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Affordable Care Act headed for Supreme Court

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WASHINGTON — Regardless of which way the Supreme Court rules next year on a challenge to President Obama’s health care overhaul, the decision is likely to have major implications for community pharmacies across the country.

The law — formally known as the Patient Protection and Affordable Care Act — is set to bring more than 30 million additional people into the ranks of the insured. Pharmacy operators say that a decision on whether the law is constitutional will give them a sense of finality and allow them to focus on gearing their businesses one way or another.

The Supreme Court agreed on November 14 to hear a challenge to the 2010 health care overhaul law. Oral arguments are expected to begin in March and the court is expected to rule in late June.

In agreeing to accept the case the Supreme Court said it will hear five and a half hours of arguments from lawyers on the constitutionality of the so-called individual mandate that is at the heart of the law and three other related questions about the act.

Under the individual mandate — which has been the subject of several lawsuits in lower courts over the past year — individuals would be required to buy health insurance starting in 2014 or pay a penalty.

The justices’ willingness to devote so much time to oral arguments is unprecedented.
The only time the court has allotted that much time was in 2003 for consideration of the McCain-Feingold campaign finance reform. That case consumed four hours of argument.
The arguments over the health care reform law are likely to spread over two days, as the justices rarely hear more than two or three hours a day.

Since the Affordable Care Act was passed in the spring of 2010, four appellate courts have ruled on challenges to the law.

Two of those courts upheld the law, one struck down the individual mandate, and one determined that it was premature to decide the law’s ­constitutionality.

The most recent of those rulings came early last month when a federal appeals court in Washington determined that Congress did not overstep its authority by including the insurance mandate in the law.

The opinion marked the second time an appeals court upheld the law on the merits. Earlier the federal appeals court in Cincinnati also upheld the law.

Another federal court, however, felt differently. In August the Court of Appeals for the 11th Circuit, based in Atlanta, struck down the individual mandate in a lawsuit brought by officials of 26 states. That court, though, upheld the rest of the law.

The case before the Supreme Court is an appeal of that ruling, in which a divided three-judge panel said the mandate overstepped congressional authority and violated the Constitution’s commerce clause.

While the Supreme Court’s ruling could decide the law’s fate, the justices left themselves an opening to defer a decision if they choose by requesting arguments on one lower court’s ruling that a decision must wait until 2015, when one of the law’s many deferred provisions takes effect.

Meanwhile, proponents of the health care reform measure and those who oppose it say they are confident that the high court will rule in their favor.

“We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree,” White House communications direct Dan Pfeiffer said in a statement.

On the other side, Senate Republican Leader Mitch McConnell of Kentucky called the law an “unprecedented and unconstitutional expansion of the federal government into the daily lives of every American.”

“In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same,” he said.

Legal scholars say the health care reform case could be the Supreme Court’s most significant and political ruling since its 5-4 decision in the Bush v. Gore case nearly 11 years ago secured George Bush’s 2000 presidential election victory.

In addition to deciding whether the law’s central mandate is constitutional, the justices will also determine whether the rest of the law can take effect even if that central mandate is held unconstitutional.

Health care reform opponents argue the entire law should be thrown out if the individual mandate falls.

The administration, however, says that even without the mandate, most of the law still could function. But they stress that requirements that insurers cover anyone and not set higher rates for people with pre-existing conditions are inextricably linked with the mandate and shouldn’t remain in place without it.

As part of its review of the health care law, the Supreme Court will also look at the expansion of the Medicaid program that will extend health insurance to hundreds of thousands of currently uninsured people.

Although no lower court has questioned the health care reform law’s provision that the Medicaid program be expanded, 26 states say the law goes too far in coercing them into participating by threatening a cutoff of federal money.


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