Health Care Reform at the U.S. Supreme Court: Florida v. HHS

MaryBeth Musumeci

Senior Health Policy Analyst

Kaiser Commission on Medicaid and the Uninsured

Policy and Political Implications of the Supreme Court Case

on the Affordable Care Act

Washington, DC

March 14, 2012

FIGURE 1

Parties

NFIB and

Individual Plaintiffs

26 States, led by Florida

vs.

U.S. Departments of

Health & Human Services,

Treasury and Labor and

FIGURE 2

Key Dates

March, 2010: ACA

enacted and Fl. v. HHS filed

January, 2011:

Fl. district court

decision

August, 2011: 11th

Circuit decision

November, 2011:

Supreme Court

accepts case

January, 2012:

Supreme Court

briefing begins

March, 2012: Supreme Court oral arguments

Supreme Court

decision expected by June,

2012

FIGURE 3

The Road to the Supreme Court

At least 26 cases filed in federal district courts: 2 struck down mandate, 24 have not

Decisions from 7 federal appeals

courts: 1 struck down mandate, 6 did not

Fl. v. HHS accepted by

the Supreme Court

FIGURE 4

States’ Positions in FL. v. HHS

WY

WI

WV

WA

VA

VT

UT

TX

TN

SD

SC

RI

PA

OR

OK

OH

ND

NC

NY

NM

NJ

NH

NV NE

MT

MO

MS

MN

MI

MA

MD

ME

LA

KY KS

IA

IN IL

ID

HI

GA

FL

DC

DE

CT

CO

CA

AR AZ

AK

AL

States both challenging and supporting the ACA (2 states)

States challenging the ACA (25 states)

States not taking a position in the litigation (12 states)

States supporting the ACA (11 states)

Note: VA filed its own challenge separately and is not a

party in the case accepted by the Supreme Court

FIGURE 5

Issues

1.Do courts have jurisdiction to decide the

constitutionality of the ACA’s individual mandate

provision now?

2. If so, is the ACA’s individual mandate provision

constitutional?

3. If unconstitutional, is the individual mandate

provision severable?

4. Is the ACA’s Medicaid expansion constitutional?

FIGURE 6

Issue 1: Anti-Injunction Act (AIA)

• If the Court decides that the ACA’s financial

penalty is considered a “tax” under the AIA, this

challenge to the mandate is dismissed, and

courts cannot hear cases about the whether the

mandate is constitutional until April, 2015.

• If the Court decides that the AIA does not apply,

the Court will decide whether the mandate is

constitutional now.

FIGURE 7

Issue 2: Constitutionality of the Mandate

• Possible Bases for Constitutionality:

-Commerce Clause

-Necessary and Proper Clause

-Tax Clause

• If the Court decides the mandate is

constitutional, it will take effect in 2014,

unless Congress acts to repeal or postpone

it.

FIGURE 8

Issue 3: Mandate is Struck Down – Is it Severable?

• If the Court decides the mandate is not severable

from the rest of the law, it invalidates the entire

ACA.

• If the Court decides the mandate is severable, the

Court could

-strike just the mandate, or

-the Court could also strike the guaranteed

issue and community rating provisions.

FIGURE 9

Issue 4: Medicaid Expansion Upheld

If the Court decides the Medicaid expansion is

constitutional, it takes effect in 2014, unless

Congress acts to postpone or repeal it.

FIGURE 10

Issue 4: Medicaid Expansion Struck Down

• If the Court decides the Medicaid expansion is not

severable, it invalidates the entire ACA.

• If the Court decides the Medicaid expansion is

severable, the Court could:

-strike just the Medicaid expansion, or

-strike the Medicaid expansion and other

provisions of the ACA.

FIGURE 11

What’s At Stake for Health Care Reform in the Supreme Court?

• Individual Mandate

• Medicaid Eligibility Expansion

• Entire ACA, including: – Health insurance market reforms

– Health insurance exchanges

– Employer responsibility provisions

– Tax subsidies for premiums and cost-sharing

– Medicare benefits expansion, payment reductions

– Delivery system reforms (ACOs, etc.)

– Public Health and Prevention Fund

– Health care workforce expansions

– Transparency and program integrity provisions