Health Care and the Supreme Court


Health Care Decision Hinges on A Crucial Clause

By Nina Totenberg, NPR News and Kaiser Health News

Protestor at Supreme Court in March during oral arguments on the Affordable Care Act. (Getty Images: Mark Wilson)

Protestor at Supreme Court in March during oral arguments on the Affordable Care Act. (Getty Images: Mark Wilson)

All of Washington is breathlessly awaiting the Supreme Court’s imminent decision on the Obama health care overhaul. Rumors circulate almost daily that the decision is ready for release. As usual, those rumors are perpetrated by people who know nothing, but the decision is expected by the end of this month.

The near hysteria is partially about politics: Congressional Republicans hate the bill, and some see President Obama’s chance at a second term hinged to the fate of the law. But constitutional scholars know there is much more at stake here than an individual election. Just how much is illustrated by the legal history of the Commerce Clause of the Constitution.

The ACA presents a watershed, a potential breaking point with the legal framework that has undergirded our modern economy.

It gives Congress the power to “regulate commerce … among the several States,” and it authorizes Congress to “make all laws which shall be necessary and proper” for achieving that goal. The Founding Fathers’ purpose was to put an end to the interstate rivalries that balkanized the country after the American Revolution. But the words of the Commerce Clause are pretty general, and it is the Supreme Court that for more than 200 years has interpreted what they mean.

Early Decision: Broad Power

The court’s first major Commerce Clause decision came in the 1824. The great Chief Justice John Marshall, who was himself one of the Founding Fathers, wrote in Gibbons v. Ogden that the Commerce Clause gives Congress broad power to regulate commerce and that this power is mainly limited by the power of the people to deny their representatives re-election if they don’t like what Congress does. Continue reading

Politics in the High Court — Right, Left or Not at All?

(Mark Wilson: Getty Images)

(Mark Wilson: Getty Images)

Every news organization in the country is busy parsing the Supreme Court today and State of Health is no exception. But if you’re tired of arcane discussions of the Commerce Clause, the individual mandate and (heaven forbid) the 1867 Tax Anti-Injunction Act, read on.

In a “Health Law Hearings Wrap Up” this morning on KQED’s Forum, I perked up when the guests got going on how much to read into the justices’ questions. These are not the first legal experts to focus on Justice Kennedy, the perceived swing vote, who asked many tough questions of the attorney defending the government’s position on the constitutionality of the health care law.

But Vikram Amar, professor at the UC Davis School of Law urged caution in trying to analyze the questions too closely. “Justice Kennedy at some points in the past asked very tough questions of the government and ended up not striking down the law in question,” he said. Continue reading

Full Audio & Transcripts: Supreme Court’s Oral Arguments on the Health Law

(Jessica Marcy: KHN)

(Jessica Marcy: KHN)

The Supreme Court’s historic hearings of the Affordable Care Act have wrapped up. The Court addressed four issues over the last three days and held a total of six hours of oral arguments.

Below is complete audio and transcripts from each set of arguments.

First, the court heard arguments about whether it can even consider the case now. Under the new law, the first penalties would be assessed in 2015 for those who do not purchase health insurance. An arcane 1867 law says people can’t sue over a tax until they pay a tax. Must the court wait until 2015 to decide whether the health law is constitutional?

You can listen to the 90 minutes of oral arguments here:

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Or read on for the complete transcript as well as audio and transcripts from the other arguments:
Continue reading

Legal Levity: Moments of Humor During Historic Hearings

Supreme Court Justice Antonin Scalia was one of the justices making the occasional joke today. (Courtesy: U.S. Supreme Court)

Supreme Court Justice Antonin Scalia was one of the justices making the occasional joke today. (Courtesy: U.S. Supreme Court)

It was the hottest ticket inside the Beltway–the Supreme Court’s hearings on the federal health care law. Kaiser Health News reporter Phil Galewitz was determined to get in, but didn’t have a press pass (and no member of Congress gave him one, either). Instead–just by standing in line–he got in.

There were two sets of arguments today. For the earlier arguments, Galewitz only snagged a “three-minute pass” then parlayed it into a full six minutes. But for the second hearing about the Medicaid expansion, he got a special “gray” ticket for the full, one-hour session.

Galewitz picks up his story from there–and it turns out the Justices can be funny: Continue reading

Court Considers Whether Entire Health Care Law Should Be Struck Down

By: KQED News Staff and Wires

(Jessica Marcy: KHN)

(Jessica Marcy: Kaiser Health News)

The Supreme Court signaled Wednesday that it could throw out other key parts of the Affordable Care Act if it first finds the individual insurance requirement unconstitutional.

On the third and last day of arguments, the justices appeared to accept the administration’s argument that at least two important insurance changes are so closely tied to the insurance requirement that they could not survive without it. Those two changes are the popular provisions that both require insurers to offer insurance to applicants with pre-existing conditions and also requires insurers to charge the same rates to people who are roughly the same age, regardless of their health.

Those changes should go, the Obama Administration argued, because without the individual mandate, people might wait until they’re sick before they signed up for coverage. Not enough people would be in the health insurance pool to spread risk. Ruin could come to the insurance market.

In short the Court faces three scenarios if it strikes down the individual mandate: Continue reading

Audio/Transcripts of Supreme Court Hearings on the Fate of the Health Law

Updated 12:15pm PT

The Supreme Court heard two sets of oral arguments today in its final day of considering the health care overhaul. The second arguments were extended and wrapped up about an hour ago. In that session, the Court addressed the question:

Is the Medicaid expansion constitutional?

Remember that Medicaid is the health care plan for the poor and disabled that is run by individual states with both state and federal dollars. The Affordable Care Act expands those eligible for Medicaid to adults earning 133 percent of the federal poverty level. But in order for states to continue receiving any federal money for Medicaid, the ACA requires them to comply with this expansion. Twenty-six states have challenged this requirement saying that withholding all monies for Medicaid is coercive and therefore unconstitutional. Those states which support the expansion–including California–say that Congress can constitutionally attach such conditions under what’s known as the “Spending Clause.”

You can listen to the complete oral arguments about Medicaid expansion here:

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Or read on for the complete transcript … and for audio/transcripts of all the Court’s earlier sessions:
Continue reading

Can Health Law Stand Without the Individual Mandate?

The constitutionality of the Medicaid expansion is also before the Court today.

(Image: Kaiser Health News)

(Image: Kaiser Health News)

WASHINGTON (AP) — The heart of the Obama administration’s health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down.

The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people.

The first two days of fast-paced and extended arguments have shown that the conservative justices have serious questions about Congress’ authority to require virtually every American to carry insurance or pay a penalty. Continue reading

Slideshow: A Cold Morning But Crowds Pro and Con Gather at Supreme Court

Slideshow produced by Jessica Marcy, Kaiser Health News and Amanda Stupi, KQED

Inside the Supreme Court building this week, the nation’s highest court is hearing oral arguments in a case that seeks to overturn the 2010 health law. Outside the building, Americans gathered to express their support or opposition to the law — or just to see history being made.

The second image is of Spike Dolomite Ward, who wrote an apology to President Obama in December.

What Impact Will the Court’s Decision Have on California?

(Ronnie Pitman: Flickr)

Over the last year as the myriad court cases about the federal health care law have made their way to the highest court in the land, California has spent that time moving ahead aggressively in implementing the Affordable Care Act (ACA). California was the first state to pass legislation to set up a health insurance exchange. The state also set up a new high risk pool so people with pre-existing conditions can get health insurance.

But what happens if the Supreme Court declares the individual mandate unconstitutional? Or overturns the entire law? What can still go forward in California?

The answer depends in part upon whom you ask. But for the most part California — like all states — will find it tough to move forward without the backing of the federal law. Continue reading