A key part of the ruling was written by Judge Jeffrey Sutton -- a President George W. Bush appointee and considered a conservative on the court. He said the health care field is different from other streams of "commerce."
"Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life. Not every intrusive law is an unconstitutionally intrusive law," he said. "Time assuredly will bring to light the policy strengths and weaknesses of using the individual mandate as part of this national legislation, allowing the peoples' political representatives, rather than their judges, to have the primary say over its utility."
Sutton added, "The government has the better of the arguments." He was supported by Judge Boyce Martin -- who is considered a liberal and was named to the bench by President Carter. He turned aside the argument by opponents of the law that economic "inactivity" cannot be regulated by the national legislature.
"Congress had a rational basis for concluding that the minimum coverage provision is essential to the Affordable Care Act's larger reforms to the national markets in health care delivery and health insurance," he said. "The provision regulates active participation in the health care market, and in any case, the Constitution imposes no categorical bar on regulating inactivity."
Judge James Graham -- a Reagan appointee -- agreed with most of the opinion but expressed some concern Congress could go too far in other economic arenas, under limits imposed by the Constitution's commerce and spending clauses.