As I mentioned a couple of days ago, the United States Supreme Court will be hearing arguments regarding the constitutionality of the health care reform law, beginning today, March 26th. With an allotted time of six hours for oral arguments, over the next three days, the justices will consider four legal issues, based on three different cases and the opposing positions of the legal representatives of those cases.
Issue 1. The Individual Mandate
This has been the central argument regarding the PPACA – whether the government can require that individuals purchase health insurance , or face paying a fine. Those who oppose this part of the bill do so under the Commerce Clause of the Constitution which provides the government with the authority to regulate interstate economic activity. Supporters of the individual mandate maintain that a failure to purchase health insurance has a direct economic effect, and results in taxpayers being stuck with the bills for those not otherwise covered. Opponents state that not doing something has the effect of economic inactivity and therefor cannot be regulated by the federal government.
Issue 2. Tax Anti-Injunction Act
Simply put, the Anti-Injunction Act prohibits courts from hearing lawsuits challenging a federal tax. It will mean that the Court will either rule that the Anti-Injunction Act applies or doesn’t apply in this matter, and therefor, whether this aspect of the challenge may or may not go forward.
Issue 3. The Question of Severability
With regard to this portion of the debate, the Court will hear arguments as to whether the entire health care reform should be invalidated if the individual mandate is found to be unconstitutional. In other words, can it be severed from the PPACA, or must the entire law be found as exceeding the limited and enumerated powers of Congress as granted them by the Constitution.
Issue 4. Federalism and Medicaid
This final set of arguments will be presented to the Court on Wednesday and deals with the possibility that Congress may have also exceeded its powers by placing burdensome conditions on the States through coercion. The claim has been that the federal government has threatened to withhold all federal funding under the Medicaid program. The PPACA provides for expansion for Medicaid coverage, something that would place an even greater weight on already overburdened States.
There are a few ways that the Court could rule on these issues. One is that the Court simply decides that the PPACA, in its entirety, is constitutional and that the law move forward as written and scheduled. A second outcome could be that the individual mandate is barred by the Constitution, while allowing the rest of the law to stand. A third possibility is that the Court finds that if the individual mandate fails to prevail, the entire PPACA will fall along with it, because the mandatory purchase of insurance is the very foundation upon which the PPACA is built. Lastly, the Court may decide that the entire matter has not ripened, and will dismiss the cases. In other words, as the law does not come into full effect until 2014, no one has been forced to purchase insurance or been fined for not doing so, and therefor there is no action for the Court to determine. Four federal appellate courts have issued rulings with mixed results, with two upholding the law, one coming to the opposite conclusion, finding it unconstitutional, and a fourth dismissing two cases for lack of standing – the lack of ripeness argument.
It’s a complicated set of issues and the Court has its hands full. Although six hours may not seem like a lot of time for oral arguments, it is one of the lengthiest that the Court has allowed in decades. There are volumes of legal briefs, from both sides of each issue, and lower court rulings to pour over. Experts believe that the justices will make a decision sometime in June. It’s going to be an interesting debate, and the Court’s ruling may very well be an election cycle game-changer.