Perspectives on the Supreme Court Proceedings on Health Reform

by Rebecca Farley on March 29, 2012

The Supreme Court this week held three days of hearings on four constitutional issues related to the 2010 Affordable Care Act. The hearings generated substantial media hype and sparked round after round of debates on what the Justices’ questions indicated about their likely votes on the law. Here, we offer insights into the three days of hearings and the ramifications of the Supreme Court’s decision.

First, a quick refresher on the 4 key issues at stake:

  1. Is the coverage mandate constitutional? Opponents of the ACA argue that Congress overstepped its bounds in requiring Americans to have health insurance coverage.
  2. Is the coverage mandate equivalent to a tax? If so, the Court cannot decide on the constitutionality of the mandate until its financial penalties are first assessed in 2015.
  3. Can the coverage mandate be “severed” from the rest of the law? If not, the entire ACA must be struck down in the event the mandate is found unconstitutional.
  4. Is the Medicaid expansion constitutional? Opponents of the ACA say that Congress is coercing states into covering new populations by making federal Medicaid funding contingent upon their doing so.

For day-by-day summaries of this week’s hearings and to read our in-depth analyses of each of these four issues (including our most recently published post on severability), please see the links to our blog below.

How Will the Justices Vote?

Justices grilled the lawyers exhaustively throughout the 3 days, critiquing their arguments and regularly asking for more details. The conservative Justices in particular seemed skeptical of the government’s case in favor of the law, but the Justices’ questioning did not break down entirely along ideological lines: several of the liberal Justices expressed doubts about some of the legal arguments in favor of the law, while Chief Justice John Roberts (appointed by President George W. Bush) led some observers to believe that he might be a vote in favor of the law.

Something of a cottage industry arose in the media sphere this week as legal experts and journalists attempted to predict the Court’s ruling based on the quality of the oral arguments, the number of questions asked of each lawyer, the Court’s history in ruling for or against the plaintiff in a case, and other factors. Speculation also swirled around whether Justice Anthony Kennedy, the Court’s most frequent swing vote in 5-4 decisions, would vote to uphold or strike down the law.

Despite pundits’ endless prognostications and the media’s conventional wisdom that the government’s case for the health law now stands on shaky ground, it is impossible at this time to say how the Justices will rule. Predicting the outcome of Supreme Court cases is fraught with uncertainty, and with the Justices’ deliberations taking place out of the public eye, nothing will be known for sure until late June when the Court issues its ruling.

What Are the Possible Outcomes for the Law?

The four issues at stake in this case are interrelated, with the Court’s decision on one point affecting how it may rule on the remaining points. The eventual ruling could decisively strike down the ACA, decisively uphold it, or deal a mixed hand – for example, by striking down the mandate but leaving the insurance reforms intact. ProPublica has published a helpful flowchart outlining the potential outcomes for health reform based on how the Justices decide each question.

What Will Be the Political Ramifications of the Court’s Decision?

Right now, public opinion polls put the economy and jobs in the number-one spot in the public’s concern. However, that could change if the Court strikes down all or part of the health reform law while the economy continues to improve. Polling indicates that Americans have conflicting views on the law that are largely based on widespread confusion about what it contains. When asked if they favor repealing or keeping the law as a whole, a majority of respondents typically favor repeal. Yet, when asked if they support individual provisions within the law – such as the ban on pre-existing condition exclusions, closing the Medicare prescription drug donut hole, or allowing children to stay on their parents’ insurance until age 26, a large majority of Americans say they support the law.

If the health law were to be overturned, these popular provisions would disappear, putting pressure on Congress to enact a fix. A decision against the law would also roil the health insurance market, the business community, and the health services industry, which have now spent two years preparing for the ACA’s new regulations and the associated influx of previously uninsured consumers (who are also new insurance customers) into the healthcare system. However, Congressional leadership staff from both parties say that there is little chance of Congress being able to enact a replacement law until after the November elections. That means that the ultimate outcome of health reform could rest in large part on the balance of power in Washington after November 6.

Ultimately, the Court’s decision is not likely to sway partisan voters into changing their minds about the law. No matter the decision, politicians from both sides of the aisle are likely to continue the debate over how best to reform the U.S. healthcare system and whether the ACA should be repealed.

In Case You Missed It: the National Council’s Analyses and News Roundups

All month, the National Council has been providing updates and analyses of the Supreme Court case on our blog, Visit the blog to find:

  • A summary of the 4 key points at stake in the health law challenge
  • An analysis of the Anti-Injunction Act question, which could prevent the Court from ruling on the ACA until after it actually goes into effect
  • An analysis of the coverage mandate question
  • An analysis of the severability question
  • An analysis of the Medicaid expansion question
  • Our roundup of Day 1 of the Supreme Court hearing
  • Our roundup of the Day 2 events
  • Our roundup of the proceedings on Day 3


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