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Washington --Away from the emotional atmosphere outside the U.S. Supreme Court, justices in their three days of oral arguments on the national health system reform law focused on the constitutional and legal issues. Philosophical discussions among the justices about markets, mandates and tax code were more common than talk of patients, preexisting conditions and access to medical care.
The heart of the justices’ review was the law’s individual mandate, the provision requiring nearly all Americans to obtain insurance by 2014 or pay a penalty. That was the primary line of attack by states and employers that want to see the statute overturned, and justices in their questioning appeared evenly split along ideological lines on whether the federal government can compel the purchase of a commercial product.
The four questions before the court
When U.S. Supreme Court justices rule on the health system reform law, probably in June, they will make decisions on four distinct questions.
- Does the Anti-Injunction Act prevent justices from ruling on the law’s individual mandate until after 2014?
- Did Congress have the authority under the Commerce Clause to require individuals to obtain health coverage or pay a penalty?
- If the individual mandate is struck down, must any or all of the law’s other provisions be struck down, too?
- Does the law’s requirement that states pay a portion of a Medicaid expansion or give up all federal Medicaid funding represent unconstitutional coercion?
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