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The Patient Protection and Affordable Care Act of 2010, better known as Obamacare, was designed to patch the insurance gaps between Medicare, Medicaid, and employer-sponsored health care, which is bolstered by a tax carve-out for workplace benefits. Obamacare was barely two years old when it faced its first challenge at the Supreme Court.
A decade after that first challenge, the law remains on the books. But the outcome of that case has shaped both the health law's evolution and its public perception, leaving Americans with a major federal program that even its fiercest advocates say does not live up to its goals.
The justices heard arguments for and against the constitutionality of Obamacare's health insurance mandate, which required every American who did not qualify for an exemption to carry federally approved health insurance. They also considered arguments over the law's mandatory expansion of Medicaid, which penalized noncompliant states with a massive clawback of federal funds.
A year earlier, Judge Roger Vinson of the United States District Court for the Northern District of Florida had struck down the individual mandate and declared that, because it was central to Obamacare, the entire statute should fall. Many observers expected the Supreme Court to likewise rule against Obamacare. They thought the only question was whether the Court would strike down just the mandate or the entire sprawling bill.
As it turned out, the vote was 5–4 to save the mandate. In a strained opinion that would remain controversial for years, Chief Justice John Roberts wrote that the mandate could not be justified under the Commerce Clause, because the power to regulate interstate commerce does not include the power to compel commercial activity—in this case, the purchase of government-approved medical insurance. But because people who failed to comply with the mandate were subject to an IRS-administered financial penalty, he said, the provision could be upheld as an exercise of Congress' taxing power.
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