Battle over health care law returns as court case looms


In one week, the Supreme Court will begin hearing arguments over the constitutionality of President Obama's defining legislative achievement: The Affordable Care Act, the federal health care law that many Republicans simply call "Obamacare."

The decision in the case, which is expected over the summer, will have a significant - and unpredictable - impact on the presidential race. If the Supreme Court strikes down the law, it could energize Republicans and deal a major blow to the president's stature. But it could also rally Democrats angered by the decision to rally behind a president who has not always lived up to their expectations. If the high court upholds the law, it could validate the president in his effort to push through the controversial legislation but also reinvigorate conservatives whose angry, vocal opposition to the law dominated headlines in the summer of 2010.

The key issue up for consideration will be the mandate that Americans purchase health insurance, over which lower courts have been split. The Republican presidential candidates - some of whom backed a mandate for health care coverage, on the state and/or federal level, in the past - rail against the provision as reflecting overreach by an out-of-control federal government, and they are vowing to repeal it if elected if the court does not strike it down.

The mandate is central to the law, though it's not clear whether striking it down would also mean striking down the Affordable Care Act, much of which has yet to be implemented, in its entirely. The mandate is designed to solve a problem: If you're going to require that insurance companies cover people with pre-existing conditions, how do you keep people from just waiting until they get sick to buy insurance? If the mandate is struck down, the requirement that insurance companies cover those with pre-existing conditions would become unworkable, since the pool of insured would have far fewer healthy people in it to offset the costs of those who need expensive medical care.

Democrats say the individual mandate is constitutional under the commerce clause to the Constitution, which allows the federal government to regulate interstate commerce; Republicans say the commerce clause does not mean the government can force Americans to purchase health care coverage.

Ahead of the two-year anniversary of the law's enactment on March 23, Republicans are aiming to frame the national debate in their favor. In a new memo, Republican National Committee Political Director Rick Wiley points to polls showing "anemic" support for the law and argues that the health care law "may prove to be the single biggest contributor to [President Obama's] defeat in November." (Polls generally show a near-even split in support for the law, with little sign that Americans have warmed to it since it was signed.) 

The memo is part of the RNC's kickoff to what it calls a "coordinated effort with Republicans on the Hill and leading healthcare voices to draw attention to the failures and unpopularity of Obamacare." The RNC plans run ads about the law on both national cable and in local markets where Mr. Obama is visiting; RNC Chairman Reince Priebus is also traveling the country to criticize the law, and Republican surrogates are making themselves available to news outlets to spread the message.

The Republican controlled House, meanwhile, plans to consider a bill later this week to repeal the part of the health care law that critics have said sets up "death panels." The bill would abolish the Independent Payment Advisory Board (IPAB), which is designed to control Medicare costs if spending targets are not reached; Republicans complain the board has the power to deny coverage to seniors in need. The bill likely won't come up for consideration in the Democrats-led Senate, but it will once again put a spotlight on the law and GOP efforts to overturn it in full or in part.

The Obama reelection campaign did not immediately respond to a request for comment, but the White House has repeatedly pointed to the law's most popular provisions, including the fact that it fills the Medicare drug coverage "donut hole," allows young people to stay on their parents' insurance longer, and keeps health care companies from invoking lifetime coverage limits. The Obama campaign has also cast the law as reflecting an effort to control skyrocketing medical costs in the face of Republican intransigence. In remarks at an Atlanta fundraiser on Friday, Mr. Obama said the law will mean 30 million people get health care for the first time, and cast it as part of a series of initiatives designed to "reopen opportunity for everybody, and give people more security as they pursue their dreams."

With reporting by CBS News Producer Jill Jackson.