Historic judgments now on the docket

WASHINGTON, D.C.-As expected, the Supreme Court will decide if key provisions of the healthcare overhaul law violate the Constitution. State officials and other parties are challenging the constitutionality of the individual mandate provision in the Patient Protection and Affordable Care Act (PPACA), and differing legal rulings on the issue have necessitated a High Court judgment.

The Justices decided last month that they will hear oral arguments in March, which would lead to a ruling on the case in June, just four months prior to the November presidential elections.

The decision will have a profound impact on the national political debate and will shape the legacy of the Supreme Court under Chief Justice John Roberts.

Somewhat surprising is the broad range of issues that the High Court will consider. In addition to the main controversy over the individual mandate, the Justices also will weigh the issue of severability: whether a ruling that the individual mandate is unconstitutional also undermines the rest of PPACA.

The Justices also will consider arguments from some states that the law's expansion of Medicaid illegally coerces them to spend additional money. Medicaid supporters are particularly upset, pointing out that much of the cost of increased Medicaid coverage will be borne by the federal government.

The last topic on the docket is a more technical point: whether an 1867 law prevents the government from challenging new taxes-in this case, the penalty assessed to those who do not obtain health coverage-before they are collected. Although most parties maintain that the law does not apply to PPACA, one appeals court says that judicial review of the tax issue should wait until a fee is assessed, which would first occur in 2015. If the High Court agrees, all parties will be sorely disappointed, as that would delay a ruling on the larger constitutional issues for several years.

The Justices are allowing more than five hours to hear arguments, a remarkably long amount of time that reflects the national importance of the subject under debate.

The administration "is confident that the law will be upheld as constitutional," according to Health and Human Services Secretary Kathleen Sebelius at a press briefing November 14, to announce separate health reform initiatives. Many Supreme Court experts agree, based partly on comments from lower-court conservative jurists on the validity of the law.