Supreme Court Reviews ACA

Beginning on March 26, 2012, the Supreme Court will begin hearing oral arguments related to the constitutionality of two major provisions of the Affordable Care Act (ACA). The landmark health care reform was signed into law in March of 2010 and its implementation spans through 2018.

Two Major Provisions of ACA Under Consideration

The Individual Mandate: The minimum essential coverage provision of the ACA, known as the individual mandate, requires most people to maintain a minimum level of health insurance coverage for themselves and their tax dependents in each month beginning in 2014. If a person does not satisfy the individual mandate, she will owe a financial penalty, known as the shared responsibility payment. The financial penalty will be a percentage of household income, subject to a floor and capped at the price of the forgone insurance coverage, assessed and collected by the IRS, and reported on federal income tax returns.

Medicaid Expansion: The ACA expands the eligibility for Medicaid, which is currently a joint federal and state-run program, to provide health insurance to citizens with low incomes. The program is voluntary for states but currently all states participate. To be eligible for federal Medicaid funding, states must adhere to specific federal rules. One of the requirements concerns the groups of people who are eligible for the state's Medicaid program. The ACA expands the Medicaid program's mandatory coverage groups by requiring that participating states cover nearly all people under age 65 with household incomes at or below 133% of the federal poverty level, beginning in January of 2014.

Implication of Anti-Injunction Act

Prior to even hearing oral arguments on the constitutionality, the court must decide whether the federal Anti-Injunction Act (AIA) prevents the courts from deciding lawsuits about the ACA at this time. The AIA is a part of the Internal Revenue Code that bars lawsuits that seek to restrain the assessment or collection of a tax. Individuals who want to challenge the imposition of a federal tax must first pay the tax and then seek to have the tax refunded through the courts.

Supreme Court Timeline

Possible Outcomes of Individual Mandate Ruling

From the perspective of the impact on the future of the Country's health care delivery system, the most significant decision rests with the individual mandate. It is clear that if the Court upholds the individual mandate, this provision of the law will take effect as currently planned in 2014. If the court invalidates the individual mandate then the situation becomes a bit more complex.

If the court invalidates the individual mandate provision, it must also rule on whether the mandate is severable from the remainder of the law. A "severable" ruling would enable the rest of the ACA to be implemented as planned. If the mandate is found to be unconstitutional and not severable, the entire ACA would be struck down. It is also possible the Court could invalidate only specific provisions of the law. Ultimately, in event of a unconstitutional ruling, the Court must determine whether the rest of the law is able to function independent of the individual mandate.


Most legal prognosticators forecast a split vote typically favoring the direction of their own political views. One of the few areas where all parties agree is on the need for a quick ruling so that States and the industry have time to plan and implement based upon the direction of the ruling. Whether one's interest is specifically related to health care, State vs. Federal power or simply a legal junkie, the next few months should provide an exciting screenplay providing direction on a number of significant topics impacting the United States.