On March 26, 2012 the United States Supreme Court began three days of
hearings on the constitutionality of President Obama’s Affordable Care Act,
including arguments on the controversial individual mandate, which would
require most Americans to purchase health insurance. While the court will not
issue a ruling on the Act until June, the hearings foreshadowed the rough legal
terrain that lies ahead for the President’s signature domestic policy accomplishment.
On day one, justices considered the Anti-Injunction Act –an archaic
law which prohibits challenges to certain tax assessments, ultimately deciding
that it did not preclude the court from hearing this case. On the second day, the main legal question for the justice centered on
whether or not Congress had exceeded its constitutional powers to regulate
interstate commerce. Those who challenge the law –attorneys general in 26
states, led by Florida, the National Federation of Independent Business and
others, argue that the law gives Congress unwarranted power to infringe on
individual freedom. In contrast, the Obama Administration argued that it is
necessary to, “fashion a comprehensive response to a national crisis in the health care market, by regulating how people pay for the health care they will almost inevitably need.”
By the third day, justices shifted their attention to a more practical
public policy question: What would
happen to the rest of the Affordable Health Care Act if the individual mandate
provision is removed? Justice Antonin Scalia stated that “[if] you take the heart out of this statute. The statute’s gone.” The Obama Administration argued
that “if the mandate falls, two politically popular provisions would inevitably die with it –including restrictions that prohibit insurers from declining coverage or charging higher premiums because of pre-existing conditions.”
Even though the court’s decision is not expected
until June 2012, it’s significant that many members of the court expressed
concerns about the constitutionality of the individual mandate. Many health
care reform advocates believe that without this provision, the Affordable Care
Act will not achieve its intended goals of universal coverage. Jonathan Gruber,
one of the main architects of the Massachusetts Health Care Reform concludes
that “without a mandate, the law will result in a terrible spiral [since] only relatively sick Americans will choose to get insurance, leading premium prices to rise and causing the healthier of even those sick people to drop their insurance, sending prices higher and higher.” Gruber is describing the problem
of adverse selection –a situation where a person waits to get sick in order to
purchase health insurance. By including an individual mandate in the Affordable
Care Act, insurance companies will not have to deal with issues of adverse
selection since the mandate will attract a more diverse pool of purchasers.
The court’s decision in the coming months
will shape not only the nation’s health care future, but its political,
election year landscape as well. High court watchers, politicians and health
care advocates alike will no doubt remain on the edge of their seats in a
virtual waiting room until this verdict comes down.
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