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Primer: Supreme Court’s Health Reform Ruling Expected Thursday

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Updated June 27 | The “best-kept secret in Washington” is about to go public. Three months after the Supreme Court’s hearings on the health care reform law, the justices are expected to announce their decision a few minutes after 10 a.m. Thursday.

The pre-ruling radio silence from the Court has only fueled speculation about whether the justices will strike down the Affordable Care Act or leave part — or all — of it standing. But regardless of the outcome, most agree on one thing: This decision is likely to shape the course of American health care for years to come.

According to a recent New York Times/CBS poll, two-thirds of Americans are hoping the Court will strike down at least part of the law. A full 41 percent said the entire law should be overturned while only 24 percent want the Court to “keep the entire health care law in place.”

Joining us for a refresher on all of this is NewsHour Supreme Court analyst Marcia Coyle, who is also a reporter for the National Law Journal.

Marcia, let’s review the basics. In March, the Court considered several issues tied to the Affordable Care Act. Can you walk us through them one more time?

Coyle: I’m happy to do it. If you recall, the justices agreed to decide four questions about the health care law:

  • Does an 1867 law, the Anti-Injunction Act, prevent the Supreme Court from reviewing and deciding the health care law challenge? The act bars pre-enforcement challenges to taxes. The penalty in the health care law for failure to purchase minimum insurance will be enforced by the Internal Revenue Service, but will not appear on a taxpayer’s tax return until 2015.
  • Is the so-called individual mandate to purchase health insurance constitutional?
  • If the mandate is unconstitutional, can it be severed from the rest of the law or must the entire law fall?
  • Does the expansion of Medicaid coverage for the poor and disabled unconstitutionally coerce the states into participating, because if they do not participate, they risk losing federal money in the federal-state funded program?

What options does the Court have in deciding the challenge?

Coyle: The justices have the following options:

  • They can rule that their jurisdiction to decide the challenge is barred by the Anti-Injunction Act. That decision would only put off the constitutional test until at least 2015 when the penalty on eligible persons who fail to buy minimum coverage is enforced.
  • They can rule that the law is constitutional. That would end the legal debate, but not the political debate. Whatever the justices do, the health care law likely will be an issue in the presidential election campaigns.
  • They can strike down the individual mandate. If they take that option, they then face three sub-options (You didn’t really think this was going to be simple, did you?)
    • They could decide the mandate cannot be severed from the rest of the law, and the entire law must fall. This probably would create considerable chaos and uncertainty, because a number of states already have moved to implement the law and have offered insurance to people who were unable to get it or afford it prior to the law’s enactment. However, such a decision also would end the legal, but not the political debate.
    • They could decide that the mandate can be severed from the rest of the law. The government argues that the mandate is inextricably entwined with two other provisions — a prohibition on insurers denying coverage of preexisting conditions and charging higher premiums based on health status or gender. Without the mandate, the government predicts premiums would skyrocket and other market reforms would fail.
    • They could sever the mandate and the guaranteed issue and community rating provisions and decide that the rest of the law can function as Congress intended.
    • They could uphold the expansion of the federal-state Medicaid program.
    • They could strike down the Medicaid expansion as unconstitutional.

What is at stake beyond the immediate issue of health insurance for the uninsured?

Coyle: Whatever the Court says about the constitutionality of the individual mandate will have major implications for Congress’ power to regulate interstate commerce and its ability to address problems that are national in scope and that the states are unable to solve. We will also likely learn how this Court views more generally the balance of power between the federal government and the states. The latter could have implications for many areas of the law.

The Medicaid decision also has potentially broad ramifications. The Supreme Court has never struck down a law enacted pursuant to Congress’ spending clause power, because it is unduly coercive of the states. The spending clause has been Congress’ source of authority for enacting major federal laws in many areas, such as civil rights, transportation, education and national security.

Do we know when the decision will be handed down by the Court?

Update June 25: The Supreme Court is expected to rule on health care reform Thursday.

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