For weeks, we've talked about the viability of the Affordable Care Act's individual mandate. As the most personal element of the ACA appeal, everyone seemed to have an opinion about whether the government should be allowed the require people to purchase health insurance. But today, the Supreme Court reminded us that the ACA Medicaid provisions could also doom the healthcare legislation.
For the final day of the ACA appeal, the Supreme Court examined whether the ACA was subject to severability, and the constitutionality of the ACA Medicaid expansion programs. While severability was supposed to be the star of the day, NPR argues that the Medicaid decision could have broader implications. If the Court rules that the feds can't force the states to participate in the ACA, what other programs might be derailed?
First, let's consider the severability arguments. It seems like that justices don't want to strike down the entire health care law over one or two provisions. They also don't want to address 2,700 pages of legislation line by line. (Justice Kennedy, always the swing vote, suggests that severability would make the Court de facto legislators).
There's no clear winner in the severability arguments. SCOTUSblog concludes that resistance to severability may have ultimately "shored up support" for the individual mandate, while Jennifer Rubin at The Washington Post thought that the ACA suffered "a severability trainwreck."
As for the Act's Medicaid provision, Chief Justice John Roberts expressed concern that the ACA amounted to federal coercion of the state. (Though state participation in Medicaid is voluntary, all states participate in the program.) Justice Elena Kagan, by contrast, was incredulous that states could characterize Medicaid funding -- 90 percent of which comes from the federal government -- as coercion. While anti-coercion justices seemed to be in the minority today, we're guessing that they will emerge as the victors in the Medicaid debate.
Now that oral arguments are over, who made the better case? Was it Paul Clement and the ACA challengers, or Donald Verrilli and the government? Winners will be selected this summer, but you can get your healthcare debate fix until then at FantasySCOTUS.
- A Swing and a Miss? Kennedy Skeptical of Individual Mandate (FindLaw's Supreme Court Blog)
- Supreme Court's Obamacare Ruling May Affect Your Biz (FindLaw's Free Enterprise)
- Did Bloggers Kill the Health Care Mandate? (The Atlantic)