US Supreme Court hears challenge to Obama healthcare law


Rival demonstrators at the Supreme Court made their voices heard as the arguments began.

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The US Supreme Court has finished the first day of a landmark hearing on the constitutionality of President Barack Obama's signature healthcare reform.

Twenty-six US states are challenging the 2010 law, which greatly expands access to health insurance but is called unconstitutional by critics.

They say the requirement to buy insurance intrudes on civil liberties.

The court will hear three days of argument, with a ruling expected during June - in the thick of election season.

Monday's hearing focused on whether the judges actually had the power to rule on the case.

The justices spent 90 minutes actively questioning lawyers about an obscure 19th-century piece of legislation - the 1867 Anti-Injunction Act - which bars legal challenges to any tax that has not yet been collected.

Supreme Court schedule

  • Monday: Can the court legally hear the case?
  • Tuesday: Is the requirement to purchase health insurance legal?
  • Wednesday: Could the rest of the law survive with the requirement struck down?
  • Wednesday: Is the expansion of Medicaid constitutional?

The healthcare act requires most people to buy health insurance or pay a penalty. If the justices define that penalty as a tax, they could rule that the Anti-Injunction Act prevents the Supreme Court from making a ruling on the matter at this point in time.

The Washington DC court, which holds about 400 people, was packed with lawmakers, senior Obama administration officials and members of the public on Monday.

People had been camping outside the white marble building since Friday.

Controversial mandate

The nine Supreme Court justices, five of them appointed by Republican presidents and four by Democrats, have allotted six hours of argument - the longest in decades - for the case.

The court's proceedings are not televised, but daily audio recordings and transcripts are being made available.


It's been almost exactly two years since President Obama signed the Affordable Care Act into law. But if anyone thought the titanic struggle that accompanied its passage through Congress would end with a stroke of the president's pen, they were sorely mistaken.

Even as the law's early provisions have come into effect - to general approbation - the overall law remains profoundly contentious. It's become a poster child for everything Republicans say is wrong about Barack Obama's style of government.

Opponents of the act have managed to frame the debate over "Obamacare" (they also changed its name) into one about constitutional fidelity, religious freedom and the size of government.

The law's actual purpose - to extend insurance coverage and put an end to discrimination based on pre-existing conditions or ability to pay - sometimes seem to have been forgotten.

From the start, it was almost inevitable that the bill - and specifically the individual mandate - would end up being litigated before the Supreme Court. What the nine justices conclude, a few months before a presidential election in which healthcare remains a hot topic, could have an enormous impact.

It is one of the most politically explosive cases since the 2000 election wrangle that saw the White House awarded to Republican George W Bush over Democrat Al Gore, or the hearings on the 1974 Watergate tapes that led to President Richard Nixon's resignation.

The Patient Protection and Affordable Care Act, passed in March 2010, has been the divisive centrepiece of President Obama's term in office.

If upheld, the law would forbid insurance companies from denying coverage because of pre-existing medical conditions. It would also limit how much they can charge older people.

But the most controversial aspect of the law is its core requirement that most people buy health insurance or pay a tax penalty.

The healthcare law's insurance mandate does not begin until 2014, and those who flout the requirement to have insurance would not face a penalty until the following year.

Monday's hearing focused on whether the terms of the Anti-Injunction Act could mean the Supreme Court is currently barred from ruling on it.

Neither the government nor the challengers believe the 1896 law is applicable in this case, and the court appointed another lawyer to argue that case on Monday.

Several judges cast doubt on whether such a fine would constitute a tax - which correspondents saw as an indication that the court would not postpone the case.

Justice Stephen Breyer said that the fact the penalty would be "collected in the same manner of a tax doesn't automatically mean it's a tax, particularly since the purpose of the Anti-Injunction Act is to prevent interference with the revenue stream".

Justice Antonin Scalia seemed to agree, saying the court should rule on the matter unless there was a clear argument not to. "I find it hard to think this is clear, whatever else it is," he said.

The broccoli question

The most eagerly anticipated day is Tuesday, when the judges will hear arguments on the constitutionality of the individual insurance requirement.

Republican Rick Santorum: "This is the most important issue in this election"

The 26 states led by Florida say the federal government has no power to force individuals to buy health insurance.

Critics say that if Congress can require citizens to buy health insurance, it could also force consumers to eat broccoli, purchase gym membership or buy American-made cars.

However, the Obama administration says Americans who have no healthcare simply push their unpaid health bills upon taxpayers, who are forced to subsidise emergency room visits.

On Wednesday, two questions will be heard.

The first is whether, if the individual mandate is declared unconstitutional, the rest of the law can stand or must be struck down in its entirety.

The other is whether Congress unfairly burdened states when it expanded eligibility under Medicaid, the medical care programme for poor people.

A ruling on the intensely partisan issue is expected only several months before November's general election.

The US was the only major developed country without a national healthcare system until President Obama's reform.

An opinion poll published on Monday found that 47% of voters disapproved of the healthcare law and 36% were in favour.

Republicans seeking to foil President Obama's bid for a second term have vowed to repeal it if elected.

Mitt Romney, who is the front-runner to be this year's Republican presidential candidate, called the law an "unfolding disaster for the American economy".

His rival, Rick Santorum, appeared outside the court after Monday's hearing to say that "Obamacare" should be the central issue of the forthcoming election campaign.

Who's uninsured? Health insurance rates across the US
Health insurance map

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  • rate this

    Comment number 138.

    donruth123 - The ignorant has spoken - and people look at the US and shake their head.

  • rate this

    Comment number 137.

    It is everyone's personal responsibility to ensure their own health . . by eating well . . not smoking [etc; etc;]

    Well, youre right, to a point. However, when you & mother nature aint getting along some unfortunate day, despite living life like a saint (some may say martyr!), whistle dixie if you aint got the bucks to pay. Good luck to you!

  • rate this

    Comment number 136.

    the americans are a funny lot as a percentage of gdp they spend 16% on health care the uk about 8.4. now bear in mind in the uk our 8.4% is spent on everyone in the us on its mainly on those with insurance but a lot of americans see the word 'social care' and see socialist. i'm just glad i live in the uk.

  • rate this

    Comment number 135.

    A lot of the comments here don't hold water.
    1. To the poster asserting that most Americans probably have healthcare, which their employer provides: Wrong. Healthcare through an employer is not "provided to you". The employee is on his own to enroll in and pay for his own insurance. The employer only facilitates a group rate.

  • rate this

    Comment number 134.

    As Americans, we don't generally make distinctions between goods (cars) and services (healthcare). If you have more money, you can have more goods and services. Ideally, this encourages everyone to work harder (more money, goods, services). As a country, we don't give away what we could otherwise sell. A free market economy is like 'survival of the fittest'. The product is irrelevant. Capitalism.

  • rate this

    Comment number 133.

    The real problems with the bill are that it's loaded with hidden agendas that are not in the best interests of the people.

  • rate this

    Comment number 132.

    Any UK residents reading this take note. I've worked in the US healthcare system and seen people turned away even WITH insurance! Theres insurance and there is "INSURANCE", gedit? If you dont, your a very mad person. Hundreds of pounds a month, just to keep you out of the crapper. NHS is one socialist ideology I am perfectly comfortable with, thank you very much.

  • rate this

    Comment number 131.

    they'll do a load of probably unnecessary tests, procedures and checkups with you, charge you about $2000 for it, and not tell you the price until afterwards. It's a business after all, businesses are run for profit."
    It's aggravating & costly, but generally more for insurance reasons, not so much for profit.

  • rate this

    Comment number 130.

    As an expat Brit, I find US healthcare high quality but shockingly expensive. The UK has much to teach the US in terms of civilized treatment of its citizens (if one accepts - as I do - that basic healthcare is a public good, like street lighting).

    In my view Obamacare is insufficient - it merely tinkers with the existing insurance system: a true system that is free at point of use is needed.

  • rate this

    Comment number 129.

    It is everyone's personal responsibility to ensure their own health to the best of their abilities. This means exercising daily (free), eating well (cheap), and not smoking. We all need care sometimes but can mitigate most routine needs.

    The fact that I don't feel like I should have to pay for everyone else's lack of personal responsibility apparently makes me a jerk to the rest of the world!

  • rate this

    Comment number 128.

    There is nothing unconstitutional about healthcare reform. Remember at one point people thought slaver was constitutional. Time to evolve with the times. I would gladly pay more tax if it meant that we could get a system like the NHS. Those of us who are insured pay high monthly premiums,copays and still wait as long as, if not longer for services than I ever did in the U.K., Spain, or France.

  • rate this

    Comment number 127.

    I have lived in the US for 15 years and in that time I have paid $100,000 in health insurance - I have used maybe $8000 - seems to me that if this $100,000 went into a fund - it would have benefited others - Yes I am al for socialized medicine.

    Wake up America - there are third world countries that have better medical coverage than US citizens.

  • rate this

    Comment number 126.

    How long has the UK had the NHS? Since 1948? Seems like if it was so terrible your citizens would have managed to get rid of it in the last 64 years. We had a false start on universal health care over here in the U.S. with Medicaid (signed into law by a Republican by the way) and this new law isn't quite the final answer, but we're getting closer to matching the rest of the civilized world.

  • rate this

    Comment number 125.

    I am furious that these morons are using MY tax dollars (Florida) to challenge these reforms, which bring a modicum of fairness to the insurance-industry-controlled U.S. healthcare system. "Socialized" medicine (ie single-payor system) has been argued about here for 75+ years, and we are finally moving in the sensible direction that the rest of the world has been headed for a century.

  • rate this

    Comment number 124.

    I would rather live in a free country with 95% of the people uninsured than a socialist dump like the UK where everyone is insured. Not because I don't care about sick people, but because I care more about my rights as a free man.

    Do you refuse to use any other government socialist services such as the highways, airports, water treatment as well?

  • rate this

    Comment number 123.

    Like my mom use to say: "Not even love is free today" Everything is money, money, money, and I wonder why people loose their precious time analyzing or trying to explain themselves such huge scam using ethical analogy. Today Health Care it is not about heath care, it is solely about easy, BIG money, like all other easy targets, pharma, food, etc. It is not only in the US, but it is pandemic.

  • rate this

    Comment number 122.

    Simple math.
    (Insurance Companies X Exhorbitant profit) / Expert Capitol Lobbyists =
    Screwed average citizen.

  • rate this

    Comment number 121.

    There is so much stupidity on this healthcare issue. In this so called land of the free, it is a no brainer that everyone should be entitled to healthcare - either one buys insurance or if cannot, the state should step in. Because that society is riddled with so much selfishness, greed and egoism, it is no surprise that such a simple concept may look like sci-fi to some over there. Shame America.

  • rate this

    Comment number 120.

    Surely in the land of the free, ensuring access for the weakest and most vulnerable is a top priority?"
    The Medicaid program is free &has been available for some time to those you describe.Free or income based payment insurance is also available on a state level to all lower income children.Thanks for asking.

  • rate this

    Comment number 119.

    It takes an educated populace to have a well functioning democracy. Healthcare for all in the US? No chance.


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