WASHINGTON  –– Although the individual mandate in the 2010 health reform law does not pass constitutional muster under the Commerce Clause of the Constitution, it can be upheld as an acceptable exercise of Congress’ taxing powers, the U.S. Supreme Court ruled June 28.

IhealthcareSupporters of the administration’s health care reform law demonstrate in front of the U.S. Supreme Court building in Washington June 28. The nation’s high court upheld the Patient Protection and Affordable Care Act as constitutional but placed some limit s on the federal government’s ability to terminate states’ Medicaid funding. (CNS photo/Joshua Roberts, Reuters)n a 65-page opinion written by Chief Justice John Roberts, five members of the court upheld the Patient Protection and Affordable Care Act in full but limited the federal government’s right to withhold its share of Medicaid funding from states that do not expand the health program for the low-income and disabled as mandated by the law.

Joining Roberts in the majority opinion were Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan, although Ginsburg differed from the other four on whether the mandate was constitutional under the Commerce Clause.

“The federal government does not have the power to order people to buy health insurance … (but) does have the power to impose a tax on those without health insurance,” the Roberts opinion says. The mandate “is therefore constitutional, because it can reasonably be read as a tax.”

Dissenting were Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito, who would have overturned the entire law as an unconstitutional violation of the Commerce Clause.

By forcing those who are young and healthy to purchase health insurance, the law compels those who do not wish to participate in a particular marketplace to do so, the dissenters said.

“If Congress can reach out and command even those furthest removed from an interstate market to participate in the market, then the Commerce Clause becomes a font of unlimited power, or in (Alexander) Hamilton’s words, ‘the hideous monster whose devouring jaws … spare neither sex nor age, nor high nor low, nor sacred nor profane,'” said the dissenting opinion, written by Scalia.

The decisions do not affect other lawsuits against the health reform law’s requirement that most religious employers must provide contraceptives, including some abortion-causing drugs, and sterilization to their employees at no cost. Those cases are still in lower courts and have not yet reached the Supreme Court.