Obama's Health Care Law In Court: An Overview

The Supreme Court is getting ready to hear its biggest case in decades — or at least its longest. Next week, three days and six hours of hearings may determine whether President Obama's landmark health care law lives or dies.

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The U.S. Supreme Court is getting ready to hear its biggest case in decades - or at least its longest. Next week, three days and six hours of hearings may determine whether President Obama's landmark health care law lives or dies. They will be diving into the weeds. We'll try to follow along. But let's start by getting the 10,000-foot view of the case. NPR's Ari Shapiro is on the line to help us do that.

Hi, Ari.


INSKEEP: Ordinarily, if I'm not mistaken, Supreme Court justices hear one hour of arguments. They're pretty strict on the time limit. Why go so much longer this time?

SHAPIRO: Yeah, this is pretty extraordinary. The last time the Supreme Court took six hours to hear arguments in a case was 1966. And in all the years since then, there has not been more than four hours set aside for any case.

The reason this is getting so much time is that there were a lot of different challenges to the health care law working their way up through the courts. Those brought up tons of different legal issues. Most of them have fallen by the wayside. But there are still a few very distinct, very unrelated legal issues. And so as we go through these days of arguments, each day, each set of arguments, is going to be set aside for a different, distinct, unrelated legal question from the others.

INSKEEP: So we're actually talking about, in effect, several different legal cases here.

SHAPIRO: Exactly.

INSKEEP: And so what's first up on Monday?

SHAPIRO: So the first question is taxes. Now, the health care law says everyone must buy coverage, and if you don't, starting three years from now, in 2015, you're going to have to pay a penalty. So Monday's question...

INSKEEP: (Unintelligible)

SHAPIRO: Exactly. If you don't follow the mandate, you pay this penalty. And Monday's question is: Is the penalty a tax? Here's why that matters: The law says you can only challenge a tax as being unconstitutional if you've already paid the tax. Now, nobody has to pay this penalty until 2015. So if the court says the penalty is a tax, that means the court is not ready to hear the case, they could just bump this to 2015, when presumably things will be a less politically fraught than they are right now in the middle of an election year.

INSKEEP: Oh my gosh. OK. Well, if the penalty is not a tax, what is the next question that the court would have to face here?

SHAPIRO: OK. Well, this takes us to Tuesday's arguments, which are focused on whether the individual mandate is constitutional. The individual mandate is the requirement that everyone buys health coverage. The people who oppose the law say Congress cannot require every American to buy a product. They can't require Americans to buy broccoli or buy a car any more than they can require an American to buy health coverage.

Supporters of the law say health care is different because everybody in America will at some point in their life need health care. It's not a question of whether you get health coverage; it's just a question of when. And if people are not required to buy health coverage early in life, when they're healthy and everyone is guaranteed coverage when they need it, if you don't require it early on, then everyone will just pile on at the end when it costs the most, and financially the system is unsustainable.

INSKEEP: OK. A lot of questions dealing with that one issue – whether this is covered by the Commerce Clause of the Constitution, whether it's a massive overreach by the federal government or not. But if the court then decided for whatever reason that the individual mandate is unconstitutional, the next question is, I suppose, is whether that means the whole law would go away.

SHAPIRO: Exactly. And the key word here to listen up for is severability. Can you sever the individual mandate from the rest of the law and let the rest of the law stand? That's the question that Wednesday's arguments are going to be devoted to. So depending on how the court answers each one of these different questions – about the tax, about the individual mandate's constitutionality, about severability, the Commerce Clause, there's questions about Medicaid, depending on how they answer each one of those different questions, we could see the court strike down the whole law, strike down parts of the law, uphold the whole thing, or just punt on the question and kick it a few years down the road.

INSKEEP: This has got to be the most politically significant case the court has heard in years?

SHAPIRO: Totally. It is hard to overstate how politically important this case is. Health care coverage for everyone has been a dream of the Democrat Party literally for generations. This law was the top accomplishment of the Obama White House. The law passed without a single Republican vote. Democrats have focused so much energy on passing this law and Republicans have focused more energy on repealing this law than they have on almost anything else in the last couple of years. Put it in the middle of a presidential campaign and the stakes get even higher, where, you know, Republicans saying that they're going to repeal this law is often the biggest applause line of a Republican stump speech. So depending on what this decision out of the court is, it could give Democrats vindication, it could give Republicans vindication, or it could provide more fuel for this fire that has already been burning so hot for so long.

INSKEEP: A preview of what lawyers will be arguing about before the Supreme Court in the coming days from NPR's Ari Shapiro. Ari, thanks very much.

SHAPIRO: You're welcome.


INSKEEP: You hear Ari on MORNING EDITION from NPR News.

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