Q&A with Robert Field: The Supreme Court Health Care Decision July 11 2012 It was one of the most hugely anticipated rulings in recent Supreme Court history. On June 28, the court upheld President Barack Obama’s historic health care overhaul law, ruling it was lawful for the government to mandate all Americans purchase health insurance (or pay a fee for not doing so), because such power was authorized under Congress’ tax authority. The court upheld the law by a vote of 5-4, with Chief Justice John Roberts proving to be the swing vote. In the wake of the decision, DrexelNow asked Dr. Robert Field, a professor at the School of Public Health and the Earle Mack School of Law, to put the ruling in context, and offer his thoughts on whether the fight over the controversial law was really over—or if it had just begun. Were you surprised by the Court's ruling? If so, why? I was surprised by the ruling. I had expected the court to strike down the mandate in the law. I attended the oral arguments on the mandate, and was impressed by the extremely negative tone of the questioning by the conservative justices. However, there did seem to be more receptiveness to the notion that the mandate could be justified as a tax. In light of that, in retrospect, the outcome makes sense. Broadly speaking, what does this ruling mean for our health care system going forward? In the short term, the ruling means that health reform can move forward. In the long-term, the consequences of the ruling are less certain. The Roberts decision imposed new limits on Congress's authority to implement new regulatory programs based on the Constitution's commerce and spending clauses. Congress will have to proceed carefully if it tries something as ambitious as the Obama health reform plan again. Would you call this a complete "victory" for the Obama administration, or do conservatives have something to be happy about, too? The ruling is definitely not a complete victory for the Obama administration. For one thing, the decision significantly changed the part of the law that expands Medicaid. States now have the ability to opt out of the expansion without penalty. Many with Republican governors have indicated that they plan to do so. This could significantly lessen the health reform plan's effectiveness. The ruling also sets new conditions on Congressional actions going forward. I have heard some experts say that this is but the first battle of many to come regarding the ultimate implementation of this law. Would you agree with that statement? Whether there are more impediments to implementation of the health reform law remains to be seen. Republicans will certainly try to impose roadblocks between now and the election. After that, they may try to follow through on their threat to repeal the program, but they would have to control both houses of Congress and the White House to accomplish that goal. After the election, health reform may no longer serve their political purposes, and they may begin to ignore it. They may also find strong opposition to repeal efforts from consumers who would lose new protections and from businesses that would lose new opportunities. Nevertheless, this is an ongoing soap opera, and it is difficult to predict how it will end.