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Health Care Insurance Reform’s Fate in Supreme Court’s Hands

By Jessica Webb-Ayer, J.D., BLR Attorney Editor

The U.S. Supreme Court recently heard oral arguments on challenge to the massive health care insurance reform law, the Patient Protection and Affordable Care Act (PPACA), enacted March 2010. Although there’s no crystal ball to tell us how the justices will inevitably rule, the oral arguments did provide a few takeaways about the future of health care insurance reform.

On the first day of arguments, the justices heard oral arguments about whether it’s too soon to decide the case because of the Anti-Injunction Act (AIA), a federal law that requires a tax to be collected before it can be challenged in court. Beginning in 2014, the PPACA’s individual mandate would require most individuals to obtain health care insurance or pay a fine. Although the justices’ views on the other issues in the case may be hard to determine by their questions during the oral arguments, most analysts agree that they seemed to be very skeptical regarding whether the AIA applied to the case.

Individual mandate
On the second day of oral arguments, the Supreme Court justices heard abouttwo hours of arguments on the issue that many describe as the “heart” of the case — whether the individual mandate is unconstitutional under the Commerce Clause of the U.S. Constitution. Although, as expected, several justices appeared to accept that Congress had the power to require individuals to purchase health care insurance, other justices seemed to think that such acceptance would lead to a slippery slope. Justice Anthony Kennedy, who often has the swing vote in close cases, noted that the government faced a “heavy burden of justification” to show that the mandate was authorized under the Constitution.

On the third day, the justices heard arguments on whether the individual mandate could be severed from the rest of the law if the Court found it unconstitutional. The PPACA challengers argued that the individual mandate is unconstitutional and the rest of the law can’t stand without it because the law’s provisions are so interconnected, while the government argued that if the Court decided the mandate was unconstitutional, it shouldn’t throw out the whole law.

The justices appeared to be divided on whether they thought it would be better to get rid of just the individual mandate (if they decided it was unconstitutional) or to scrap the whole law. Several of them seemed reluctant to take on the task of deciding which provisions should stand and which ones should fall and thought Congress would be in the best position to make such calls.

Medicaid expansion
Finally, the Court heard arguments regarding whether the PPACA unlawfully requires states to expand the Medicaid program. Although a state’s participation in Medicaid is voluntary, if a state declines to be involved in the program, it would be turning down a huge amount of federal assistance. The PPACA challengers argued that the law’s expansion of the program unconstitutionally coerces states to spend more on Medicaid. Justice Elena Kagan and Justice Ruth Bader Ginsburg expressed their doubts about whether states were being coerced, but a few of the justices appeared to possibly buy into the coercion argument.

What’s next?
So where does the Supreme Court go from here? The Court is expected to issue a decision regarding the health care insurance reform law by the end of June. But that doesn’t mean employers should stop their implementation of various health care insurance reform requirements. At this point, the PPACA is still the law of the land, and employers need to make sure they are in compliance with it. Additionally, even if the Supreme Court decides that the individual mandate and/or the Medicaid provisions are unconstitutional, the rest of the law may remain in effect.

Keep up with the latest developments in employee benefits compliance and learn more about how health insurance reform will affect employers with Benefits Complete Compliance