Health Reform Law to Have Its Day in Nation's Highest Court Next Month

Article excerpt

The historic 2010 health reform law designed to Make health care more affordable and accessible will hang in the balance in late March, when the U.S. Supreme Court takes up questions about the constitutionality of the Patient Protection and Affordable Care Act.

The court has allotted five-and-a-half-hours over three days to hear arguments in the case, a clear sign that the justices are acutely aware of the implications of their decision. Generally, the court allots about an hour on one day to hear arguments from both sides of a case.

"They consider this to be a very important case," said Tim Jots, the Robert L. Willett Family Professor of Law at Washington and Lee University. "Since the ... 1930s, the Supreme Court has shown great deference to Congress in regulating the economy and spending money for the general welfare. If the Supreme Court holds that (the Affordable Care Act) is unconstitutional, it will signal an intent to dramatically cut back on the power of Congress."

Such a decision would call into question many types of laws Congress has adopted, Jots said, including civil rights, environmental reform, education reform and transportation and public safety laws.

The court will review the 11th Circuit Court of Appeals decision in Florida et al. v. United States Department of Health and Human Services, which was brought by 26 states.

During the three-day hearing, the justices will examine four questions about the law, two of which are substantive and two of which are minor.

The court will look at whether the individual mandate, the part of the law that requires nearly everyone to have health insurance or to pay a penalty if they do not, is constitutional. That is a major issue that has been the crux of most legal arguments against the new law. Those opposed to the law argue that Congress does not have the power to compel people to purchase a product such as insurance.

The second substantive issue is the question of whether an expansion of Medicaid to cover more people is constitutional. Those opposed to the law say that the expansion is unprecedented in scope and threatens to withhold federal funding under Medicaid, which they say has never happened before.

Most people did not expect that the court would consider that issue, according to Jots, because the lower courts rejected the claim, and "no federal court has ever found a condition in a federal funding law to be coercive."

"If they find the Medicaid expansion to be unconstitutional, the court will be Creating new law," he said.

APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E), called it "wrongheaded" to oppose the Medicaid expansion. All the federal government is doing in expanding Medicaid to include those who make up to 133 percent of the federal poverty limit is to add another eligibility group, something it has done numerous times before, he said.

Families USA Executive Director Ron Pollack expressed similar concerns in a statement released shortly after the court announced its intention to review the case.

"We are surprised and troubled that the court has decided to review the states' objections to the Affordable Care Act's expansion of Medicaid to millions of low-income Americans," he said. …