Overview of Supreme Court Health Cases

Monday June 25 is the last scheduled date for the release of Supreme Court opinions, but SCOTUSblog says that they fact the Justices did not today announce that Monday will be the last day of the session means that opinions will be released after Monday. There are 5 cases left to be announced if you consider the health care cases to be one. In fact, there are three cases that were heard and it is unclear if there will be three sets of opinions, or a unified opinion of some sort.

SCOTUSblog provides great plain english summaries of all Supreme Court cases that are linked below, with my understanding of the bottom line questions to be decided in each case.

U.S. Department of Health and Human Services v. Florida.

  • Can Congress require most everyone to purchase health insurance or pay a fine?
  • Since no one has yet had to pay this fine (couldn’t until 2014), is it too soon to decide this question?

National Federation of Independent Business v. Sebelius.

  • Can Congress make states choose between complying with the ACA or lose federal Medicaid funding?
  • If the requirement for most everyone to purchase health insurance or pay fine is unallowable, does that invalidate the entire law or just the insurance provisions?

Florida v. Department of Health and Human Services.

  • Can Congress make states choose between complying with the ACA or lose federal Medicaid funding?
  • If this is unallowable, does that invalidate the entire law or just the Medicaid expanions?

The entire ACA could be upheld or struck down, or only certain provisions could be struck down (such as the requirement to buy insurance or pay a fine, the so-called individual mandate), or the Medicaid expansions. Most writing has focused on the title I aspect of the case, the individual mandate and private insurance changes. However, around half of the coverage expansions contained in the ACA come via Medicaid. In policy terms, if the Medicaid expansion is struck down (basically saying it is coercive for the federal govt to provide states with “an offer they can’t refuse a la the Godfather”) that would have a huge impact on the ability of the federal government to use one of its most straightforward tools to expand insurance coverage.

If the individual mandate is struck down, there are other policy mechanisms through which to pool risk (and the penalty is quite weak), though revisions to the law to bring them about would require 218 votes in the House, 60 in the Senate and 1 in the White  House and it is hard to see those three bodies agreeing that today is Thursday at this point.

As far as predictions go, I am not an experienced court watcher and have no idea what they are going to rule.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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