U.S. Supreme Court accepts ACA case | Ear, Nose & Throat Journal Skip to content Skip to navigation

U.S. Supreme Court accepts ACA case

November 16, 2011
by Mark Hagland, Editor-in-Chief, Healthcare Informatics
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On Nov. 14, the Supreme Court announced that it would hear one of several cases that have been working their way through the federal court system challenging the Affordable Care Act (ACA), the federal healthcare reform legislation passed by Congress and signed into law in March 2010 by President Barack Obama.

The announcement from the nation’s highest court came just six days after the U.S. Court of Appeals for the District of Columbia Circuit had affirmed the entire ACA on Nov. 8. That ruling was the fourth among four federal appeals courts that had taken on legal challenges to the ACA. Two of these courts (the D.C. court and the Sixth District court in Cincinnati) had affirmed the entire law, while the Fourth District court in Richmond had declared the plaintiffs in the two cases it heard to have lacked the legal standing to bring their cases. However, the Eleventh District Court of Appeals in Atlanta had ruled against the individual insurance mandate in a 2-1 decision on Aug. 12, although that court had also determined that the ACA as a whole was constitutional.

In sum, no federal appellate court has struck down the entire ACA as unconstitutional, while the Eleventh Circuit struck down only the individual mandate element of the law. Still, the U.S. Supreme Court has agreed to take on the entire law and could rule the entire law constitutional; could rule the entire law unconstitutional; or could rule only on the constitutionality of the individual mandate. It could also decide that it is too early to rule on the constitutionality of the ACA, based on the fact that its individual mandate element does not become effective until 2014, by applying a federal law that says that legal challenges cannot be brought to taxes until those taxes are actually levied. The Republican leadership in the U.S. Congress has declared itself uniformly opposed to the ACA and has encouraged the legal cases challenging its constitutionality, while most Democrats in Congress voted for the ACA and continue to support it. Meanwhile, the Obama administration on Sep. 28 announced that it would not seek a full appeals court review of the Aug. 12 decision, and instead petitioned the U.S. Supreme Court to take that case, with the Justice Department stating on Sep. 28 that, “Throughout history, there have been similar challenges to other landmark legislation, such as the Social Security Act, the Civil Rights Act and the Voting rights Act, and all of those challenges failed. We believe the challenges to the Affordable Care Act—like the one in the 11th Circuit—will also ultimately fail and that the Supreme Court will uphold the law.”

On Nov. 14, Speaker of the House of Representatives John Boehner (R-Ohio), said in a statement, “This government takeover of healthcare is threatening jobs, increasing costs, and jeopardizing coverage for millions of Americans, and I hope the Supreme Court overturns it.” Meanwhile, in a statement also on Nov. 14, White House Communications Director Dan Pfeiffer said, “We know that the Affordable Care Act is constitutional and are confident the Supreme Court will agree.” The justices have announced that they will hear five-and-a-half hours of arguments, an exceptionally long block of time dedicated to the questions around healthcare reform. Legal experts made note of the length of time being scheduled for oral arguments in a case that is unprecedented, given the complexity of the legislation involved, as well as the fact that the Supreme Court will be ruling on the constitutionality of that legislation during the course of a presidential campaign.

The outcome, experts agreed, is potentially very open. Paul Rothstein, a professor of law at Georgetown University Law School, told MSNBC’s Thomas Roberts on Nov. 14 that “There are just too many variables here” to be able to predict with any certainty how the nation’s high court might ultimately rule, adding that “it’s an issue that cuts across conservative and liberal lines. Some of the justices in the courts below that have ruled in favor of the Obama healthcare plan have been Republicans, and vice-versa; so it's really very hard to call it.”

Rothstein went on to say that “The Supreme Court, even though it's taken the case, could decide that it's too early to call it, based on the idea that people don't have the right to challenge it until their ox is gored. Also, there's a law that says that you can't challenge a tax until it has to be paid. So we really don't know what the Supreme Court is going to do. There are also lots of regulations besides the individual mandate, and they're going to have to decide [about those], too."

The high court is expected to hear oral arguments by sometime in March 2012 and will likely issue a ruling by June.