Understanding the Legal Issues in Health Care Reform

The Legal Information Institute has set up this mini-website to provide straightforward, unbiased legal analysis for journalists, students, teachers, and anyone interested in the legal issues the Supreme Court will address in its review of the health care law.

This site’s content is by the LII Supreme Court Bulletin Editorial Board. For more Supreme Court analysis and timely case decision notification: Subscribe to the LII Bulletin.

Background

On March 23, 2010, President Obama signed a comprehensive health care reform bill into law: the Patient Protection and Affordable Care Act (PPACA). A number of states and organizations challenged the law in federal court.

Those lawsuits made their way through the courts, leading up to the current Supreme Court review of the law. Perhaps signaling the importance of the health care law to this Court, the Supreme Court has set aside an unprecedented three days, March 26-28, to hear arguments on both sides on the issues.

The Issues

Look for the Supreme Court to address the following major issues in its review of the law, and follow the links for deeper legal analysis:

• Issue 1: The Anti-Injunction Act (AIA). Can the Court even hear arguments about the “individual mandate” (below) now, or must it wait until 2014 when the law takes effect? Read our backgrounder on the Anti-Injunction Act and Dept. of HHS v. Florida AIA case preview.
• Issue 2: The Individual Mandate. The most controversial provision in the health care law requires everyone to have health insurance, or else be penalized. Can the government require individuals carry insurance? Read our Individual Mandate Backgrounder, and our Dept. of HHS v. Florida, Minimum Coverage case preview.
• Issue 3: “Penalty” vs. “Tax.” The legality of the individual mandate may hinge on the court’s interpretation of whether the law requires those without insurance to pay a “tax” or a “penalty.” Read our Penalty or Tax Backgrounder.
• Issue 4: The Guaranteed Issue Provision of the Act prevents health insurers from denying coverage based on a person’s health. But if the individual mandate is ruled unconstitutional and the rest of the Act remains in place, this guaranteed issue provision will greatly increase the cost of providing insurance. Can the Court invalidate the mandate and leave intact the rest of the law? Read our Gauranteed Issue Provision Backgrounder and Severability preview.
• Issue 5: Medicaid. The new health care law promises federal funds to states that adopt the law’s Medicaid expansion, and withholds funds from states that do not. Is the way in which the Act approaches Medicaid expansion within Congress’ power? Read our Medicaid Backgrounder and our Florida v. Dept. of HHS case preview.

More Resources on this Site:

The PPACA makes major changes to Medicare. While not specifically at issue for the Supreme Court, we have a Medicare Backgrounder that analyzes the law’s effects on Medicare.

We have also created a glossary of the legal terminology related to the health care reform legal debate.