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Conservatives question chief justice’s motive for upholding health-care law

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On March 30, the justices met privately to discuss the health-care case and to cast their votes. The chief justice speaks first at such conferences.

Roberts apparently agreed the insurance mandate could not be upheld as a regulation of commerce, a view echoed by the four other conservatives. He also apparently agreed that the states could not be required to expand the Medicaid program and provide more free health care to poor people.

But the court still had to decide two other questions. Could the law’s tax penalties be upheld as an incentive for people to obtain insurance? And if the insurance mandate were declared unconstitutional, must the entire act be voided?

Roberts learned that the four conservatives — Scalia, Kennedy, Thomas and Alito — were determined to strike down the entire law. Their dissent last week derided it as a “Christmas tree” decorated with ornaments. “We think the proper rule must be that when the tree no longer exists, the ornaments are superfluous,” they said.

The four liberal justices — Ginsburg, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan — were determined to uphold the insurance mandate as a regulation of commerce. They thought it was radical and extreme to throw out a national regulatory law passed by Congress and signed by the president. The court had not struck down such a law since 1936.

But in a partial concession, Breyer and Kagan agreed with Roberts that the states could opt out of the Medicaid expansion if they were willing to forgo the extra federal money.

When the private conference ended, the justices on both sides may have hoped they would prevail. Roberts assigned the majority opinion to himself.

About six weeks later, when Roberts circulated his draft opinion, it became clear he had decided to uphold the law’s tax penalties for those who did not obtain insurance. But he stuck to his view that people could not be forced to buy insurance as a regulation of commerce and that states could not be forced to expand Medicaid. The conservative side had won on the major constitutional issues but lost on the result.

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