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The Supreme Court and the Affordable Care Act: Yes? No? Maybe?

March 1, 2012
by Ron Manderscheid, PhD
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Will social justice prevail in the Supreme Court decision?

On a long flight from Frankfurt, Germany, to Washington, D.C., in the brilliant sunlight of a late winter’s day, I had the opportunity to reflect on the upcoming U.S. Supreme Court decisions regarding the Affordable Care Act of 2010 (ACA). Current plans call for the Court to hear arguments on March 26-28 and to issue an opinion before the current session ends in June. Will social justice prevail in the Supreme Court decision?

We are rapidly approaching a critical juncture that should cause all of us to pause and to reflect. On one side, we have the ACA and the promise it holds for all Americans. It is particularly crucial for those who live on the edge of financial disaster because they do not have health insurance. On the other side, we have “business as usual” healthcare that excludes many. As we all know, our current system promotes ever increasing prices for health care and dramatic annual growth in overall costs. Which of these courses will the Court select for us?

The Court is being asked to rule on two issues that have been placed before it, both of which concern the appropriate constitutional exercise of Congressional authority in the ACA: First, what is the constitutionality of the individual health insurance mandate [i.e., everyone is required to purchase minimal health insurance]? Second, is the Medicaid Expansion constitutional?  In this short commentary, I would like to examine the context in which these decisions will be made and the consequences of each decision.

Today, our US health care “system” is very large, equal to about one-fifth of our annual economy. It dwarfs other human concerns, such as education and human welfare, which are minor by comparison. As we look toward the future, we can see clearly now that rapid continued annual growth in expenditures will occur due to several factors, including changing demographics (the elderly population will double in 20 years), rapid implementation of expensive new technologies and medications, and continued and growing use of expensive emergency department care by those who lack health insurance. Not to engage in hyperbole, but to underline the significance of these trends, it is fair to say that the growth in total health care costs in the US have the potential to overwhelm both the US economy and the federal government’s capacity to provide necessary funding for health care. Thus, to me, immediate action is fully warranted, and the ACA is a fully appropriate response to a very severe and growing problem.

Now, let’s consider the questions before the Court:





A great analysis of a vitally important issue.

I was just traveling in Arizona where the problem of "uninsured motorists" is severe and often attributed, fairly or not, to Arizona's population of undocumented individuals. The feeling is, of course, that people ought not use the nation's road system unless they contribute to insuring possible losses.

In Ohio, my home state, and in virtually every state, it is illegal to operate an automobile without insurance to cover, at a minimum, the financial liability to which you might subject others.

I have great difficulty understanding any case against the insurance mandate.


Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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