Con decisione adottata 5 voti a 4 la Supreme Court statunitense ha fatto salvo il Patient Protection Affordable Care Act (PPACA), il testo cardine della riforma sanitaria varata dall'amministrazione Obama. La questione di costituzionalità era incentrata in primis sulla previsione relativa al c.d. individual mandate, in base al quale tutti i cittadini dovranno (shall), entro il 2014, ottenere una polizza assicurativa che garantisca una copertura essenziale minima. Nel caso in cui tale dovere non dovesse essere adempiuto interverrà l'obbligo di corrispondere al governo federale uno “shared responsibility payment”, una sorta di tassa individuale penale.
US Supreme Court - National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al.: assicurazione sanitaria obbligatoria
28 giugno 2012
Numero
11-393
Anno
2012
Secondo la Corte l'imposizione di una tassa rientra nella discrezionalità del Congresso e la previsione non si tradurrebbe dunque in una invasione della vita privata dei cittadini.
Nelle parole della Court's opinion (relatore Roberts, C. J.): «[...] the shared responsibility payment may for constitutional purposes be considered a tax. The payment is not so high that there is really no choice but to buy health insurance; the payment is not limited to willful violations, as penalties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation. [...]. None of this is to say that payment is not intended to induce the purchase of health insurance. But the mandate need not be read to declare that failing to do so is unlawful. Neither the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS. And Congress’s choice of language – stating that individuals “shall” obtain insurance or pay a “penalty” – does not require reading §5000A as punishing unlawful conduct. It may also be read as imposing a tax on those who go without insurance».
«The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness».
Un secondo profilo riguardava poi l'estensione del c.d. Medicaid, il programma che offre fondi federali agli Stati per assistere nelle spese sanitarie determinate categorie di soggetti (donne incinte, bambini, famiglie bisognose, ciechi, disabili...). Il PPACA aumenta i fondi federali per coprire nuove spese e prevedeva che il mancato adeguamento da parte di uno Stato alle nuove previsioni avrebbe comportato la perdita di tutti i fondi federali per il Medicaid. La Corte censura questo secondo profilo, affermando che «[a]s for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the
States must have a genuine choice whether to accept the offer. The States are given no such choice in this case: they must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding. The remedy for that constitutional violation is to preclude the Federal Government from imposing such a sanction. That remedy does not require striking down other portions of the Affordable Care Act».
I giudici firmatari della dissenting opinion (Scalia, Kennedy, Thomas, Alito) ritengono invece che il PPACA ecceda i poteri federali «both in mandating the purchase of health insurance and in denying nonconsenting States all Medicaid funding. These parts of the Act are central to its design and operation, and all the Act’s other provisions would not have been enacted without them», con la conseguenza che «the entire statute is inoperative».
Pubblicato il: Giovedì, 28 Giugno 2012 - Ultima modifica: Giovedì, 12 Settembre 2024
