The U.S. Supreme Court today will begin deliberations to decide whether the Patient Protection and Affordable Care Act and its individual mandate are constitutional.
President Barack Obama on March 23, 2010 signed the act that aims to lower health care costs by requiring all U.S. citizens to have health insurance. Known as the individual mandate, the act requires all individuals to have health insurance, starting Jan. 1, 2014. Those who don't buy health insurance must pay a penalty.
Many parties, including states, national organizations and private entities, have questioned the constitutionality of requiring individuals to purchase insurance.
Three federal circuit courts of appeals have reviewed the mandate in the past two years:
- The 4th Circuit Court in Virginia, which didn't fully examine the merits because it doesn't go into effect until 2014.
- The 6th Circuit Court in Ohio, which upheld the act in its entirety.
- The 11th Circuit Court in Georgia, which struck down the individual mandate.
It is the 11th Circuit Court case that now comes before the Supreme Court. The plaintiffs are 26 states, including Pennsylvania, and Tennessee-based National Federation of Independent Business.
Four issues will be discussed in the next three days:
- The Anti-Injunction Act and if it is applicable to the health care reform law. If the penalty is considered a tax, under the 1700s-era act the Supreme Court cannot rule for or against the law until the tax has been enacted. The Supreme Court has appointed its own attorney to present on this matter.
- The constitutionality of the individual mandate.
- The severability of the individual mandate from the rest of the health care act.
- The expansion of Medicaid, which under the health care act was widened to include anyone earning up to 133 percent of the federal poverty line.
The Anti-Injunction Act portion of the case today will be discussed for one hour and 30 minutes. The constitutionality will be presented Tuesday for two hours. The severability issue will be considered Wednesday for 1 hour and 30 minutes, and Medicaid's expansion will be heard for one hour on Wednesday.
Although the time allotted doesn't seem like much, "This is the most time the Supreme Court has given for oral arguments since 1967," said David Vassilaros, director for health care reform and regulatory affairs for Dauphin County-based health insurer Capital BlueCross.
The Supreme Court is in session through June, and a ruling is expected then.
"There's a possibility that the ruling would come later," Vassilaros said. "The context of this whole issue is the presidential election, and the court is well aware of the political impact (of any) decision."
The act has two main pieces, he said.
The first is health insurers must provide coverage for everyone. The second is everyone must then purchase insurance.
If the individual mandate is struck down, the system will not work, as has been demonstrated in a handful of states, he said. If coverage is provided for everyone but there is no requirement to purchase health insurance, "individual market premiums go way up, insurers leave the market and choices among plan designs go down," he said.
Uncertainty surrounds the act, which is one of the worst things for business owners, Vassilaros said. Both putting off the case until after 2014 because of the Anti-Injunction Act or full invalidation of the law would create a lot of unknowns in the health care arena, he said.
"Total invalidation might not be so bad for business owners because all the new mandates have cost employers money," he said.