Understanding the Supreme Court's health care case

The Supreme Court heard three days worth of testimony from lawyers on either side of the Affordable Care Act (ACA) debate. Now, the justices will discuss that testimony and are expected to release a ruling toward the end of June.

Interest groups are jostling in the capital to weigh in on the law often nicknamed "Obamacare." Many people lack a clear understanding of why the ACA is facing the Supreme Court, what the procedure is now or how it will effect the government of the United States in the long run.

Unlike other cases, where the Supreme Court is the last chance to appeal a previous ruling, it is the first to hear cases brought against the federal government. The ACA hearing is formally titled the Department of Health and Human Services vs. the State of Florida.

While Florida is the state in the title of the case, there are 25 other states involved in the lawsuit, including Ohio, Wisconsin, Indiana and Michigan. Also on the side of those 26 states is the National Federation of Independent Business, a lobbying firm for small businesses across the nation.

The lawyer for the plaintiffs is Paul Clement. Clement formally represented House Republicans in arguing the Defense of Marriage Act and represented the NBA in negotiations with the players union, among other prominent cases.

Defending the administration is Deputy Solicitor General Edwin Kneedler. Kneedler has worked in the Department of Justice since graduating University of Virginia law school in 1975, and he was appointed by former President George Bush to replace former Solicitor General Garre in 2009.

There are nine justices sitting on the Supreme Court, five of them conservative and four of them liberal. This means that upholding the bill will require one conservative justice to take what is typically seen as the ‘liberal’ stance and support keeping the law.

There are two issues for the case that are listed officially by the Supreme Court. The first is whether Congress has constitutional power to require virtually all Americans to buy health insurance or face a penalty. This is often referred to as the "mandate" issue.

The second is whether the law in place called the Anti-Injunction Act, which prohibits taxpayers from challenging a tax until it goes into effect, in turn prohibits challenging the ACA mandate until it goes into full effect in 2014.

After hearing testimony from both sides, the Supreme Court will take until near the end of June (right before they recess) to release a decision. Last Friday, according to DePaul political science professor Anna Law, the Supreme Court took what is called a "straw vote," which is a non-binding vote.

Afterwards, each justice will be able to choose whether to vote with the opinion, vote in agreement but write their own opinion or write a dissenting opinion that explains their disagreement with the Court’s legally binding decision.

The Supreme Court has four possibilities for ruling, according to David Burnam, political science professor at DePaul University. They can choose to either uphold the law, “decide not to decide,” strike down a portion of the law or strike it down in its entirety.

If the Court chooses to strike down only a portion, it is fairly easy to assume that it would be the mandate. However, the ACA will be unable to stand without the mandate.

Because of the ‘guarantee of coverage’ in the law, which prohibits insurance companies from denying coverage based on pre-existing conditions, there are a few economical reasons why the mandate is critical for the law’s survival.

Consider a person in good health. Knowing that insurance cannot deny him or her coverage, that person would decide it is in their best interest not to buy insurance until they got sick.

Due to this, premiums would skyrocket for those who did have insurance, and even more healthy people would drop their insurance and simply wait until they needed it, said Burnam. Logically, this would wind up with a healthcare market even more expensive than it is today, he said.

While the political fallout will be substantial to whichever side "loses" the case, Burnam senses that the administration will fare better than opponents. “My sense is that if the law is upheld, Obama wins, and if the law is overturned, Obama also wins,” said Burnam.

He explained that if the administration lost, it would give their grassroots campaign a boost, “based on the disturbing proposition that a small, unelected court (and in particular a single member of a small, unelected court) can prevent the elected national legislature (Congress) from successfully addressing and forging a solution to a complex social and economic problem.”

In the long term, if the Supreme Court overturns the law, they will have raised a question on Congress’ ability to pass laws using authority granted in the Commerce Clause of the Constitution, according to political science professor David Will.

Because of this, according to Will, the federal government could face many more challenges on laws that were passed under this same authority. This would potentially include a wide range of laws and regulations. Even education reforms and the civil rights laws were passed using the power of the Commerce Clause.

As the Supreme Court listens to arguments in the case, the nation watches. Understanding the basics will make it easier to sort through the rhetoric and form an educated opinion on this important issue.