Supreme Court Debates Health-Care Reform Law

This week, in a rare three-day hearing, the U.S. Supreme Court is considering a challenge to a key provision of the Patient Protection and Affordable Care Act [pdf], the law passed by Congress in 2010 that is the cornerstone of the Obama Administration's efforts to reform health care in America.

The administration and the law's supporters see health-care reform as necessary to make health care more affordable and accessible to Americans, millions of whom long went without coverage. Some opponents, however, see the program as government intrusion on the health-care industry and on patients' choices, while others charge that it will drive up costs rather than control them, and will add to the federal deficit. Some opponents have tried to get the federal courts to overturn the law. The Supreme Court agreed to consider a lawsuit filed by the state of Florida [pdf] that challenges one of the law's key provisions -- the "individual mandate," which requires that Americans not covered by an employer-provided plan obtain their own insurance. From Washington Post economics reporter Ezra Klein, here's an explanation of how the individual mandate would work when -- or perhaps if -- it takes effect in 2015.

Because of the gravity of the case, which could affect a vast segment of the American public, justices are devoting six hours, spread over three days, to hearing oral arguments on the lawsuit. It's the longest hearing for a single case since March 1966. (On that occasion, the Supreme Court heard seven hours of arguments before rejecting a challenge to the 1965 Voting Rights Act by the state of South Carolina, which objected to a ban on literacy tests for black voters.)

Here's a roundup of news coverage of the case, and some sources that will help you to understand what the law may mean for you and other middle-aged Americans.

How did it come to this? National Public Radio correspondent Ari Shapiro offers this four-minute primer on how the case got to the Supreme Court and what basic issues are at stake. As Shapiro explains, one crucial legal question is this: Should the penalty that the new law would impose in 2015 on anyone who doesn't buy coverage be considered a form of taxation? If the Supreme Court ultimately decides that the provision is a tax, then the current legal challenge would be rejected, since it's only possible to challenge a tax as unconstitutional if you've already paid it. Another issue is whether requiring all Americans to have health insurance is permissible under the Commerce Clause of the U.S. Constitution, which limits the federal government's ability to regulate commerce (in this case, health insurance). 

As Shapiro notes, opponents believe the government doesn't have the power to compel people to buy insurance any more than it can "require Americans to buy broccoli or a car." Supporters, in contrast, argue that health care is different "because everybody in America at some point in their life will need health care," and if young healthy people are allowed to opt out, the system will be financially unsustainable." From The New York Times, here also is another more detailed primer on the law and the challenge to it.

Will the Supreme Court overturn the law? According to this New York Times account of Tuesday's session, four of the court's more conservative justices peppered the administration's lawyer, Solicitor General Donald B. Verrilli, Jr., with skeptical questions only minutes into the argument. Chief Justice John G. Roberts, for example, asked Verrilli if the government also had the power to compel people to buy cellphones, while Justice Samuel A. Alito, Jr. wanted to know if officials could force the public to buy burial insurance. Times writer Adam Liptak noted that "the administration will need one of those four votes to win the case, and it was not clear on Tuesday that it had captured one." The court's fifth conservative, Justice Clarence Thomas, followed his usual practice of not asking any questions. Justice Ruth Bader Ginsburg, a Democratic appointee and one of the court's four liberal justices, said the individual mandate was a response to the fact that uninsured people receive free health care that ends up being paid for by others. "They are making the rest of us pay," she said. BloombergBusinessWeek predicts that the court's five Republican appointees will band together to topple the law.

How will health-care reform affect you? A recent Kaiser Family Foundation poll found [pdf] that most Americans -- 64 percent -- think the Supreme Court's decision on the law will have at least some impact on their families, though only 28 percent say it will have a lot of impact. That said, 59 percent concede that they don't have enough information about the law to understand exactly how it will affect them and their families. Despite extensive news coverage of political debate over health-care reform, many were in the dark when it came to key parts of the law. Only one in four, for example, were aware that it had lowered seniors' prescription drug costs by closing the so-called "donut hole" in the Medicare prescription drug program. Kaiser found that except for the individual mandate, which is favored by only 32 percent of Americans, large majorities support the law's key provisions.

How much would it cost? In 2015, the penalty for not carrying the required health insurance would amount to $325 or 2 percent of personal income, whichever is greater, according to this Congressional document [pdf]. That's still far less than the thousands of dollars it might cost to buy private health insurance. Another concern is whether Obamacare is causing premiums for workers with employer-provided health insurance to go up, as opponents claim, or down, as the White House insists. Here's a piece from FactCheck.org, which suggests that the law hasn't stopped the rise in insurance premiums, but it may have helped slow it.

What happens if the individual mandate is thrown out? According to this CBS News analysis, throwing out the individual mandate would radically alter, and perhaps cripple, Obama's health-care reform effort. The president has said that the provision is a crucial part of his plan to control costs. The administration argues that without the individual mandate, another part of Obamacare that is far more popular among the public -- the ban on insurers denying coverage because of pre-existing conditions -- would not work. Officials say another popular part of the law -- the requirement that insurers offer plans within the same price range to all customers, regardless of age and other factors -- would be unworkable, as well. 

What's next: The legal arguments will wrap up today.

Previous Post: 5 Novels Capture World War II

Next Post: Reading List: 10 Insightful Books for Career Changers