High Noon for Health Care

At the heart of the legal showdown over the Affordable Care Act are questions of governmental power: How broad is Congress’s authority to regulate interstate commerce, and does it extend to an individual’s health care choices and the private insurance market? Can Washington unilaterally double the size of Medicaid, which is funded partly by the U.S. Treasury but run by the states? On the line, in the middle of an election year, is the President’s key domestic-policy achievement. The Supreme Court proceedings begin March 26 and will last three days. A ruling is expected in late June.

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Differing Opinions

The Justices have been split over Congress’s power to regulate commerce, the key issue in the health care case

Less power

Chief Justice John Roberts

Samuel Alito

Antonin Scalia

Clarence Thomas

Anthony Kennedy

More power

Elena Kagan

Ruth Bader Ginsburg

Stephen Breyer

Sonia Sotomayor

The Challengers

Republican attorneys general and governors from 26 states plus a trade group representing small businesses

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The Politics

The President asked for an expedited review of health care reform, thinking he’d win, but an election-year court rejection could backfire on his campaign

What the Court Might Do

Uphold the Law

The court could find that the entire Affordable Care Act is constitutional, with centrist Justice Anthony Kennedy and possibly some conservatives joining the court’s liberal wing to hold that the government has the power to force Americans to buy health insurance. The court could also uphold the law if it decides that the fine imposed on Americans who don’t buy insurance is technically a tax and therefore within the government’s unquestioned power to raise revenue.

Toss All of It

The court’s conservative wing could find that the entire reform law is unconstitutional, negating the signature domestic initiative of Barack Obama’s presidency.

Toss Part of It

The Justices could rule that only parts of the law, such as the requirement that all Americans have insurance by 2014 or the government’s huge expansion of Medicaid, are unconstitutional. This could leave the rest of the law in place but make reform prohibitively costly.

Punt

The court could decide that it is too soon to rule on a law that won’t be fully in place until 2014. But whether there will be five votes to postpone a decision after months of preparation, briefing and anticipation remains uncertain.

Can They Make You Pay?

Over the past 70 years, the Supreme Court has found that Congress has extremely broad but not limitless powers to regulate your economic life under the Constitution’s commerce clause.

WICKARD V. FILBURN

A unanimous 1942 decision held that the government could penalize even the most private economic behavior. The court ruled that an Ohio farmer had to pay a penalty for growing wheat for his own use because not buying on the open market could affect grain prices nationwide.

GONZALES V. RAICH

A 2005 decision held that the feds could prohibit home-grown medical marijuana, overruling state law. Justice Antonin Scalia wrote as part of a 6-3 majority that Congress needed the expansive power to ensure that its regulation of drugs nationally wasn’t undermined by California’s permissive dope laws.

U.S. V. MORRISON

But Congress can’t control every aspect of American life through its power over the economy. In 2000, Scalia and Justice Anthony Kennedy sided with then Chief Justice William Rehnquist in ruling that the Violence Against Women Act went too far in allowing rape victims to sue for civil damages in federal court. Doing so could usurp state powers and “create a completely centralized government,” Rehnquist argued.

6 Number of hours of oral arguments scheduled for the health care law, the most for any case in more than 40 years