The Supreme Court wrapped up its third and final day of oral arguments on the Patient Protection and Affordable Care Act today, as it considered two distinct questions.
The first case dealt with how much of the reform law should survive if the Court strikes down the mandate that most Americans must buy health insurance or pay a penalty. Lawyers for the opponents of the law argued that the entire Act must be thrown out. The Obama Administration position is that the prohibition against insurers discriminating against those with pre-existing conditions, as well as insurance rate controls, would be invalidated. A Court-appointed lawyer argued a third position, that the mandate could be severed without affecting the rest of the law.
If the Court does indeed strike down the mandate and decides that at least some of the law should survive, it will be faced with the difficult task of untangling an extremely complicated piece legislation. Congress originally included the mandate in order to defray costs associated with such benefits as covering pre-existing conditions and extending parents’ health care coverage to children up to age 26. Requiring insurance companies to continue to meet these requirements would place a significant financial burden on them. In addition, there are other provisions of the law that are completely independent of the insurance mandate, such as funds for maternal care programs, research grants, and support for hospitals and clinics — many of which are already in the process of being implemented. The Court would be presented with the daunting task of determining what should and should not be eliminated — something several of the justices seemed reluctant to undertake.
The second half of the oral arguments was over the constitutionality of a provision of the law expanding the Medicaid program, which is run jointly with states to provide health care to the poor. At issue is whether Congress has exceeded its power by requiring states to go along with expansion of the program to cover people with incomes up to 133 percent of the poverty line or face the loss of all Federal Medicaid funds. Although the Federal government will pay for 100 percent of the expansion for the first two years, by 2020 its share would drop to 90 percent.
Such requirements by the Federal government are far from unusual. For instance, Congress often has made the receipt of highway money, educational funds, and unemployment insurance contingent on States’ meeting a variety of requirements. If the Court ruled in favor of the challengers in this case, it could represent significant shift of power from the Federal government to the States.
A transcript of the severability case is available here and an audio recording is here. For the Medicaid case, a transcript is here and an audio recording is here. Supreme Court Debates will cover the health care court challenges in depth in next the May issue.
