In 2012, in a highly anticipated decision, the United States Supreme Court upheld the constitutionality of a requirement that most Americans obtain health insurance or pay a monetary penalty.' The statute in question that contained this requirement, the Patient Protection and Affordable Care Act (Act or ACA), often labeled as "Obamacare," or the Affordable Care Act, was a monumental piece of legislation (over 900 pages) that was passed by Congress and signed into law by President Barack Obama in 2010. The Act represented a significant overhaul of the country's health care system and structure. The primary objectives of this legislation were to expand the number of individuals covered by health insurance and decrease the overall cost of health care in the country. In the 2012 elections, President Obama won re-election and Senate democrats strengthened their majority in the U.S. Senate. Consequently, many experts believed the Act was here to stay; however, questions remain regarding its implementation. Although the Supreme Court essentially ended two years of uncertainty on the legal status of the Act, it is now unclear whether the original goals of the Act and the individual mandate adding millions of new consumers to the health insurance market and increasing the number and share of Americans who are insured can still be met. This article explores the Court's taxing power decision with respect to the individual mandate and the direct implications of that decision to not only the Act's objectives for greater individual health insurance coverage, but also the possible impact in other health care areas. Two years after the Court's decision, the Act's overall implementation is still uncertain. As states work to implement the Act or choose to maintain their own healthcare models, the healthcare market is in a state of flux. Due partially to the Court's decision to restrict the Medicaid expansion, the Act's effectiveness is now more questionable than ever. Questions addressed by this Article include whether there really still is a legal individual mandate requiring the purchase of health insurance and whether further legislation could be possible under Congress's taxing power if the goals under the Act are not met. This article also reviews the question of whether there has been an expansion of Congress's taxing power, along with an analysis of current efforts at implementation and consideration of whether the Court's decision may ultimately have done more harm than good to the individual mandate.
HEALTH CARE L. & POL’Y No. 2 (2014)