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Posted by on Mar 1, 2012 in Health care, Legal, Legislation

Re PPACA: 4 Issues To Be Examined by the 9

Re PPACA: 4 Issues To Be Examined by the 9

Constitution.jpgThis week’s NEJM offers a very nice we-are-here review of the status of PPACA (aka ObamaCare) and the Supremes’ anticipated review of the appellate case, Florida v HHS (which challenges the constitutionality of the law), on March 26th-28th. The 4 questions that the ultimate court will address in the ultimate appeal of this case, according to authors Curfman et al, are the following:

  1. Whether contesting the law is premature. In other words, can the legality of a tax (or penalty or whatever) for not buying health insurance be challenged before the tax is levied (in the case of PPACA, in 2014)?
  2. If the Supremes decide that a legal review is not premature (ripe?), does Congress have the authority to mandate the purchase of health insurance or levy a tax (or penalty or whatever) for not doing so? Evidently much of this decision rests on the interpretation of the Commerce Clause. A related concern is whether Congress can tax (penalize, whatever) US citizens for not buying a product from a private entity (eg, health insurance or, by extension according to one lower-court judge, a car or broccoli).
  3. If the mandate is unconstitutional, the Supremes must then decide if the mandate can be excised from the law or if the entirety of PPACA must be tossed.
  4. Last the Supremes must determine if PPACA’s expansion of Medicaid exceeds the authority of the federal government to regulate states’ voluntary operation of Medicaid programs. Curfman et al note that lower courts have considered this argument a non-starter, but the high court said it would consider it anyway.

Also the NEJM provides yet-another neato, interactive graphic of the case decisions to date.

  • 7 at the district court level (1 dismissed, 3 in which PPACA was upheld, 3 in which PPACA was unconstitutional).
  • 6 at the appellate court level (4 dismissed, 2 in which PPACA was upheld, 1 in which in which PPACA was unconstitutional)

The one appellate case in which PPACA was determined to be unconstitutional, Florida v HHS, is the case that will be considered by the Supremes later this month.

PPACA = Patient Protection and Affordable Care Act.

bmartin (1082 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.