This June, the Supreme Court is expected to hand down its landmark decision over the constitutionality of the
Affordable Care Act. The case is billed as a constitutional showdown that could define the scope of congressional power for years to come.
So what’s the case about and what’s at stake? Read on to find out.
Early challenges to health reform.After the Affordable Care Act was signed into law, a number of lawsuits challenging certain provisions of the bill were filed in federal courts. In November 2011, the Supreme Court agreed to examine several issues related to healthcare reform, including the individual mandate and the expansion of Medicaid.
These challenges were argued before the Supreme Court over the course of three days in March. Representing the government was Solicitor General Donald Verrilli and arguing on behalf of the plaintiffs was former Bush administration Solicitor General Paul Clement and Washington attorney Michael Carvin. The plaintiffs represented in the Supreme Court case include 26 states, along with the National Federation of Independent Business and several private individuals.
Results in the lower courts have been mixed. Three federal courts have ruled the individual mandate as unconstitutional, while three other decisions have upheld the law.
Public sentiment appears to be trending against the individual mandate. Before the Supreme Court hearings, nearly 51 percent of Americans agreed the individual mandate should be struck down, while only 28 percent said the justices should uphold the law.
Examining constitutional powers.The main question the Court will have to decide is whether or not the individual mandate violates the powers enumerated in the Constitution under the Commerce Clause, the Necessary and Proper Clause and the Taxing Power.
Article I, Section 8 of the Constitution states “Congress shall have Power... to regulate Commerce with foreign Nations, and among the several States, and with Indian Tribes.” It has been established through previous Court decisions that Congress can regulate any economic activity that they feel significantly affects interstate commerce.
Opponents to the law say the Affordable Care Act is an unprecedented use of congressional power which forces people to enter into commerce by mandating they purchase health insurance. In his brief to the court, Clement called the law a “revolution in the relationship” between the government and the people.
The plaintiffs argue that the mandate is being used by the federal government to force healthy individuals to
purchase a minimum level of health insurance to help pay for reforms that expand coverage to low-income individuals and those with preexisting conditions. They say that the federal government has limited powers and cannot create a market for health insurance just so that Congress can regulate it.
In response, the government says that the Affordable Care Act is within the scope of congressional power under the Commerce Clause because all Americans may need insurance at some point in their lives and the cost of that insurance can vary. The government maintains that it is well within Congress’s power to require that people purchase insurance to bring down the cost imposed on the market by those who do not carry insurance.
The government also states that the individual mandate also falls under Congress’s power to pass laws that are “necessary and proper” because without the individual mandate, Congress would not be able to properly regulate the market and insurance costs would increase.
The other constitutional issue regarding the individual mandate is the Taxing Power. The government says that the mandate is legal because the penalty for failure to purchase insurance will be administered through the tax code. The plaintiffs say that the mandate is not a tax but a punishment for breaking the law.
Healthcare and broccoli?The arguments presented to the court raised valid questions from the justices and signaled the Court’s skepticism of the constitutional validity of the individual mandate.
Conservative justice Antonin Scalia grilled Verrilli on his argument that the health insurance market was different from other markets because all Americans would need insurance at some point in their lives. Scalia asked if this meant Congress could require everyone to buy broccoli stating, "Everybody has to buy food sooner or later, so you define the market as food. Therefore, everybody is in the market. Therefore, you can make people buy broccoli.”
Justice Samuel Alito added to this argument by stating that most Americans would need burial insurance at some point in their lives, so why doesn’t the government require everyone to
purchase burial insurance as well?
General Solicitor Verrilli appeared to struggle while responding to the Court’s inquiries. Reports indicate that he frequently stumbled over his words and seemed unprepared for basic questions concerning the commerce clause. CNN legal analyst Jeffrey Toobin proclaimed Verrilli’s performance as a “trainwreck.”
Despite Verrilli’s shaky performance before the Court, the vote deciding the fate of healthcare reform is expected to be split between conservative and liberal justices. Justice Anthony Kennedy is said to be the swing vote that could decide whether healthcare reform stays or goes.
Predicting the outcome.Many legal analysts and pundits have offered predictions of the Supreme Court’s decision. Some say the justices’ line of questioning indicate the Court is leaning toward striking down the law, but a poll of former Supreme Court clerks and federal court judges predict the law will be upheld.
Regardless of the outcome, the Supreme Court’s decision will be one for the record books and will determine how you will access your healthcare in the future. The final decision is sure to create controversy and will spark continued discussion over the proper role of government in healthcare reform heading into the 2012 presidential election.
Cited Sources
"A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law."
The Henry J. Kaiser Family Foundation. The Henry J. Kaiser Family Foundation, Jan. 2012. Web. 25 May 2012. <www.kff.org/healthreform/upload/8270-2.pdf>.
Ingram, David. "CNN Train Wreck Comment on Healthcare Case Leaves a Mark."
Reuters. Thomson Reuters, 28 Mar. 2012. Web. 28 May 2012. <http://www.reuters.com/article/2012/03/28/us-usa-healthcare-court-toobin-idUSBRE82R0ZL20120328>.
Kane, Jason. "Supreme Court Reviews Health Care Reform Law: A Guide to Day 2."
PBS. PBS, 27 Mar. 2012. Web. 28 May 2012. <http://www.pbs.org/newshour/rundown/2012/03/health-care-reform-vs-supreme-court-a-viewers-guide-to-day-2.html>.
Richey, Warren. "Obama Health Care Law at Supreme Court: Mega Case for the History Books."
The Christian Science Monitor. The Christian Science Monitor, 24 Mar. 2012. Web. 28 May 2012. <http://www.csmonitor.com/USA/Justice/2012/0324/Obama-health-care-law-at-Supreme-Court-mega-case-for-the-history-books>.
Simon, Ammon. "Summary of the Supreme Court Health-Care Oral Arguments - By Ammon Simon - Bench Memos - National Review Online."
NRO. National Review, 23 Mar. 2012. Web. 28 May 2012. <http://www.nationalreview.com/bench-memos/294294/summary-supreme-court-health-care-oral-arguments-ammon-simon>.
Stein, Sam. "Supreme Court Clerks Predict Health Care Reform Will Be Upheld."
The Huffington Post. TheHuffingtonPost.com, 26 Mar. 2012. Web. 28 May 2012. <http://www.huffingtonpost.com/2012/03/26/supreme-court-health-care-reform-affordable-care-act-obamacare_n_1379805.html>.
Vicini, James. "Broccoli, Cellphones and the Obama Healthcare Law."
Reuters. Thomson Reuters, 27 Mar. 2012. Web. 28 May 2012. <http://www.reuters.com/article/2012/03/27/us-usa-healthcare-court-broccoli-idUSBRE82Q1B420120327>.
