The U.S. Supreme Court held three days of oral arguments on the multi-state lawsuit challenging the health care law. On March 26, 27 and 28 the Court Justices sat for a combined six hours to determine the constitutionality of the Patient Protection and Affordable Care Act. The case is officially known as Florida v. Department of Health & Human Services.

Anti-Injunction Act

On the first day, the Supreme Court heard one-and-a-half hours of oral argument on the jurisdictional issue of whether the federal Anti-Injunction Act is relevant to the Affordable Care Act and if so, does the Court have jurisdiction. The Anti-Injunction Act prohibits the Courts from striking down tax laws before they take effect.

Both the Administration and opposing counsel agreed that the law does not constitute a tax, so the court took the unusual step of appointing a third party to argue for the application of the Anti-Injunction Act.

Individual Mandate

The individual mandate portion of the law goes into effect on January 1, 2014. It requires virtually all Americans to obtain health insurance or pay a fine. On Tuesday, the Supreme Court heard two hours of oral argument on the mandate.

Severability

On the last day of oral argument, the Court considered whether the rest of the health care law can stand if the individual mandate provision is found unconstitutional, known as severability.

Opponents of the law contend that if the mandate is stricken, the entire Health Care law should be struck down. While the government says that if the mandate is considered unconstitutional, only two major provisions of the law would have to fall, but the rest of the law can stand.

Medicaid

The final question before the Court was whether the Affordable Care Act’s expansion of the Medicaid program violates the Constitution.

Twenty-six states challenged the decision in the Affordable Care Act to expand Medicaid coverage, an expansion that the states argue will bust their budgets. The states argue that federal Medicaid funding they rely on will be taken away if the states do not agree with this portion of the law.

Defenders of the Medicaid expansion provision argued that states can decide whether they want to participate in Medicaid on the terms outlined in the Act.

Background

Before the Supreme Court oral arguments on March 26, 27 and 28, three different circuit courts heard oral argument on the new health care law.

In May 2011, the Fourth Circuit in Richmond, Virginia heard two cases on the health care law. In Liberty University v. Geithner, the Court decided 2-1 that the individuals in the case could not challenge the law until after the law goes into effect.  And Virginia v. Sebelius, the court dismissed the case on the rationale that the only plaintiff in the case, the Commonwealth of Virginia, had no legal right to bring a lawsuit because the individual mandate affects only individuals.

The first appellate court with a decision on the law was the Sixth Circuit Court of Appeals in Cincinnati, Ohio in Thomas More Law Center v. Obama. The Court decided 2-1 to reject the Center’s argument that the individual mandate can never be constitutional, an argument known as a “facial challenge.”

In an opinion by Judge Jeffrey Sutton, a conservative judge who clerked for Justice Antonin Scalia, the court held that it is constitutional to require all Americans to buy health insurance.

The next to hear a challenge to the health care law was the Eighth Circuit Court of Appeals in Atlanta. That Court reached the opposite conclusion from the Sixth Circuit in the case brought by Florida and a group of twenty-five other states, along with the National Federation of Independent Business (NFIB).

The Court sided with the challengers that the individual mandate is unconstitutional.  However, the court also held that even if the individual mandate was unconstitutional, the rest of the health care law could still go into effect, a legal concept known as “severability.”

The 26 States in the lawsuit before the Supreme Court are: Alabama, Alaska, Arizona, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.