On Monday, November 14th, the Supreme Court announced that it will hear a challenge to the constitutionality of the Affordable Care Act. The Court is expected to hear oral argument on the case in late March, which would mean a decision could be expected in June.
The case the Court will hear is a decision from the 11th Circuit Court of Appeals in Atlanta. This is the only appellate decision to date to find a part of the law unconstitutional; two other federal appellate courts have upheld the ACA’s constitutionality. Although the Court was widely expected to decide the ACA’s constitutionality, the details of the announcement were somewhat surprising and could have broader implications for public health than was expected.
The Court has wide discretion in not only what cases it hears but also on which issues in those cases it will decide. Here, the Court has scheduled an extraordinary five-and-a-half hours of oral argument on four issues, including the law’s “individual mandate,” the requirement that most Americans carry health insurance. Supreme Court review of this issue was widely predicted. In a surprise move, the Court also announced that it will examine the constitutionality of the ACA’s Medicaid expansion, a key measure that will expand health coverage to millions of previously uninsured people. The court will also decide the question of “severability” - whether, if the individual mandate is found unconstitutional, the other parts of the ACA can survive on their own. Finally, the Court will hear argument on whether it has the authority to decide these questions before the individual mandate goes into effect in 2014.
The Court’s decision to hear argument on the Medicaid expansion provision was unexpected, since no lower courts have found that the provision exceeds Congress’ authority. Under current law, low-income people are eligible for Medicaid only if they also meet other conditions, such as being pregnant or disabled. The ACA expands the program to most people who earn under 133 percent of the poverty level (currently around $24,600 for a family of three). Significantly, the expansion will be paid, for the most part, with federal funding, unlike the federal and state cooperative funding that is typically used for the Medicaid program.
The fact that the Court has agreed to decide whether the expansion is constitutional is of concern. It could affect the Medicaid program significantly. And, many other federal laws, including many environmental regulations, are set up like Medicaid—with federal funding predicated on a state’s agreement to comply with federal mandates. If the Court finds that Congress did not have the authority to authorize the Medicaid expansion, those programs could be vulnerable as well.
Of the five-and-a-half hours of oral arguments, the Court has devoted an hour and a half – more time than it typically affords to entire cases – to the question of severability. Like the Medicaid expansion question, the decision on this provision could have deep repercussions for public health. The ACA contains a large number of provisions that directly and indirectly affect public health, from grants for community transformation to initiatives that expand the public health workforce. If the Supreme Court decides that the individual mandate is unconstitutional and non-severable, all of the ACA’s other provisions – including those public health programs that have nothing to do with the mandate – will end as well.
This information was developed by Corey Davis, staff attorney, for the Network for Public Health Law – Southeastern Region at National Health Law Program.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.