Supreme Court upholds Mandate

Hochul, Collins Discuss

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.

The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.

The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

"The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding," the dissenters said in a joint statement.

Republican campaign strategists said presidential candidate Mitt Romney will use the court's ruling to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.
 

Between 400 and 500 people will crowd into the marble courtroom, the only witnesses to a historic moment that will not be broadcast live on television or radio. Some of those hoping for seats already were in line early Wednesday afternoon.
 

EARLIER  COVERAGE:  New York Ready, But States Not United |  Is Debate About Politics? | Health Care Ruling Hangs Over Elections, Congress | Romney, Obama Ready For Ruling | On The WBEN Liveline & In Studio, In-Depth

A: That would settle the legal argument but not the political battle.

The clear winners if the law is upheld and allowed to take full effect would be uninsured people in the United States, estimated at more than 50 million.

Starting in 2014, most could get coverage through a mix of private insurance and Medicaid, a safety-net program. Republican-led states that have resisted creating health insurance markets under the law would have to scramble to comply, but the U.S. would get closer to other economically advanced countries that guarantee medical care for their citizens.

Republicans would keep trying to block the law. They hope to elect Mitt Romney as president, backed by a GOP House and Senate, and repeal the law, although their chances of outright repeal would seem to be diminished by the court's endorsement.

Obama would feel the glow of vindication for his hard-fought health overhaul, but it might not last long even if he's re-elected.

The nation still faces huge problems with health care costs, requiring major changes to Medicare that neither party has explained squarely to voters. Some backers of Obama's law acknowledge it was only a first installment: Get most people covered, then deal with the harder problem of costs.

Q: What happens if the court throws out only the expansion of the Medicaid program?

A: That would limit the law's impact severely because roughly half of the more than 30 million people expected to gain insurance under the law would get it through the expansion of Medicaid, the federal-state health insurance program for low-income people.

But a potentially sizable number of those low-income people still might be eligible for government-subsidized private insurance under other provisions. Private coverage is more expensive to subsidize than Medicaid.

States suing to overturn the federal law argue that the Medicaid expansion comes with so many strings attached it amounts to an unconstitutional power grab by Washington. The administration says the federal government will pay virtually all the cost and says the expansion is no different from ones that states have accepted in the past.

(CBS News) The Supreme Court this week will rule on the constitutionality of the Affordable Care Act, adding a new chapter to the debate over the health care overhaul. The court, however, isn't just going to vote up or down on the issue -- there are a number of questions it has to answer.

Here's a look at the questions before the court:

1. Can the court rule on the law's constitutionality, or does it have to wait until 2015?

Before it heard arguments over the health care law's constitutionality, the Supreme Court in March asked whether now is even the appropriate time to take up the case.

The 1867 Anti-Injunction Act bars most lawsuits challenging a tax that hasn't been paid. The individual mandate, which requires all Americans to purchase insurance, doesn't kick in until 2014, meaning no one has paid the fine (or "tax," as some may call it) for failing to purchase insurance -- thus, as the argument goes, the current case may be invalid.

If the court decides the Anti-Injunction Act applies to the health care law, the case could be argued in 2015, once someone has actually paid a fine.

Most parties watching the case, however -- and even Mr. Obama's Justice Department -- believe that the Anti-Injunction Act doesn't apply here. "It's pretty much a slam dunk they're going to hear the case," Robert Alt, senior legal fellow at the conservative Heritage Foundation, told Hotsheet in March.

Watch CBS News political director John Dickerson's Reporters Roundtable's discussion on President Obama's health care law and the Supreme Court.

2. Is the mandate constitutional?

If the court decides it can rule on the case now, the primary question is whether the individual mandate is constitutional, or whether the government oversteps its authority by compelling every person to either get insurance or pay a fine.

As many as 28 states filed lawsuits calling the mandate unconstitutional, and one federal appellate court agreed with that assessment. Two other federal appellate courts have upheld the law.

This question strikes at the heart of the opposition to Mr. Obama's reforms: Most Americans disapprove of the mandate, according to CBS News/New York Times polling, and seven in 10 want the entire law or at least the mandate overturned.

3. If the mandate is unconstitutional, can other parts of the law survive without it?

Question No. 2 also happens to strike at the "heart" of the law itself, as some, like Justice Antonin Scalia, have called the mandate. If the court strikes down the mandate, it will have to decide whether other parts can survive without it -- and if so, which parts.

During the March hearings, Scalia suggested he was inclined to just throw out the whole law. "My approach would say if you take the heart out of the statute, the statute's gone," he said.

After winning the White House, President Obama told Congress a mandate was an essential part of improving the nation's health care system. The administration argued to the Supreme Court that without the mandate, two other provisions -- "guaranteed issue" and "community rating" -- won't work and should be thrown out.

Guaranteed issue, which is nearly twice as popular among the public than the individual mandate, requires health insurers to cover everyone who applies for coverage, regardless of pre-existing conditions. Community rating requires insurers to offer plans within the same price range to all customers, regardless of factors like age.

Many health care experts argue that without the mandate, health care costs would spiral out of control, but the true impact of keeping the rest of the law in place without the mandate is up for debate.

4. Is the expansion of Medicaid constitutional?

In addition to the individual mandate, the Supreme Court is considering the constitutionality of a provision from the Affordable Care Act that would greatly expand Medicaid.

Currently, Medicaid is a joint federal-state program that provides health care to certain poor Americans, such as children and the elderly. In 2014, the Affordable Care Act opens up Medicaid to anyone with an income under 138 percent of the federal poverty line.

The federal government is expected to pay for the vast majority of the Medicaid expansion, but 26 states argued that paying their portion of the expansion will be an unfair burden. If a state chose not to expand the program as the law requires, it would have to opt out of Medicaid completely -- something no state could afford to do.