Kaiser Family Foundation explores PPACA issues
Since agreeing in November 2011 to consider several constitutionality issues relating to the Patient Protection and Affordable Care Act (PPACA), the U.S. Supreme Court will hear oral arguments March 26-28 on cases against the legislation. The Henry J. Kaiser Family Foundation released a report in January explaining the issues raised by the cases pending before the Supreme Court and considered the potential effects of the court’s decisions.
The foundation noted some key questions regarding the cases National Federation of Independent Business v. Sebelius, and Florida v. Department of Health and Human Services, including:
What have the lower federal appellate courts decided about the constitutionality of the PPACA? In the cases accepted by the Supreme Court, the 11th Circuit Court of Appeals struck down the individual mandate but upheld the Medicaid expansion. The 4th Circuit Court of Appeals dismissed two PPACA cases concerning the individual mandate, finding that the suits were barred under the Anti-Injunction Act. “Nearly all the pending lower court cases concerning the PPACA have been put on hold awaiting the Supreme Court’s decision,” the report stated.
What issues will the Supreme Court consider in its review of the PPACA? The court has agreed to hear four issues—the constitutionality of the individual mandate and Medicaid expansion. If the court finds the mandate unconstitutional, it will decide whether the mandate is severable from the rest of the PPACA legislation. In addition, the court will consider whether this is the appropriate time for courts to rule on the PPACA’s constitutionality or instead whether the Anti-Injunction Act prevents courts from deciding lawsuits about the PPACA until after taxpayers incur the financial penalty for failure to comply with the mandate.
What are the implications of a Supreme Court decision on the constitutionality of the individual mandate? Within the context of the PPACA, if the court upholds the individual mandate, this provision of the law will take effect in 2014. “If the court invalidates the individual mandate, it will then consider whether the mandate is severable from the remainder of the law, which could impact whether the PPACA’s other provisions, particularly those related to expanding access to affordable health insurance coverage, survive and how they are implemented,” the report noted. “Within the broader context of Congress’s legislative powers, the court’s decision may clarify, reaffirm or reverse course on existing constitutional doctrine, with potentially significant effects on Congress’s power to regulate interstate commerce and the constitutional balance of legislative power between the federal government and the states more generally.”
What are the implications of a Supreme Court decision on the constitutionality of the Medicaid expansion? The court’s decision about the constitutionality of the Medicaid expansion could have effects far beyond whether that particular provision of the PPACA is implemented, because no court to date has invalidated federal spending clause legislation on the basis that it is unduly coercive of states, the report stated. “Any developments in this area of constitutional law could extend to the wide range of spending clause legislation, including civil rights statutes that prohibit discrimination on the basis of race, gender and disability and federal laws in a myriad of areas, such as education, transportation and national security.” If both the individual mandate and the Medicaid expansion are struck down, the PPACA will lack two major provisions to expand access to affordable health insurance. If the individual mandate is upheld and only the Medicaid expansion is invalidated, cost-sharing subsidies through the exchanges would be available only for individuals with incomes at or above 100 percent federal poverty level, and Medicaid coverage of people with lower incomes would be at the states' option and at the states’ regular federal matching rates, not the enhanced rates provided in the PPACA.
“The Supreme Court case is proceeding on a relatively fast timeframe, as all of the parties agree that resolving the constitutionality of the PPACA is important so that states can understand what is needed to plan for the implementation of the Medicaid expansion, assistance available through the exchanges and other aspects of health reform scheduled to take effect in January 2014,” the authors concluded. “Although there is no set timeframe within which the court must act, it is likely to issue a written opinion before the close of the current term in June.”
The foundation noted some key questions regarding the cases National Federation of Independent Business v. Sebelius, and Florida v. Department of Health and Human Services, including:
What have the lower federal appellate courts decided about the constitutionality of the PPACA? In the cases accepted by the Supreme Court, the 11th Circuit Court of Appeals struck down the individual mandate but upheld the Medicaid expansion. The 4th Circuit Court of Appeals dismissed two PPACA cases concerning the individual mandate, finding that the suits were barred under the Anti-Injunction Act. “Nearly all the pending lower court cases concerning the PPACA have been put on hold awaiting the Supreme Court’s decision,” the report stated.
What issues will the Supreme Court consider in its review of the PPACA? The court has agreed to hear four issues—the constitutionality of the individual mandate and Medicaid expansion. If the court finds the mandate unconstitutional, it will decide whether the mandate is severable from the rest of the PPACA legislation. In addition, the court will consider whether this is the appropriate time for courts to rule on the PPACA’s constitutionality or instead whether the Anti-Injunction Act prevents courts from deciding lawsuits about the PPACA until after taxpayers incur the financial penalty for failure to comply with the mandate.
What are the implications of a Supreme Court decision on the constitutionality of the individual mandate? Within the context of the PPACA, if the court upholds the individual mandate, this provision of the law will take effect in 2014. “If the court invalidates the individual mandate, it will then consider whether the mandate is severable from the remainder of the law, which could impact whether the PPACA’s other provisions, particularly those related to expanding access to affordable health insurance coverage, survive and how they are implemented,” the report noted. “Within the broader context of Congress’s legislative powers, the court’s decision may clarify, reaffirm or reverse course on existing constitutional doctrine, with potentially significant effects on Congress’s power to regulate interstate commerce and the constitutional balance of legislative power between the federal government and the states more generally.”
What are the implications of a Supreme Court decision on the constitutionality of the Medicaid expansion? The court’s decision about the constitutionality of the Medicaid expansion could have effects far beyond whether that particular provision of the PPACA is implemented, because no court to date has invalidated federal spending clause legislation on the basis that it is unduly coercive of states, the report stated. “Any developments in this area of constitutional law could extend to the wide range of spending clause legislation, including civil rights statutes that prohibit discrimination on the basis of race, gender and disability and federal laws in a myriad of areas, such as education, transportation and national security.” If both the individual mandate and the Medicaid expansion are struck down, the PPACA will lack two major provisions to expand access to affordable health insurance. If the individual mandate is upheld and only the Medicaid expansion is invalidated, cost-sharing subsidies through the exchanges would be available only for individuals with incomes at or above 100 percent federal poverty level, and Medicaid coverage of people with lower incomes would be at the states' option and at the states’ regular federal matching rates, not the enhanced rates provided in the PPACA.
“The Supreme Court case is proceeding on a relatively fast timeframe, as all of the parties agree that resolving the constitutionality of the PPACA is important so that states can understand what is needed to plan for the implementation of the Medicaid expansion, assistance available through the exchanges and other aspects of health reform scheduled to take effect in January 2014,” the authors concluded. “Although there is no set timeframe within which the court must act, it is likely to issue a written opinion before the close of the current term in June.”