Given that the court split three ways, at least on certain questions, it is not a simple task to piece together the court's collective holding. Here is a quick overview--perhaps a bit simplistic, but I think it will suffice until I've had a chance to read the opinions more carefully:
1. The court unanimously concluded that it had subject matter jurisdiction: that at least one plaintiff had Article III standing, and that the Anti-Injunction Act did not deprive the court of jurisdiction.
2. Judges Sutton and Graham concluded that the minimum essential coverage provision is not a valid exercise of Congress's taxing power under the General Welfare Clause. Congress intended to impose a regulatory penalty, not a tax, regardless of the provision's practical operation or economic effects. Judge Martin does not reach this question.
3. Judges Martin and Sutton concluded, using different rationales, that the minimum essential coverage provision is a facially valid exercise of Congress's authority to regulate interstate commerce. Judge Graham dissents.
(a) Judge Martin concluded that the regulated activity--the decision as to how to finance the purchase of health care services--is economic in nature, and thus can be reached by Congress under the Lopez framework. In addition, the individual mandate is a necessary component of the ACA's broader regulation of the health insurance and health care services markets, and thus is justified by the holdings in Raich and Wickard.
(b) Judge Sutton concluded that the individual mandate is constitutional as applied to at least four discrete categories of individuals: (1) those who have already purchased insurance voluntarily and who want to maintain coverage; (2) those who voluntarily obtained coverage but do not wish to be forced to maintain it; (3) those living in states that already require them to obtain insurance and who may have to obtain more coverage to comply with the mandate; and (4) those under 30, no matter where they live and no matter whether they have purchased health care before, who may satisfy the law by obtaining only catastrophic-care coverage. Because the mandate is constitutional as applied to a substantial number of persons to whom it applies, the pliaintiffs' pre-enforcement, facial challenge to the Act must fail under Salerno.
(c) Judge Graham would hold that the minimum coverage provision exceeds Congress's enumerated powers, stating that he "believe[s] the Supreme Court remains committed to the path laid down by Chief Justice Rehnquist and Justices O’Connor, Scalia, Kennedy, and Thomas to establish a framework of meaningful limitations on congressional power under the Commerce Clause. The current case is an opportunity to prove it so." Judge Graham also concludes that Salerno is inapplicable in cases concerning Congress's enumerated powers (as opposed to cases seeking to vindicate individual rights).
