Smithsonian.com

Sailors were required to buy health care in 1798. Photo: U.S. Navy

The Supreme Court handed down its decision on the Affordable Care Act this morning, and the individual mandate —the requirement that all Americans buy health insurance, which was one of the bill’s most at-risk provisions—survived. Chief Justice John Roberts voted with the majority, which upheld most of the law, limiting only the federal government’s power to stop states’ Medicaid funds.

SCOTUSblog explains the details of the decision on the mandate:

The money quote from the section on the mandate: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.

The court reinforces that individuals can simply refuse to pay the tax and not comply with the mandate.

Now, for some perspective! Mandates for health insurance aren’t exactly new, as Forbes reported last year:

In July of 1798, Congress passed – and President John Adams signed - “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance.

Granted, sailors aren’t the same thing as the entire American public, but then neither do the (expensive) miracles of modern medicine resemble the simple (and often ineffective) health care of yore.

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