Supreme Court Arguments Relative to the Legal merits of the Affordable Care Act

On Monday, March 26, 2012, the United Church of Christ joined other ecumenical and interfaith organizations in solidarity at the steps of the United States Supreme Court to pray and call on the Supreme Court to act with moral conviction on behalf of the common good as they hear arguments relative to health care for all.

“For decades, faith communities have worked both individually and collectively to move our nation toward a more inclusive and just system of health care—with particular focus on the poor and vulnerable. They all agree that it is the calling of government to bring justice and protection to the poor and the sick, a goal that is consistent with the U.S. Constitution.”  (Click here to read the entire Amicus Brief.)

The prayerful witness was convened by Faithful Reform in HealthCare – the largest coalition of faith and interfaith organizations working collectively on health care reform and WISC-HC the Washington Interreligious staff Community on Health Care.  These two coalitions have worked together for decades to lift up the moral imperative of health care and to work on policies and resources that reflect these beliefs and values. (Click here to read the Interfaith Statement of Principles:  Protecting Medicaid and Medicare.)

For three days, the Supreme Court heard arguments for and against the legality of the health care law.  The central controversy of the law centered on whether the entire law would be overturned if the individual mandate – the requirement that almost all Americans either buy health care insurance or pay a penalty is ruled unconstitutional.  Because of ideological differences among Democrats, Republicans and the Supreme Court Justices, many have speculated that this seems likely. Recent summaries by several national news media have speculated on the outcomes that the Supreme Court Justices might decide. These speculations include:

1) Individual mandate and insurance reforms overturned;

2) Individual mandate overturned – other pieces remain intact;

3) Entire law is overturned;

4) Health Care Law remains as is

 If the Affordable Care Act (ACA) is overturned, some sort of healthcare reform must still be enacted, like Medicare for all. According to one summary a bigger impact may be the damage to the US political system and citizen trust in Congress, the Presidency, and Supreme Court.

In this same summary, a specific insight regarding elderly health care is provided by Forbes: What might happen to senior care if the Court concludes the mandate is unconstitutional?

  • Medicaid benefits for long-term care services–already facing major cuts–would be at even greater risk.
  • Several new home and community-based care programs would die with the law.
  • The “donut hole” for seniors participating in the Medicare Part D drug benefit program would remain, and the ACA’s prescription assistance would go away.
  • The small increase in payroll taxes aimed at increasing revenues for Medicare would not occur, placing even greater financial pressure on that popular program.
  • Important incentives to encourage hospitals, nursing homes, doctors, and other providers to work together to improve care for people with chronic disease would disappear.

The United Church of Christ, a founding member of Faithful Reform in Health Care, participated in the prayerful witness as it continues to speak prophetically that health care for everyone in this country.  Jesus asked, which of these three do you think was a neighbor to the man who fell into the hands of the robbers?  He said, “The one who showed him mercy.”  Jesus said to him, “Go and do likewise.”  Luke 10:36-37. This familiar story of the Good Samaritan in Luke’s Gospel makes a clear case for heath care for all.  Jesus reminds us of what it means to love our neighbor; it means we stop and assist in a caring manner that nurtures the neighbor back to health and wholeness.  Persons in need are not to be passed by, nor are they to be left abandoned and ignored by the side of the road.  Those who would be caring neighbors cannot rest until proper care and services have been obtained for the ones in need.

The United Church of Christ believes that the Affordable Care Act is a huge step in the right direction to providing much needed health care for millions who continue to live their lives without it and in fear that one catastrophic illness would plunge them into deep financial ruin.  We participated in the prayerful witness because we believe that the law itself and the expansion of Medicaid included in the Affordable Care Act both speak to the moral and justice imperatives of equal access for all.   

 Background: How Did We Get Here?

In 2009, the United Church of Christ joined other mainline denominations, faith and interfaith organizations, health and secular organizations in mounting one of the most intentional and assertive campaigns proclaiming health care for all as a moral imperative and calling for the President of the United States and Congress to pass health care reform. 

As we approach the 2nd anniversary of the Affordable Care Act (ACA) a coalition of faith leaders working under the umbrella of Faithful Reform in Health Care and the Washington Interreligious Staff Community on Health Care are galvanizing again in preparation of the upcoming Supreme Court Hearings.

Collectively, various faith communities have risen to this challenge by enlisting the assistance of a top health care law firm in the country and a Professor of Law at Washington and Lee School of Law to submit an Amicus Brief on behalf of various faith communities in Support of the Government’s position on Medicaid in the Affordable Care Act. Click here to read the entire Amicus Brief.

The General Synod of the United Church of Christ has become a friend of the court to support the Medicaid Expansions and Improvements in the Affordable Care Act.  The signing of the Amicus Brief was done by Don Clark, Nationwide Special Counsel for the United Church of Christ.  The decision was authorized by Rev. Geoffrey Black, General Minister and President and Rev. Penny Lowes, Chair of the Executive Council of the United Church of Christ.

A broad contingency of faith leaders are supporting this brief from a moral perspective, as many faith communities already support assisting the poor and vulnerable with health care access.  The brief does not include any language about states participating in the Medicaid Expansion one way or another.  However, we are aware that if the Supreme Court rules in favor of the states on this issue, it will undue what we (the faith community) have worked hard to support.  Therefore, Medicaid Expansion is a crucial issue that the collective faith coalition can mobilize behind

The brief was not written in support of the severability because of the extensive legal language involved.  Further, it was not written to support or not to support the Individual Responsibility clause because in the past there has not been consensus in the faith community on this issue and some faith partners have never addressed this issue.  Although the faith coalition did take a collective stance that health care is a basic human right and a human need, it did not take a collective stance on how to make health care for all happen.  Since the law as passed, many members of the faith community now believe that the provisions in the ACA will make it possible for many to buy affordable health insurance.

Click here to read the Interfaith Statement of Principles:  Protecting Medicaid and Medicare.

The following information is from the Families USA document Talking about the Affordable Care Act and the Supreme Court. Click here to download this entire document.

From March 26 to 28, 2012 the United States will hear arguments in challenge to the Affordable Care Act.   These three days of argument will attract substantial media attention.  No case has been allotted this much time for argument since the 19th century.  The far-reaching consequences of the court’s ruling will likely impact the cost of health care.

Since the Affordable Care Act (ACA) was enacted in March 2010, dozens of legal cases have been filed against the law.  Most cases have been dismissed on procedural grounds.  However, in the Eleventh Circuit, in a case brought by the attorneys general of 26 states and the National Federation of Independent Businesses, the court found the individual responsibility provision to be unconstitutional.  However, that court left the rest of the law in place and specifically found the Medicaid Expansion unconstitutional. 

The Federal government has appealed the decision striking down the individual responsibility provision.  The states and National Federation of Independent Businesses has appealed the parts of the decision that upheld the Medicaid Expansion and that left the rest of the law in place. 

 Questions that the Supreme Court Will Answer

The Supreme Court has divided the case into four separate questions:

  1. Is the challenge to the individual responsibility provision premature under the Anti-Injunction Act, which prohibits challenging a tax prior to that tax being imposed?
  2. Is the individual responsibility provision constitutional?
  3. If the individual responsibility provision is unconstitutional, what other parts of the law, if any, must also be struck down (referred to as “severability”)?
  4. Is the Affordable Care Act’s expansion of Medicaid constitutional?
 Key Points

1. Striking down the Affordable Care Act would take away protections that Americans already have or about to gain, including:

  • Rules prohibiting insurers from denying coverage to people, including children, with pre-existing conditions.
  • Tax credits that are helping small businesses provide coverage to their employees.
  • Rules prohibiting insurers from canceling coverage when people get sick.
  • Rules prohibiting insurers from dropping young adults from their parents’ coverage.
  • Rules prohibiting insurers from imposing annual or lifetime caps on coverage.
  • Improved prescription drug coverage and preventive benefits for seniors and people with disabilities who rely on Medicare.

2. The Law is constitutional. 

It has been upheld by multiple courts, including by leading conservative judges.  If the Supreme Court follows existing precedent, it will uphold the law.

3. The Law is fair. 

The individual responsibility provision is a common-sense rule that will ultimately affect about 1 percent of Americans. 

  • 83 percent of Americans who already have health insurance (for example, through their jobs or through Medicare) will not be affected by the rule.
  • The ACA makes coverage affordable and eliminates exclusions for pre-existing conditions.  When people with pre-existing conditions finally get coverage they need, they will not be subject to the penalty.
  • It is estimated that, at most, 1 percent of the population will refuse to buy coverage and will not qualify for an exemption (for example, for religious reasons or economic hardship).  These people should pay their fair share and get coverage before they get sick; waiting until they get sick to get coverage will shift the cost of their care onto everyone else.

4. The expansion of Medicaid in the Affordable Care Act is constitutional – and it’s good policy.
Medicaid is a federal-state partnership that has been expanded many times in its history.  No court has ever rejected an expansion of Medicaid.

  • The Affordable Care Act’s Medicaid expansion was upheld by the eleventh Circuit of Appeals, even when the same court struck down the individual responsibility provision.
  • Medicaid is an efficient, cost-effective way to provide health insurance to low-income Americans.
  • States are responsible for, at most, less than 10 percent of the cost of the Affordable Care Act’s expansion of Medicaid.

5. We’ve seen challenges like this before.

    As with past legislation, the more people experience the benefits of the new law, the more they like it.

    • All big changes generate opposition.  The Social Security Act in the 1930s and Medicare and the Civil Rights Act in the 1960s were bitterly attacked at the time they were passed. They were even declared unconstitutional by lower courts before the Supreme Court upheld them.
    • People like the consumer protections in the law.  They do not want to give up the vital protections that the ACA provides them and go back to being at the mercy of insurance companies.

    More information on the Supreme Court Hearings.

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    CONTACT INFO

    Ms. Barbara T. Baylor
    Policy Advocate for Health and Wholeness Issues
    100 Maryland Avenue, NE
    Suite 300
    Washington, District of Columbia 20002
    202-543-1517
    baylorb@ucc.org