- Can the court hear the case right now since the individual mandate has not yet taken effect and no one has technically been harmed by the new penalty/tax for non-compliance?
- Is the individual mandate unconstitutional?
- If the individual mandate is struck down, what other sections of the bill must also be struck down?
- Is the ACA’s mandatory expansion of Medicaid enrollment an undue burden on the states that wish to continue to have a Medicaid program?
Speculation is rampant about the expected outcomes of these questions. News sources are analyzing every word of the 421 pages of transcripts trying to identify the tell-tale signs as to which way the Justices will vote. At this point, the Court has no deadline for releasing their decision. Many argue that the longer it takes for them to complete their work, the more likely they are to find against the President’s plan.
The debate on Wednesday was especially interesting during the argument about what other provisions of PPACA should be dropped if the mandate is declared unconstitutional. Justices on both sides of the political spectrum pressed hard to get the lawyers being questioned to identify the textual correlation between the mandate and other portions of the massive 2700 page law. The questions gave rise to the theory that the more liberal Justices recognize that the mandate is likely to be struck down, so minimizing the down-stream effects would be important. Even so, many of the questions from more conservative members of the Court indicated that they too were looking for some clear delineation so as to not be forced to strike down the entire law.
Many in the medical community believe that the mandate is likely to be found unconstitutional. Only two elements of PPACA were explicitly identified as being bound to the mandate through the language of the bill itself. They are the community rating improvements and preexisting condition coverage. In addition, these portions of the law were most often discussed as linked to the mandate in some way:
- Coverage for individuals with pre-existing conditions
- Community rating adjustments
- Tax credits for purchasing health insurance
- Medicare disproportionate share funding
- Medicaid enrollment expansion
- Health Insurance Exchanges
The NCMS will continue to report on this historic debate as further analysis and more information becomes available. The transcripts for each of the three days of testimony can be found below.
No matter the outcome, there remains a heavy burden on everyone involved in medicine to find ways to further improve quality outcomes while lowering costs within the system. This debate centers on a topic that will be defining for generations to come. We continue to look to you, the members of the NCMS, for guidance and participation in the programs that will set the course for the future of your profession.