Chief Justice Roberts' vote saved the ACA.
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.
On the Medicaid issue, a majority of the Court holds that the Medicaid expansion is constitutional but that it w/b unconstitutional for the federal government to withhold Medicaid funds for non-compliance with the expansion provisions.
The key comment on salvaging the Medicaid expansion is this (from Roberts): "Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding." (p. 55)
(To be clear, what we are typing here are excerpts from the opinion or paraphrasing thereof. Not predictions anymore.)
The critical detail is that you cannot take away the existing Medicaid funds.
The Court does not reach severability issues, having upheld the mandate 5-4.
To readers of the Roberts opinion, a caution: It is the opinion of the Court through the top of p. 44; the balance is labeled as, and is, Roberts speaking for himself.
Another way to think about Medicaid: the Constitution requires that states have a choice about whether to participate in the expansion of eligibility; if they decide not to, they can continue to receive funds for the rest of the program.
Apologies - you can't refuse to pay the tax; typo. The only effect of not complying with the mandate is that you pay the tax.
The Court holds that the mandate violates the Commerce Clause, but that doesn't matter b/c there are five votes for the mandate to be constitutional under the taxing power.
The Court holds that the Anti-Injunction Act doesn't apply because the label "tax" is not controlling.
Justice Ginsburg would uphold Medicaid just as Congress wrote it. That, too, is not controlling.
In opening his statement in dissent, Kennedy says: "In our view, the entire Act before us is invalid in its entirety."