The constitutionality of the Patient Protection and Affordable Care Act (ACA) was challenged in two cases before the Supreme Court.

On June 28, 2012, the Court handed down a 5 -4 decision that upheld the bill. The two rulings focused on the individual mandate and the expansion of the Medicaid program.

One case challenged the constitutionality of the so-called “individual mandate,” the requirement for all individuals to obtain insurance coverage, by 2014 or face a penalty. The case asserted the requirement is a wrongful use of Congress’s taxation and commerce powers. The Court upheld the tax penalty as constitutionally within Congress's legislative powers to require.

The other case ruled by the Court challenged the required expansion of the Medicaid program in each state to 133% of FPL. The Court declared that although the law requiring the states to expand the Medicaid program was valid, the Federal government cannot force participation in the expansion, by removing all federal funding for those states that do not comply. This leaves states with the ability to opt-in or opt-out of the proposed expansion of the program.

In states that forgo the Mediciad expansion, this leaves in limbo many low-income persons who are not eligible for the government subsidies for purchasing insurance, but who would have otherwise qualified for the expanded Medicaid.

Despite the Supreme Court’s ruling, certain members of Congress are still threatening to alter or repeal the law. The results of the 2012 elections will play a large factor in determining the feasibility of these efforts.

If the law survives unchanged then on January 1, 2014 the individual mandate will take effect and states that choose to expand the Medicaid program could take on an estimated 16 million new individuals.