Countdown To The Supreme Court's Ruling On Health Care : Shots - Health News This week, the Supreme Court is almost certain to issue its decision on the constitutionality of President Obama's health care law. The decision could have far-reaching implications for the legal landscape, the nation's health care system and even the Supreme Court's legacy.
NPR logo

Countdown To The Supreme Court's Ruling On Health Care

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Countdown To The Supreme Court's Ruling On Health Care

Countdown To The Supreme Court's Ruling On Health Care

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


This is WEEKEND EDITION from NPR News. I'm David Greene, in for Rachel Martin.

After months of anticipation, this week the Supreme Court is finally expected to issue its decision on the constitutionality of President Obama's health care law. This is what everyone has been waiting for since the case was argued back in March.

For those of you who might have forgotten what the actual issues are, we've invited our NPR brain trust on this, legal affairs correspondent Nina Totenberg and health policy correspondent Julie Rovner, to join us for a bit of a refresher. Thank you both for coming in.



GREENE: Nina, let's start with you. as we get ready for this decision, remind us what the legal questions are that the Court is really grappling with.

TOTENBERG: OK, here's the four-point quick and dirty. First, there's the threshold question: Can you the Court can decide this now or does it have to wait until the whole thing goes into effect. And it was pretty clear at the oral arguments that they think they can cite it now.

Second, is the mandate requiring virtually all Americans to have health insurance. Is the mandate constitutional?

Third, is the expansion of Medicaid constitutional? The states have challenged the expansion, saying it's coercive even though the Feds pay for most of the bill. And finally, the Court will tell us if any of these parts is unconstitutional, can it be separated from the rest of the law, or does the whole thing have to be struck down?

GREENE: So, a lot of options for the Court. And, Julie Rovner, we've been talking about how this decision really could have a major impact on the nation's health care system?

ROVNER: Absolutely, it could. About the only thing that wouldn't have much of an impact is if the Court upholds the law in its entirety. Even striking down just a small piece could have lots of consequences; some intended, some perhaps unintended. There's this perception that most of the law hasn't taken effect yet and that's true. But even just striking down the mandate, which of course has not taken effect yet, and portions of the law that go with that mandate could prove disruptive to people's current coverage.

GREENE: But, Julie, let's clear something up. I mean, isn't it possible that some pieces of the law that have gone into effect already are going to stay if the Court strikes this down?

ROVNER: Well, yes. I mean, for example, some of the big insurance companies said that they liked to keep the coverage for young people under age 26 who are allowed to stay on their parents' health plans. But it turns out, even that's not so simple. The law waived a key tax policy, so those parents of those young adults could end up owing both income and payroll taxes on the value of that coverage. And their employers would face a huge mess trying to figure out who owes what.

You know, everyone hates the fact that this was a 2,700 page piece of legislation. But that's because health care is complicated, and it's hard to take pieces out of what really was envisioned as a whole.

TOTENBERG: You know, David, I really didn't know what was in this bill before it got to the Supreme Court. And I was struck by what a complete and interwoven overhaul of the health delivery system it is. You can like or dislike parts of it, but it truly is an attempt to make the system more rational.

GREENE: The Court might say you can separate it, but actually separating it could be an incredibly complicated thing to do.



GREENE: Nina, is this one of those big decisions that could really define a Court and its reputation?

TOTENBERG: Well, in short run and the longer run are two different questions, and I'm not quite sure how it shakes out. If the Court strikes down the mandate, for instance, it would be the first time in three-quarters of a century that the Court would have struck down a major piece of regulatory legislation.

And you know, for the last half century or so, the battle cry of conservative has been judicial restraint and criticism of judicial activism, meaning essentially that the Court should defer more to the elected branches. And now, suddenly, we're seeing conservatives calling for activism - and they're calling for it overtly. Conservative columnist George Will, for instance, has recently embraced the notion of judicial activism as the ideal.

So, where we are going to perceive this Court in the long run is very unclear to me.

GREENE: Julie, how will this be perceived on the campaign trail? I mean, President Obama, Mitt Romney already talking about health care a lot. I mean, could this change the conversation in a big way?

ROVNER: You know, there's been a ton of speculation on this. There's one camp that says that the president will be helped if the mandate, particularly, is struck down - that's the least popular part of this law. And, of course, the rest of it is relatively popular. On the other hand, this was the president's signature domestic achievement, and I think it never looks good to have a piece of your major accomplishment summarily canceled.

Just late last week, House speaker Boehner put out a memo telling his troops that, should the Court strike down all or part of the law, that there will be no spiking of the ball. Because basically that would be win for them. So I think we will see Republicans, if not gloating, at least celebrating if any part of this law is struck down.

But how it will ultimately play out at the polls, I think it's pretty soon to tell.

TOTENBERG: In fact, Senate candidate Richard Mourdock in Indiana, who beat Richard Lugar, he cut three different ads celebrating the Court striking down the decision. They were to be released depending on which variations on a theme happened, but somehow they got leaked. And now they're all over YouTube.


GREENE: Wow. Oh, so then, we now politicians are getting ready to talk about this one way or the other.

Well, Nina, when do we expect this decision. I mean it's not the only case that the Court still has left to decide on.

TOTENBERG: Oh no, there is more, much more. There's the constitutional test of the Arizona Show Me Your Papers law. There's a constitutional challenge to sentencing juveniles 14 and younger to prison for life without parole when they commit murder. And there's a constitutional challenge to the federal law making it a crime to lie about having received a military medal.

I really do, David, expect the Court to have all this decided by the end of the week. But I'm reminded of the time many years ago when I asked the late great Justice Lewis Powell if I was safe booking a plane flight to go home July 4th to visit my folks. And he said, oh, I would be fine. And at about this time, the phone on my desk rang and I picked it up. And this voice said, Nina, this is Lewis Powell, I'm afraid that I misled you.



GREENE: You might not be booking plane tickets this week either.

TOTENBERG: Well, the justices have plans to leave town at the end of the week. So we probably are safe saying it's this week.

GREENE: NPR's legal correspondent Nina Totenberg and health policy correspondent Julie Rovner, thank you both for coming in.

ROVNER: You're welcome.

TOTENBERG: Our pleasure.

Copyright © 2012 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.