Supreme Court of the United States overview

ACA and Public Administration

National Federation of Independent Business v. Sebelius (2012) is the Supreme Court case that upheld the federal government's implementation of the Affordable Care Act (ACA) and the law for Americans to purchase health insurance or pay a tax. The Court's ruling on the case addressed a number of issues, from health care to the expansion of Medicaid. As Hall (2013) points out, the "Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social and legal status" (p. 267). In other words, National Federation of Independent Business v. Sebelius essentially changed the way administrators, workers, employers, care providers, politicians, and all other stakeholders viewed the issue of health care, insurance and the funding of the industry. This paper will review Hall's (2013) thesis, methodology, and conclusions and explain why I believe Hall misses the essential point of this case and how I think the case has been impactful on PA.

Hall's thesis is that National Federation of Independent Business v. Sebelius (2012) presented an opportunity for the Supreme Court to address health care along two separate lines -- a Constitutional line and a health care policy line. In doing so, the Court struck a balance between maintaining Constitutional authority and respecting the needs of patients as well as the role that health care providers and insurers should play. Hall's methodology is based on a systematic review of Constitutional law and health care law cases: his findings show that precedent had been set in the past for this historic case to finally change the way the U.S. addresses the issue of health care. The facts of the case were and still are somewhat puzzling as the suit centered on the Anti-Injunction Act, which the Court found did not apply, as the ACA referred to the individual mandate to purchase insurance as a penalty and not a tax -- though the Court went on to hold that Congress would penalize those who did not purchase insurance, based on its ability to "lay and collect taxes" as stipulated in the Constitution. Thus, the Court ruled that the ACA was not a tax but that those who did not purchase health insurance would be taxed. The majority opinion asserted that it was not a "direct tax" (Hall, 2013). The dissenting opinions found the expansion of Medicaid desired by Congress to be coercive an unconstitutional -- though Ginsburg and Sotomayor both were in favor of the expansion, while Roberts asserted that states should be able to opt out and Scalia et al. wanted to strike down the entire ACA as unconstitutional.

Hall (2013) argues that the ruling was an important one in American law; however, I feel he misses the point -- namely that this ruling has simply enabled the health care cartel to raise rates, as costs would now be covered by the federal government through subsidization. The ruling is less about law and more about one cartel using a neoliberal Court to support its desire for increased profits. As health care costs have simply gone up along with premiums, and younger persons have preferred to pay the tax instead of buy insurance, the ACA has not done much in the way of helping average Americans: it has, however, allowed specialized health care providers to increase profits.