no matter how the justices reached the decision.

Ironically, the law was saved by five justices who were willing to do what supporters of the law, including President Obama, were unwilling to do out of fear of political repercussions: call the insurance mandate a tax, as some had always claimed should be the proper approach.