Four health care questions the Supreme Court is asking

CBS/iStockphoto

(CBS News) The Supreme Court Thursday will rule on the constitutionality of the Affordable Care Act, adding a new chapter to the debate over the health care overhaul. The court, however, isn't just going to vote up or down on the issue -- there are a number of questions it has to answer.

Here's a look at the questions before the court:

1. Can the court rule on the law's constitutionality, or does it have to wait until 2015?

Before it heard arguments over the health care law's constitutionality, the Supreme Court in March asked whether now is even the appropriate time to take up the case.

The 1867 Anti-Injunction Act bars most lawsuits challenging a tax that hasn't been paid. The individual mandate, which requires all Americans to purchase insurance, doesn't kick in until 2014, meaning no one has paid the fine (or "tax," as some may call it) for failing to purchase insurance -- thus, as the argument goes, the current case may be invalid.

If the court decides the Anti-Injunction Act applies to the health care law, the case could be argued in 2015, once someone has actually paid a fine.

Most parties watching the case, however -- and even Mr. Obama's Justice Department -- believe that the Anti-Injunction Act doesn't apply here. "It's pretty much a slam dunk they're going to hear the case," Robert Alt, senior legal fellow at the conservative Heritage Foundation, told Hotsheet in March.

Watch CBS News political director John Dickerson's Reporters Roundtable's discussion on President Obama's health care law and the Supreme Court.

2. Is the mandate constitutional?

If the court decides it can rule on the case now, the primary question is whether the individual mandate is constitutional, or whether the government oversteps its authority by compelling every person to either get insurance or pay a fine.

As many as 28 states filed lawsuits calling the mandate unconstitutional, and one federal appellate court agreed with that assessment. Two other federal appellate courts have upheld the law.

This question strikes at the heart of the opposition to Mr. Obama's reforms: Most Americans disapprove of the mandate, according to CBS News/New York Times polling, and seven in 10 want the entire law or at least the mandate overturned.

3. If the mandate is unconstitutional, can other parts of the law survive without it?

Question No. 2 also happens to strike at the "heart" of the law itself, as some, like Justice Antonin Scalia, have called the mandate. If the court strikes down the mandate, it will have to decide whether other parts can survive without it -- and if so, which parts.

During the March hearings, Scalia suggested he was inclined to just throw out the whole law. "My approach would say if you take the heart out of the statute, the statute's gone," he said.

After winning the White House, President Obama told Congress a mandate was an essential part of improving the nation's health care system. The administration argued to the Supreme Court that without the mandate, two other provisions -- "guaranteed issue" and "community rating" -- won't work and should be thrown out.

Guaranteed issue, which is nearly twice as popular among the public than the individual mandate, requires health insurers to cover everyone who applies for coverage, regardless of pre-existing conditions. Community rating requires insurers to offer plans within the same price range to all customers, regardless of factors like age.

Many health care experts argue that without the mandate, health care costs would spiral out of control, but the true impact of keeping the rest of the law in place without the mandate is up for debate.

4. Is the expansion of Medicaid constitutional?

In addition to the individual mandate, the Supreme Court is considering the constitutionality of a provision from the Affordable Care Act that would greatly expand Medicaid.

Currently, Medicaid is a joint federal-state program that provides health care to certain poor Americans, such as children and the elderly. In 2014, the Affordable Care Act opens up Medicaid to anyone with an income under 138 percent of the federal poverty line.

The federal government is expected to pay for the vast majority of the Medicaid expansion, but 26 states argued that paying their portion of the expansion will be an unfair burden. If a state chose not to expand the program as the law requires, it would have to opt out of Medicaid completely -- something no state could afford to do.

[raptor-022]

Luckily, the SCOTUS upheld the mandate and most of the PPACA, which includes several cost-saving methods like Section 1302, and the formation of health care exchanges!

As a matter of fact, even one of the REDDEST states, UTAH, has already gone forward with health exchanges, with 30% of their residents already benefiting from this cost-saving method!


Utah moves ahead with federal health reform mandates
June 23, 2012

Defining a baseline for coverage is an important step toward compliance for the state's Health Exchange, which began enrolling employees of small businesses in Utah during a test phase in 2009. It currently provides more than 140 health care coverage options to more than 7,000 individuals and their dependents.

Exchange director Patty Conner said the state will move ahead with its exchange with or without federal health reform, as it has served as "a good value to the state." She said 30 percent of the population benefiting from the exchange did not previously have coverage from an employer.

http://www.ksl.com/?nid=960&sid=20913438&s_cid=rss-960

[wizardlady]

Life, liberty and the pursuit of happiness....this might include living as a hermit and dying as one....so where would forcing this person to buy 'health insurance' be constitutional?

Choices are what gives us 'freedom'!!!!!

The big picture is not the 'better health' of the individual, but the prosperity which will come to these three: BIG PHARMA, INSURANCE COMPANIES, and HOSPITALS AND MEDICAL PERSONNEL.

[maddiekat]

Mitt Romney once said that his healthcare law, including the mandate was a model for America. Mitt flipped, say it ain't so!

[diane0224]

The Affordable Health Care Act has to be Constitutional. If not, who's going to be tell the American public that the police officers will no longer need to be asking for our proof of insurance when we get stopped or in a traffic accident?? Who will be telling the American public when we go to a bank to get a loan to purchase a home, that we will no longer need to have home owners insurance.
This is 100% why all three of these issues in the United States of America are Constitutional. Why, because these are all the three things that everyone needs for themselves or their familes to man up and take responsiblity at all times. Everyone will be taken care of and no American can dump the responsiblity of his or her medical bills upon no one but themselves, just like car insurance and home owners insurance are required. As American cizitens its our duty to be responsible and also show our children and grandchildren how to be responsible. It would be so irresponsible for the United States Supreme Court Department to rule the Affordable Health Care Act Unconstitutional. Health insurance is something that everyone needs, even though, at times you may think you don't need to be buying it but you don't know whats going to happen today, tommorrow or any day in your future. No it is not affordable, so this is why the Affordable Care Act is in place to help those who need it but cannot afford it.
If you have a long term illness,just think how will you or your family feel when you find out that you can no longer get treatment because the insurance company is going to cut you off because you have reached your insurance limits. How would you feel if your child or grandchild cannot get the help they need because they have pre-exisiting conditions. How will you feel if your children are struggling through collge being sick because they cannot afford the insurance or the treatments needed. All of these things will happen if the Affordable Health Care Law is not ruled Consitutional. "It's a no brainer" Just do the right thing and take care of yourself and your family. You cannot put a price on your life or the lives of your family!!

[smittyc]

The suspense is so exciting, I just can't wait for the verdict.

[magicbymark]

Spiraling healthcare costs will bankrupt the nation. Republicans were "for" this before they were "against" it. It's time that people stopped worrying so much about themselves and thought about future generations. Most Americans will notice little or no change but many others will finally have health care.

[Libertyprotected]

I am for less government and the US GOv dictating what I need to survive. I feel that cost will rise and taxes will also RISE if the government continues to grow at this pace.

Bottom line - can you make decisions what to do, what to buy and how to live your life OR do you have to be hand-held by politicians for the remaining of your life?

FAMOUS QUOTE===>
I predict future happiness for Americans -- if they can prevent the government from wasting the labors of the people under the pretense of taking care of them. -Thomas Jefferson

WAKE UP AMERICA -- are you babies or are you strong adults with focused mines that are able to choose what healthplan works best for your individual needs --- COLLECTISM is wrong --- in so many ways!

VOTE WISELY IN 2012

[retmw2]

Fine then if you decide you don't want to pay for health insurance, then why should I have to pay an extra $1000.00 a year on my insurance premium to cover you, when you go to the emergency room.

[nonpolitico]

Right on Liberty protected! Too many "Social Issues" put forward by what seems to me a Socialist President.
The Cost of Health Care in Europe is adding to the Euro crash. Can the USA afford to risk this with all the $$$$Trillions in debt USA is already?? Or do the SocioDems want the Dream the FF began to just fade away to a nightmare of "State Knows Best...Don`t Argue!!"???
We have been driven way down that road by Obama and a supine Congress who cannot stand up to a President who signs a Bill (regretfully)(!!?), to subvert Freedoms and the Constitution, (Forces ability to arrest citizens without cause charge or evidence).
In my opinion THAT piece of WH effrontery should attract impeachment. (Still let us hope that November brings its own form of Impeachment!!)

[occupy_cbs]

PannyHappy: "It may be right that emergency rooms treat anyone, whether they can pay or not, but it should not be a requirement. Those who cannot pay should be left to die"



Let me guess....you're just another "good christian" misanthrope, that still wants to dig up saint ronnie to foist on the American people, but unable to understand that he's the one that signed our first and only AMNESTY for illegals, that also required hospitals to treat all patients, without any regard to their ability to pay.

The seething hatred from the right-wing is unbelievable today!

[occupy_cbs]

Obviously, from your seething hatred, you're the one that is not only blind in both eyes, but completely clueless and misanthropic!

[Libertyprotected]

in the past -- and now --- Welfare medi-Cal provides for those who go to the hospital without money or means to pay

[ironpony33]

How can anyone say it is the right thing to do when no one, not even those that helped write it, have read the whole thing. Even if someone did read it, this is so long (1000 pages) that no one could possibly understand it in it's entirety. We need another try at health care reform starting totally fresh from blank paper.

[AmazingGrce]

It may be a right to have health care coverage but it is not a requirement and therein lies the difference.
Will we require all vistors to this country to prove they have health care coverage (That meets our 'standards') before we issue a visa? This would be the logical follow through is Obama care is approved.

[PannyHappy]

It may be right that emergency rooms treat anyone, whether they can pay or not, but it should not be a requirement. Those who cannot pay should be left to die as a warning to those who continue to refuse to save for their healthcare or refuse to buy insurance.

The good news is only a few of these lazy bastards have to die before the other shiftless welfare queens and their hoards of bastard brats wake up.

[cubscout09]

In England, all humans have the right to Health Care. It's part of their Constitution. In Hawaii, all Pacific Islanders, displaced by nuclear bomb tests, are entitled to free healthcare.