by Frederick Perillo
This week, all eyes turned to the three-day argument over the Patient Protection and Affordable Care Act (PPACA)--called “Obamacare” derisively by its opponents—in the Supreme Court of the United States. Twenty-Six (26) Republican Attorneys General from the states are arguing that the law should be struck down; they are aided by three more States with Republican governors but Democratic Attorneys General who refused to join the lawsuit. The law is defended by the Administration. In the lower courts, there was a split whether the act is unconstitutional.
The three days of argument were broken up into three distinct arguments: On the first day, the Court considered whether it had jurisdiction to hear the case at all. On the second, the Court heard argument whether the individual mandate was constitutional. On the third, the Court heard argument whether an expansion to the Medicaid program impermissibly intruded on the power of the States.
Day One. An 1867 law, called the “Anti-Injunction Act,” prohibits someone who wants to challenge whether a tax is constitutional from making the challenge in advance of actual collection of the tax. The fear is that challenges brought first will block the flow of revenue to the federal treasury. So, the rule has been: Pay first, then file a challenge and ask for a refund.
In the case of the Affordable Care Act, the law mandates each individual obtain health care coverage in some way, or else pay something—either a “tax” or a “penalty”—if he or she does not. This requirement, called “the individual mandate,” does not apply until 2014, however, and thus raises the question why it can even be challenged at all now. This position was taken by the Administration in the lower courts.
If the requirement that an individual pay something—either a “tax” or a “penalty”—if he or she doesn’t obtain health insurance coverage is a “tax,” then the whole challenge to the PPACA is premature. No one is actually required to pay anything until 2014. If it’s a penalty, then the case can proceed now to the constitutional questions set aside for Days Two and Three.
The first day’s argument centered on this obscure tax question, because the government argued on Day One that the payment is a “penalty” (the opposite of its position in the lower courts), while it was expected that the government would argue on Day Two that the payment is a “tax.” The Administration takes this position because constitutionally, it is much easier to defend a “tax” under Congress’s taxing powers in the Constitution than under its other powers—say, the Commerce Clause. The justices chided the government over these inconsistencies. Much of the questioning focused on whether the same payment could be a tax for one purpose and a penalty for another, and whether there are exceptions to the rule in the 1867 law that a tax cannot be challenged beforehand.
Another odd thing about Day One is that no one in the lawsuit wants to postpone consideration of the law – the Supreme Court had to appoint a special advocate to argue that the high court should not hear the case. Justice Scalia scolded the appointed attorney that federal judges are intelligent enough to pick out which challenges can safely go forward. Other justices question whether the 1867 is really a bar to court jurisdiction. Chief Justice Roberts also suggested in questioning that what is being challenged is the mandate to buy insurance, not the “or else” payment, regardless whether the “or else” is a tax or a penalty.
At the end of the first day, however, it was clear that everyone – the government, the opponents, and the justices-- want the case to go on. Reading tea leaves, there is potentially a bad sign for the government in Chief Justice Roberts’ observation that Congress nowhere called the penalty a “tax” in those words. If it’s not a tax, then the individual mandate has to be justified as an exercise of Congress’s power to regulate interstate commerce.
Day Two. It is widely presumed that the four “liberal” justices (Breyer, Ginsburg, Kagan, and Sotomayor) will side with the government, and their questions today only support this belief. It is widely presumed that Justices Alito and Thomas will vote to strike down the Affordable Care Act. Justice Thomas, at least, famously says nothing during oral argument, so we can glean nothing from his presence on the bench; and Justice Alito is openly hostile to the Act. So today, all eyes turn to Chief Justice Roberts, and associate Justices Scalia and Kennedy, particularly the latter, for signs which way they are leaning. This is a difficult game—it’s notoriously hard to judge how judges will rule based on their questions.
Legal commentators have been speculating all day, however, that the questions bode ill for the Act. Chief Justice Roberts asked whether, if the government can require a citizen to purchase health insurance, why can’t it require everyone to buy cell phones in case of an emergency? Justice Scalia trots out the favorite example of the American right wing – why can’t the government force me to eat broccoli just because it’s good for me? All of the conservative justices demand to know what is the limit of congressional power under the Commerce Clause of the Constitution to force an American to buy a product?
The argument centers around a fundamental question—is the Affordable Care Act a law about health care, or health insurance? The government is trying to argue that it is a health care law, and that everyone sooner or later participates in the market for health care. You get sick, or you have an accident, or you live long enough that the diseases of old age catch up to you—but sooner or later, you are going to need health care. Because everyone is participating in this market, whether they want to or not, Congress can regulate them by requiring them to pay a share of the cost, in the case of PPACA, by purchasing health insurance. So, it’s not like forcing someone to eat broccoli, just because the government thinks broccoli is good for you. It’s more like requiring a market participant to be responsible – not to use services that he or she can’t pay for, because he or she didn’t have insurance.
The conservatives are all pressing the government’s lawyer on whether the market is really the health insurance market—something that not everyone will buy, or has to buy, if the government doesn’t require it. Several justices throw out examples—young people who don’t need insurance themselves, and may never need it because they die young, or who buy it later in life when they do need it—to show that the Congress exceeded its power.
Justice Kennedy, the probable swing vote on the Court asks what may be the ultimate question for the Affordable Care Act: “Can you create commerce in order to regulate it?” The question suggests that Justice Kennedy doesn’t believe the law is a health care law, that is, he doesn’t think that everyone automatically is already, automatically participating in the health care market. He thinks the government is forcing people to buy insurance, and using that fact as the basis for Commerce Clause regulation. If so, it is easy to see why commentators today think the law is headed for trouble.