The United States Supreme Court on June 28 upheld President Barack Obama’s 2010 health care overhaul, handing him a huge election-year victory by preserving his signature domestic policy achievement. The law, which constituted the biggest overhaul in nearly half a century of the nation’s $2.6 trillion health care system, sought to provide health insurance to more than 30 million previously uninsured Americans and to slow down soaring medical costs.
The Supreme Court’s ruling arose from Obama’s 2010 health care law, the most sweeping health care legislation since the government Medicare and Medicaid programs of the 1960s.
Here is a chronology of the events in the legal battle over the law, and five facts about health care in the United States.
March 23, 2010
Obama signed into law the Patient Protection and Affordable Care Act (aca), which Congress approved after a long, bruising political fight. The law, which amounted to some 2,700 pages, imposed new obligations on individuals, insurers, employers and states in restructuring the nation’s $2.6-trillion-health care system. The law sought to obtain near-universal coverage and slow down soaring health care costs. It became Obama’s signature domestic policy accomplishment, and was fiercely opposed by Republicans. At the White House signing ceremony, Obama said the law embodied “the core principle that everybody should have some basic security when it comes to their health care.”
Immediately after Obama signed the law, a group of 13 states led by Florida sued to challenge the law’s constitutionality, one of a number of lawsuits brought by various parties around the country. The lawsuit, filed in federal court in Florida, was later joined by 13 more states, for a total of 26 states. It was also joined by the National Federation of Independent Business, which represents small businesses across the country. The states argued the requirement that people obtain health insurance by 2014 or pay a penalty — a provision known as the individual mandate — exceeded the powers of Congress under the u.s. Constitution to regulate interstate commerce. The states argued the mandate could not be severed or separated from the rest of the law and they also objected to other provisions, saying Congress improperly coerced the states to expand the Medicaid health care program for the poor. The state of Virginia filed its own lawsuit on behalf of its citizens.
January 31, 2011
u.s. District Judge Roger Vinson in Florida ruled for the states and struck down the law as unconstitutional. “Because the individual mandate is unconstitutional and not severable, the entire act must be declared void,” he said in his opinion, dealing the Obama administration a major setback. “Regardless of how laudable its attempts may have been to accomplish these goals in passing the act, Congress must operate within the bounds established by the Constitution,” wrote Vinson, who was appointed to the bench by Republican President Ronald Reagan. The Obama administration vowed to appeal to a u.s. appeals court and said it believed the law ultimately would be upheld.
August 12, 2011
The u.s. Court of Appeals for the 11th Circuit, based in Atlanta, ruled by a 2-1 vote that it was unconstitutional to require Americans to buy insurance, siding with the 26 states — including Washington state — that challenged the law. It rejected the administration’s arguments that Congress could adopt the individual mandate under its powers under the Constitution to regulate interstate commerce or to tax. “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy and make them repurchase that insurance product every month for their entire lives,” the majority said in the opinion. The appeals court refused to strike down the rest of the law and it rejected the challenge by the states to the Medicaid provision.
September 28, 2011
The Obama administration, the 26 states and the group representing small independent businesses filed separate appeals with the Supreme Court. Government attorneys urged the high court to uphold the mandate as constitutional. They argued that Congress had adopted the law to address a crisis in the nation’s health care market, with millions of uninsured people shifting billions of dollars in costs to others. The states and the National Federation of Independent Business in their appeals argued that the mandate was unconstitutional and that the entire law must fall. The states also argued that Congress acted unconstitutionally by forcing them to expand their Medicaid programs or risk losing federal funding.
November 14, 2011 The Supreme Court announced it would hear the appeals, setting up an expected ruling by the end of June 2012. That would be in the heat of the campaign for the presidency, which culminates on November 6, 2012. The court could leave in place the entire law, it could strike down the individual insurance mandate or other provisions, it could invalidate the entire law or it could put off a ruling on the mandate until after it takes effect in 2014. A ruling striking down the law would be a huge political and legal defeat for Obama before an election when he will be seeking a second four-year term. A ruling upholding the law would be vindication, but might make health care an even bigger political issue for the Republican presidential candidates, all of whom oppose it and want to repeal it. March 26-28, 2012 The Supreme Court heard six hours of oral arguments over three days on the fate of the health care law. The court appeared sharply divided along ideological lines, with the five Republican-appointed conservatives doubting the law would survive and the four Democratic-appointed liberals offering a strong defense for the statute. June 28, 2012 The Supreme Court upheld the law against the legal challenges to the individual mandate and the requirement that states dramatically expand Medicaid in order to extend coverage to many previously uninsured people. By a 5-4 vote, the justices decided that the individual mandate “may reasonably be characterized as a tax” and that “the Constitution permits such a tax.” The court found that Congress exceeded its constitutional power by enacting the provision of the law that requires states to expand Medicaid. But the ruling said this problem is fully remedied by precluding the government from using that provision to withdraw existing Medicaid funds from states for failing to comply with terms of the expansion. The Supreme Court cases were National Federation of Independent Business v. Sebelius, No. 11-393; u.s. Department of Health and Human Services v. Florida, No. 11-398; and Florida v. Department of Health and Human Services, No. 11-400.