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Protesters stand outside the Sandra Day O'Connor Federal Courthouse Friday, March 23, 2012 in Phoenix. during the Stand Up For Religious Freedom Rally. The rally is part of a nationwide Rally for Religious Freedom which is a reaction against the Obama Administration’s HHS mandate that will obligate Catholic organizations to provide contraceptive services to their employees. (AP Photo/Matt York)
Q&A: How health care case will unfold before the court
First Published Mar 24 2012 10:53 am • Last Updated Mar 24 2012 10:53 am

WASHINGTON • The Supreme Court will begin hearing arguments on Monday over President Barack Obama’s health care overhaul, the Patient Protection and Affordable Care Act, derisively labeled "Obamacare" by its opponents. A look at how the case will unfold before the court in question-and-answer form:

Q: What’s this all about?

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At a glance

What Obama’s health care law does

A brief summary of the 900-page plus Affordable Care Act, unless noted provisions take effect in 2014:

—Provides coverage to more than 30 million uninsured.

—Expands Medicaid to cover more uninsured low-income people.

—Creates exchanges, state-based health insurance markets, for small businesses and people buying private coverage individually.

—Provides government subsidies for many middle-class people buying private health insurance through an exchange.

—Allows young adults to stay on parents’ coverage until age 26. Already in effect.

—Requires health plans to cover preventive care without charging co-pays. Already in effect.

—Requires most citizens and legal residents to carry health insurance, either through an employer, a government program or by buying a policy directly. IRS will assess fines for noncompliance.

—Requires companies with 50 or more workers to provide coverage, or pay fines if any of their employees ends up getting a health insurance subsidy.

—Raises taxes on upper-income households; imposes a variety of taxes and fees on the health care industry. Places a 10 percent sales tax on indoor tanning. Some taxes already in effect.

—Cuts Medicare payments to hospitals, insurers and other service providers; improves preventive benefits for Medicare recipients and gradually closes prescription drug coverage gap. Limits future increases in Medicare spending. Some Medicare provisions already in effect.

—Significantly increases federal regulation of the health insurance industry. Already in effect.

—Congressional Budget Office estimates coverage expansion will have a net cost of $1.1 trillion from 2012-2021. Spending cuts and tax increases are currently projected to offset the cost, for a modest reduction in federal budget deficits.

Source: Associated Press research.

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A: The Supreme Court is hearing a challenge to the Patient Protection and Affordable Care Act, which is Obama’s signature domestic achievement. Passed by Congress in 2010, its aim is to provide health insurance to more than 30 million previously uninsured Americans, while trying to restrain costs and prevent disruptions to the majority already with coverage. Opponents say the law is unconstitutional; their chief argument is that Congress does not have the power to force unwilling Americans to buy health insurance or pay a fine.

Q: When will the court get started?

A: Justices will begin hearing arguments shortly after 10 a.m. EDT Monday, March 26. They will hear six hours of arguments on several different issues on Monday, Tuesday and Wednesday.

Q: Which issues on which days?

A: Monday’s 90-minute argument is about whether court action is premature because no one yet has paid a fine for not having health insurance. Tuesday’s two-hour argument will cover the central issue of whether Congress overstepped its authority by requiring Americans to purchase health insurance starting in 2014 or pay a penalty. Wednesday’s arguments will be split into two parts: Justices will hear 90 minutes of debate in the morning over whether the rest of the law can take effect even if the health insurance mandate is unconstitutional and another hour Wednesday afternoon over whether the law goes too far in coercing states to expand the federal-state Medicaid program for low-income people by threatening to cut off federal aid to states that don’t comply.

Q: When will the justices rule?

A: The court could decide any time, but complex cases argued in the spring normally produce decisions near the end of the court’s session, scheduled for late June.

Q: Is it possible that the justices won’t decide whether the law is constitutional or not?


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A: It is possible. The first issue the court is discussing is whether an obscure tax law makes it too early for the Supreme Court to get involved. If they decide that the issue is premature, then the case will be dismissed without a binding ruling from the justices.

Q: What did lower federal courts say?

A: The 11th U.S. Circuit Court of Appeals in Atlanta ruled that Congress overstepped its authority when lawmakers passed the insurance mandate, the only appeals court to come to that conclusion. The 6th U.S Circuit Court of Appeals in Cincinnati upheld the entire law, as did the U.S. Court of Appeals for the District of Columbia Circuit in Washington, D.C. The 4th U.S. Circuit Court of Appeals in Richmond, Va., ruled that the question was premature and the law can’t be challenged in court until after 2015, when the first penalties for not having insurance would be paid.

Q: Who are the justices on the Supreme Court?

A: The chief justice is John Roberts, who joined the court in 2005 after being nominated by President George W. Bush. In order of seniority, the other justices are Antonin Scalia (confirmed in 1986 after being nominated by President Ronald Reagan), Anthony Kennedy (1988 by Reagan), Clarence Thomas (1991 by President George H.W. Bush), Ruth Bader Ginsburg (1993 by President Bill Clinton), Stephen Breyer (1994 by Clinton), Samuel Alito (2006 by President George W. Bush), Sonia Sotomayor (2009 by Obama) and Elena Kagan (2010 by Obama.)

Q: Who will be arguing for the law?

A: Solicitor General Donald B. Verrilli, Jr. will argue for the government on Monday and Tuesday. Deputy Solicitor General Edwin S. Kneedler will present part of the government’s case on Wednesday, and Verrilli will do the rest. Information about Verrilli and the solicitor general’s office can be found here: http://www.justice.gov/osg/index.html . A court-appointed lawyer, H. Bartow Farr III, will also argue that if government cannot require people to buy health insurance, all other provisions of the law can go into effect. Another court-appointed lawyer, Robert Long, will also argue that the lawsuits challenging the insurance purchase requirement are premature because the penalty has yet to be imposed.

Q: Who will be arguing against the law?

A: Representing Florida on Monday will be Washington appellate lawyer Gregory G. Katsas. Former Solicitor General Paul Clement, now in private practice, will represent Florida on Tuesday and Wednesday. Former Justice Department attorney Michael A. Carvin will represent the National Federation of Independent Businesses.

Q: Can I go watch the arguments, and if I can’t make it to Washington, can I watch on television or online?

A: The Supreme Court does not allow live television or radio broadcasts from inside its building, so the only way Americans can actually see or hear the arguments live is to be inside the courtroom while lawyers and justices debate. There are seats reserved inside the courtroom for members of the public on a first-come, first-served basis, with some people allowed to stay for the entire argument while others have to leave the courtroom and give their seats to the next people in line after 3-5 minutes. The Supreme Court will also make the audio recording of the arguments available later the same day on its website: http://www.supremecourt.gov/oral—arguments/argument—audio.aspx.

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America’s health care reform through history

The three days of arguments beginning before the Supreme Court on Monday may mark a turning point in a century of debate over what role the government should play in helping all Americans afford medical care. A look at the issue through the years:

1912:

Former President Theodore Roosevelt champions national health insurance as he tries to ride his progressive Bull Moose Party back to the White House. It’s an idea ahead of its time; health insurance is a rarity and medical fees are relatively low because doctors cannot do much for most patients. But medical breakthroughs are beginning to revolutionize hospitals and drive up costs. Roosevelt loses the race.

1929:

Baylor Hospital in Texas originates group health insurance. Dallas teachers pay 50 cents a month to cover up to 21 days of hospital care per year. The plan grows into Blue Cross.

1932:

After five years of work, doctors, economists and hospital administrators on the independent Committee on the Costs of Medical Care publish their report about the increasing costs of health care and the number of people going untreated. They say health care should be available to all.

1935:

Americans struggle to pay for medical care amid the Great Depression. President Franklin D. Roosevelt favors creating national health insurance, but decides to push for Social Security first. He never gets the health program passed.

1942:

Roosevelt establishes wage and price controls as part of the nation’s emergency response to World War II. Businesses can’t attract workers with higher pay so instead they compete through added benefits, including health insurance, which unexpectedly grows into a workplace perk. Workplace plans get a boost the following year when the government says it won’t tax employers’ contributions to employee health insurance.

1945:

Saying medical care is a right of all Americans, President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as “socialized medicine.” Truman tries for years but can’t get it passed.

1960:

John F. Kennedy makes health care a major campaign issue but as president can’t get a plan for the elderly through Congress.

1965:

Medicare for people age 65 and older and Medicaid for the poor signed into law. President Lyndon B. Johnson’s legendary arm-twisting and a Congress dominated by his fellow Democrats succeeded in creating the kind of landmark health care programs that eluded his predecessors.

1971:

Sen. Edward M. Kennedy, D-Mass., offers his proposal for a government-run plan to be financed through payroll taxes.

1974:

President Richard Nixon puts forth a plan to cover all Americans through private insurers. Employers would be required to cover their workers and federal subsidies would help others buy insurance. The Watergate scandal intervenes.

1976:

Jimmy Carter pushes a mandatory national health plan, but a deep economic recession helps push it aside.

1986:

Congress passes and President Ronald Reagan signs into law COBRA, a requirement that employers let former workers stay on the company health care plan for 18 months after leaving a job, with the worker bearing the cost.

1988:

Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn’t last long. Barraged by protests from older people upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.

1992:

Helping the uninsured becomes a big issue of the Democratic primaries and spills over into the general election. Democrat Bill Clinton wants to require businesses to provide insurance to their employees, with the government helping everyone else; Republican President George H.W. Bush proposes tax breaks to make it easier to afford insurance.

1993:

Newly elected, Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have insurance. The plan meets strong Republican opposition, divides congressional Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It never gets to a vote in the Democrat-led Senate.

2003:

President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of Johnson’s “Great Society” program for seniors.

2008:

Hillary Rodham Clinton makes a sweeping health care plan, including a requirement that everyone have coverage, central to her bid for the Democratic presidential nomination. She loses to Barack Obama, who promotes his own less comprehensive plan.

2009:

Obama and the Democratic-controlled Congress spend an intense year ironing out a compromise that requires companies other than very small businesses to cover their workers, mandates that everyone have insurance or pay a fine, requires insurance companies to accept all comers, regardless of any pre-existing conditions, and assists people who can’t afford insurance.

2010:

Congress passes the Patient Protection and Affordable Care Act, designed to extend health care coverage to more than 30 million uninsured people. Obama signs it into law March 23.



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