ACA Update: US Supreme Court Hearings

By Emily McKinley, Health Information Specialist

The Affordable Care Act received increased attention from the media during the latter half of March.Not only was the act celebrating its second anniversary but it was also trying to withstand claims of unconstitutionality which landed the act, its supporters and opponents in the United States Supreme Court.

The nine justices of the US Supreme Court heard four oral arguments regarding the ACA and dedicated more hearing time to the act than any previous issue brought before the Court.

The first argument, presented on Monday, March 26, centered on whether the Court could even rule on the case at the present time. That is to say, the act was tested against the Anti-Injunction Act, which states that a tax cannot be challenged until it is enforced. This argument relates directly to the provisionof the ACA which states that come 2014, individuals who have not enrolled in or purchased insurance coverage will have to pay a penalty that will be collected as part of an individual’s tax obligation.Because the penalty will be collected with one’s taxes, the argument and justices’ questions centered largely on whether the penalty was, in fact, a tax. Essentially, ruling on this argument may determine whether or not the justices will also issue rulings on the remaining three arguments.

On Tuesday, March 27, the Court heard arguments regarding the individual mandate. This provisionof the ACA states that by 2014, all American must enroll in or purchase insurance coverage. Clement,the attorney for the petitioners (Florida and 25 other states) argued that not only is the individual mandate unconstitutional on the grounds that Congress overstepped its bounds with regard to regulating commerce but also primed his argument for Wednesday stating that if the provision isfound unconstitutional, so too must the entire ACA. On the other hand, the attorney representing the government, Verilli, argued that Congress already has a hand in regulating existing markets andcommerce and this is simply a measure to reform the market such that the act is able to ensure guaranteed issue (provision to prevent discrimination due to preexisting conditions) of insurance and community rating reforms (will largely affect overall price of policies) for insurance policies. The justices centered their questions on the limits of Congress to regulate commerce, specifically, if Congress can mandate purchase of insurance coverage, can they also require Americans to purchase healthy foods,like broccoli, and if not, why? Additionally, the justices asked why healthy Americans should be forced topurchase a product that they are not currently using. Verilli countered that, at some point, all Americans will access the health care system. Thus, the question regarding that access is not if but when and how.

The third day, Wednesday, Marcy 28, was the longest day for arguments. On Wednesday, the justicesheard two arguments. The first of those centered on whether the individual mandate is severablefrom the remainder of the act. In other words, if the justices rule that that provision is, in fact,unconstitutional, can the remainder of the ACA stand? Once again, the petitioners argued that becausethe individual mandate is an essential clause that directly funds and supports the other major clausesof the act, community rating and guaranteed issue, the entire act must fall. On the other hand, the government argued that if ruled unconstitutional, the individual mandate is, in fact, severable from the remainder of the ACA. This drew questions from the justices about how to determine what will be left standing if the individual mandate is removed from the ACA, and Justice Scalia scoffed at the idea of combing through the 2700 pages of legislation in order to decide the fate of the many provisions of the Act. That said, several of the justices also commented that many provisions were clearly included to protect Americans, which posed further dilemma over whether it was the justices’ or Congress’ role to sort those out if the act should require reconstruction.

Finally, in the afternoon on Wednesday, the fourth and final argument, Medicaid expansion, was heard. The petitioner argued that the federal government was essentially coercing states to acceptthe Medicaid expansion by regulating the services that must be covered as well as resident eligibilityfor the programs in order to receive federal funds. While some justices seemed receptive to this idea,others seemed reluctant to limit the spending power of Congress. Further, there was lengthy discussion suggesting that while states may depend upon the money to support their programs, federal dollars do support those programs and, therefore, come with stipulations. This was the least successful petitioner argument in state courts; in fact, no state ruled in favor of petitioners opposing the ACA’s Medicaid expansion.

As to be expected, the justices of the Supreme Court posed equally challenging questions on both sidesof the ACA, and it will not be until mid-summer that the American public will know the fate of the act asit is now written. Further, the overall picture of health care reform in our country will likely take years toshape as either the ACA is reconstructed or continues to unfold as written.

For more information about these arguments, please visit our blog where you will find an “Update onthe Supreme Court and the ACA.”