The United States Supreme Court sustained the Federal Patient Protection and Affordable Care Act of 2010 based on Chief Justice John G. Roberts, Jr.’s majority opinion in National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012). The Chief Justice’s decision to uphold the Act obviated a potentially harmful confrontation with the Obama Administration in advance of the November 2012 general election. However, the decision accomplished more than merely avoid a confrontation with the executive branch. Rather, the Chief Justice’s rationale for sustaining the Act under the Taxing and Spending Power and not the Commerce Clause is a marked departure from the Court’s prior precedent and aligns the Court’s jurisprudence in a direction that is conservative, federalist and activist. The Chief Justice’s decision to sustain the Act reminds us of Chief Justice Marshall’s decision in Marbury v. Madison, which co-opted the Jefferson Administration in a decision established the Court’s judicial review power over both executive and legislative actions and adumbrated the Judiciary’s present status as an equal branch of the federal government. Like his greatest predecessor, the Chief Justice issued a carefully reasoned decision that institutionally strengthens the Court, avoids a potentially damaging fight with the executive branch and furthers his own conservative and federalist jurisprudence.