SPECIAL REPORT: The Future of Health Reform

    28 June 2012


    Following enactment of the Patient Protection and Affordable Care Act (ACA) in March 2010, several states, organizations, and individuals filed lawsuits challenging various provisions of ACA. After four federal appellate courts ruled on multiple aspects of the legal challenges, on November 14, 2011, the United States Supreme Court agreed to hear arguments and review four issues related to the constitutionality of ACA.

    The four issues before the Court arose out of litigation in Florida that was heard on appeal and decided by the U. S. Court of Appeals for the Eleventh Circuit. The Court granted certiorari on three petitions arising out of the Eleventh Circuit decision: an appeal by the states (Florida v. Department of Health and Human Services), an appeal by National Federation of Independent Business (NFIB) (National Federation of Independent Business v. Sebelius), and an appeal by the federal government (Department of Health and Human Services v. Florida). In Florida v. Department of Health and Human Services, the Eleventh Circuit overturned the individual minimum coverage requirement (the “individual mandate”) as unconstitutional, but upheld the remainder of ACA, concluding that the individual mandate provision could be severed from the rest of the statute.

    The Supreme Court consolidated the appeals and agreed to consider four questions:

    • Whether the Anti-Injunction Act precludes the Court from considering challenges to ACA’s monetary sanctions, for failure to purchase a minimum level of health insurance, prior to their implementation;
    • Whether ACA’s individual mandate (to purchase a minimum level of health insurance) exceeds Congress’ power under the Commerce Clause of the Constitution;
    • If the individual mandate is unconstitutional, whether the individual mandate may be severed from some or all of the other provisions of ACA; and
    • Whether ACA’s Medicaid expansion provisions violate principles of federalism by coercing the states to participate?

    The first three of these questions deal with the individual mandate and related provisions, while the fourth question deals with the expansion of Medicaid.

    Over three days in March 2012, the Court heard more than six hours of oral argument – the most time devoted to a case in over 45 years. The Court’s decision, released on June 28, 2012, held that the individual mandate, which requires most Americans to purchase health insurance or pay a penalty beginning in 2014, is constitutional based on the right of the federal government to levy taxes.  The Court’s decision upheld the law in its entirety, except that the Court held that the federal government cannot revoke a state’s existing Medicaid funding if the state does not participate in ACA’s Medicaid expansion. The following is an overview of the Court’s decision, including concurring and dissenting opinions, as well as an initial analysis of its implications.

    SPECIAL EDITION: Capital Thinking Radio Show: Special Report: SCOTUS Healthcare Ruling

    The Supreme Court announced its ruling on the constitutionality of the Affordable Care Act on June 28 in what promises to be one of the most important legal decisions of our lifetime. This week's special edition of Capital Thinking offered a complete hour of legal, policy and political analysis of what the decision means for all Americans. Capital Thinking's host, Kevin O'Neill, is joined by Patton Boggs LLP healthcare attorneys Karen Thiel, Martha Kendrick, and Laura Laemmle-Weidenfeld for a lively discussion of the Affordable Care Act decision viewed from a variety of perspectives. Former Senate Parliamentarian Bob Dove and John Jonas, chairman of the Patton Boggs Healthcare Policy Group, also participates in the conversation, providing their thoughts on potential legislative reactions in Congress to the Supreme Court's decision.

    Segment 1: Karen Thiel

    Segment 2: Martie Kendrick

    Segment 3: Bob Dove and John Jonas

    Segment 4:  Laura Laemmle-Weidenfeld