The Affordable Care Act has survived a Supreme Court challenge almost unscathed. This leaves intact the key Obama Administration promise to provide health care for all Americans. At the moment, the US has the world’s most expensive healthcare system but 18%, or 50 million people, are still uninsured.

The Affordable Care Act has survived a Supreme Court challenge almost unscathed. This leaves intact the key Obama Administration promise to provide health care for all Americans. At the moment, the US has the world’s most expensive healthcare system but 18%, or 50 million people, are still uninsured. 

In a 5-4 ruling based on the power of Congress to impose taxes, the court ruled that the law’s “individual mandate” requiring that most Americans obtain health insurance by 2014 or pay a tax was constitutional. The legislation, officially termed the Patient Protection and Affordable Care Act, was signed by the President in 2010, but has been bogged down in the courts ever since. 

Surprisingly, the deciding vote came from a conservative, the Chief Justice, John Roberts. He said that the court had “a general reticence to invalidate the acts of the nation’s elected leaders.” “It is not our job,” Roberts wrote, “to protect the people from the consequences of their political choices.”

Apart from equitable access to healthcare, there were other bioethical issues at stake in the ACA. The Catholic Church and other religious groups objected to being forced to cover services to which they have moral objections. (It also observed that illegal immigrants will not be allowed to access health insurance in the new insurance exchanges.) None of these issues was affected by Thursday’s decision. 

“The Becket Fund’s religious liberty lawsuits against the unconstitutional HHS mandate will continue,” said Hannah Smith, of the Becket Fund for Religious Liberty, which is leading several lawsuits against the Act. “Never in history has there been a mandate forcing individuals to violate their deeply held religious beliefs or pay a severe fine, a fine which could force many homeless shelters, charities, and religious institutions to shut their doors.” 

Michael Cook
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