This week the U.S. Supreme Court heard oral arguments regarding the constitutionality of certain provisions of the Patient Protection and Affordable Care Act, the sweeping health reform package signed by President Barack Obama in March 2010.
The hearings began Monday, when arguments focused on the issue of the Anti-Injunction Act. The health reform law requires individuals to buy health insurance, if they are not already insured through their employer, or pay a penalty beginning in 2015. After that initial year, the penalty will increase after that. The question for Supreme Court justices on the opening day of arguments was whether or not this penalty should be considered a tax.
On Tuesday, justices looked at the question of whether the individual mandate provision in the Affordable Care Act, which requires people to purchase health coverage, is constitutional. Several states, including Florida, had challenged the constitutionality of the individual mandate. Opponents of the individual mandate maintain that the provision is an overreach of government power in that the U.S. Constitution does not give the government the authority to mandate that citizens purchase certain products or services.
Supporters of the Affordable Care Act say the health insurance market is unique in that everyone will need to consume health services at some time in their life, unlike other products or services, and that without the individual mandate, people could just buy health insurance when they got sick or injured, driving up the cost of coverage.
On Wednesday, justices considered the severability of the Affordable Care Act – that is, whether the rest of the law’s 450 provisions, including requirements barring discrimination in insurance rates and forbidding insurance companies from refusing coverage to people with pre-existing conditions, can stand even if the individual mandate provision is struck down.
Medicaid, which will expand greatly under the health reform law, was also on the table Wednesday. Starting in 2014, the health reform law would make millions of additional Americans eligible for Medicaid benefits by raising the eligible income level they earn to qualify. Initially, the federal government will pay for this expansion, but after a period of time, states will have to pick up the tab. Conservative states have criticized this expansion, saying that their autonomy is being eroded by more federal involvement in states’ Medicaid programs. They say the expansion could threaten states’ other spending priorities.
A coalition of patient advocacy groups under the umbrella of the National Health Council, released a statement Tuesday in support of the Affordable Care Act.
"We believe that although the Affordable Care Act is not perfect and is certain to evolve over time, it is already improving and will continue to improve the lives of people with chronic conditions,” the statement says.
Provisions that have already gone into effect include additional preventive services at no additional costs to most insured patients and allowing independent and dependent children up to age 26 stay on their parents’ health plan.
The Supreme Court is expected to render its final decision on the Affordable Care Act in June.