Health Care Reform FAQ: A CNN Guide to the Supreme Court's Arguments

Article excerpt

WASHINGTON (CNN) -- The U.S. Supreme Court is prepared to take on an emotionally charged case: the massive health care reform legislation championed by President Barack Obama.

The court will hear six hours of oral arguments over three days on the law's constitutionality. Here are some frequently asked questions on the crucial issues:

Question: What is the law and who is challenging it?

Answer: The Patient Protection and Affordable Care Act (PPACA) was passed by Congress in 2010 by a Democratic congressional majority with the support of the president. It has about 2,700 pages and contains 450 some provisions. The signature policy accomplishment thus far of Obama's presidency, the comprehensive legislation has received mixed reviews in the lower federal courts.

One part of the law stands as the focus of the judicial dispute and threatens to collapse the entire legislation. The "individual mandate" provision requires most Americans to purchase health insurance by 2014 or face a financial penalty. Its purpose is to spread health care costs to a larger pool of individuals.

Various states and individuals have argued the Constitution's Commerce Clause does not give government the authority to force Americans to purchase a commercial product such as health insurance they may not want or need. The opposing states equate such a requirement to a burdensome regulation of "inactivity."

The Justice Department has countered by saying the changes do not amount to taxpayer financing or a new government-run program. Supporters say Congress wanted to ensure universal coverage by forcing insurance companies to expand coverage without bankrupting them. The individual mandate, they argue, will ensure enough money is in the system to benefit all Americans. Federal officials cite 2008 figures of $43 billion in uncompensated costs from the millions of uninsured people who receive health services, costs that are shifted to insurance companies and passed on to consumers.

The largest and broadest legal challenge to the PPACA comes from a joint filing by 26 states, led by Florida. It was that series of appeals the high court has accepted for review. Lawyers for the states and a private business coalition will argue their case against the Justice Department, representing the administration and Congress.

Question: What specific issues will the court address?

Answer: The court will decide four separate legal questions in these appeals:

-- Key issue: Does the law overstep federal authority? This is particularly in regard to the key coverage and funding provision: an "individual mandate" requiring most Americans to purchase health insurance or pay a financial penalty.

-- Domino-effect issue: Must the entire PPACA be scrapped if that key provision is unconstitutional?

-- National policy implications issue: Are states being "coerced" by the federal government to expand their share of Medicaid costs and administration, with the risk of losing that funding if they refuse?

-- Jurisdictional issue: Are the lawsuits brought by the states and other petitioners barred under the Anti-Injunction Act, and must they wait until the law goes into effect?

This simplifies the legal issues to some extent, given the sweep and complexity of the healthcare law. The high court's focus will be more about how to pay for the medical care, and less about the new or expanded services the law would guarantee.

Question: I won't be among the lucky few who can get seats to these historic arguments. What will go inside the courtroom?

Answer: The court has carved out its entire week of arguments for this issue -- six hours spread over three days -- in an extremely rare move.

Ceremony and decorum will reign. Court sessions begin promptly at 10 a.m. ET, with the marshal calling the court to order. The chief justice, contrary to popular belief, does not use the wooden gavel. The audience rises as the robed justices enter through red velvet curtains from a back room. …