512px-Obama_signs_health_care-20100323Constitution Daily boils down the battle between Obama and his opponents, the role of the Supreme Court as referee, and what happens after the decision.
Here is the bottom line, in three one-minute chunks.
In March 2010, President Obama and Democratic leaders were able to pass the Affordable Care Act. Every Republican in Congress voted against the act.
The Democrats’ general theory was that broad health coverage would allow health care providers to stabilize prices because costs for uninsured patients wouldn’t be pushed onto other consumers. To do this, most Americans would need health insurance, even if it were government subsidized.
The GOP, libertarians and others believed the ACA wasn’t in the best interests of individuals, states and the economy; Congress had overstepped its powers; and parts of the law were illegal. Most of all, the ACA was seen as a program that allowed the federal government to run the nation’s health care system.
The ACA’s opponents mounted an effort to have the Supreme Court decide if the law was constitutional.
Background: Health care’s big constitutional test is at hand
In November 2011, the Supreme Court decided to hear the case. Arguments were presented in late March 2012. A decision was expected in late June.
Parts of the law already have been enacted. But other key parts don’t start until 2014, when consumers must buy health insurance, or pay a penalty on their annual tax returns.
It’s a complicated case with many issues, but the Supreme Court must deal with two key ones that will decide the rest of the case.
A key part of the ACA is the individual mandate, which requires consumers to carry health insurance starting in 2014 or pay a federal tax penalty.
Background: The clause that could kill the Health Care Act
The mandate’s funds will help insurers pay for expanding coverage to anyone with pre-existing medical problems.
Conservatives and libertarians argue the mandate violates the Commerce Clause, a power in the Constitution that lets Congress regulate trade.
They say Congress has abused this power by forcing consumers to buy a product– health insurance. The ACA’s supporters say the mandate is a tax penalty, and not a product. They also say consumers can decline to buy insurance, and just pay the fine.
Background: Here’s a basic explanation of the Commerce Clause
A second big issue is the expansion of Medicaid, which uses federal and state funds to supply health services to lower-income consumers, at a state level.
Federal funds pay for most of the Medicaid expansion, but states are already trying to cut current costs.
If a state doesn’t agree to the expansion, the federal government can cut off all federal Medicaid funds to it, even for existing programs.
A group of governors claims Congress is coercing the states by threatening to withhold all Medicaid funding as part of the ACA.
The Supreme Court will issue a decision at 10 a.m. EST, most likely next week.
The court could decide to uphold the entire law, which would put the ACA on course for its 2014 deadline. GOP lawmakers will try to repeal the law if they have enough power after the 2012 general election.
The court could reject the entire law as unconstitutional and the health care debate returns to its status as of 2009. One reason for this could be that the court believes the entire law can’t work without the individual mandate.
Temporary measures would then be put in place to deal with parts of the ACA already enacted.
The court could reject the individual mandate and keep the rest of the ACA. That would leave insurers figuring out ways to cover new customers with pre-existing conditions, and to determine how insurance rates would change without the funds from the mandate.
Survey: 16 predictions on the health care decision
The court could also reject the expanded Medicaid program. Depending on how the court rules on the Medicaid part of the ACA, all programs funded jointly by states and the federal government could be affected, or just the ACA.
What the government, insurers and health providers don’t agree on is how much all this will cost consumers.
Some insurers are taking matters into their own hands, committing to offer parts of the ACA to consumers even if the Supreme Court rules against it.
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