Justices Moving to Heart of Health Care Overhaul

By: Mark Sherman, Associated Press
By: Mark Sherman, Associated Press

Washington, D.C. (AP) - As demonstrations swirled outside, Supreme Court justices signaled on Monday they are ready to confront without delay the keep-or-kill questions at the heart of challenges to President Barack Obama's historic health care overhaul. Virtually every American will be affected by the outcome, due this summer in the heat of the election campaign.

On the first of three days of arguments - the longest in decades - none of the justices appeared to embrace the contention that it was too soon for a decision.

Outside the packed courtroom, marching and singing demonstrators on both sides - including doctors in white coats, a Republican presidential candidate and even a brass quartet - voiced their eagerness for the court to either uphold or throw out the largest expansion in the nation's social safety net since Medicare was enacted in 1965.

Tuesday's arguments will focus on the heart of the case, the provision that aims to extend medical insurance to 30 million more Americans by requiring everyone to carry insurance or pay a penalty.

A decision is expected by late June as Obama fights for re-election. All of his Republican challengers oppose the law and promise its repeal if the high court hasn't struck it down in the meantime.

On Monday, the justices took on the question of whether an obscure tax law could derail the case.

Audio of the day's argument can be found at: http://bit.ly/GSXEpf .

The 19th century law bars tax disputes from being heard in the courts before the taxes have been paid.

Under the new health care law, Americans who don't purchase health insurance would have to report that omission on their tax returns for 2014 and would pay a penalty along with federal income tax on returns due by April 2015. Among the issues facing the court is whether that penalty is a tax.

Solicitor General Donald Verrilli Jr., defending the health law, urged the court to focus on what he called "the issues of great moment" at the heart of the case. The 26 states and a small business group challenging the law also want the court to go ahead and decide on its constitutionality without delay.

But one lower court that heard the case, the federal appeals court in Richmond, Va., has said the challenge is premature. No justice seemed likely to buy that argument Monday.

The justices fired two dozen questions in less than a half hour at Washington attorney Robert Long, who was defending the appeals court ruling.

"What is the parade of horribles?" asked Justice Sonia Sotomayor, if the court were to decide the penalties were not a tax and the health care case went forward? Long suggested that could encourage more challenges to the long-standing system in which the general rule is that taxpayers must pay a disputed tax before they can go to court.

The questions came so quickly at times that the justices interrupted each other. At one point, Justices Ruth Bader Ginsburg, Elena Kagan and Sotomayor started speaking at the same time. Chief Justice John Roberts, acting as traffic cop, signaled Ginsburg to go first, perhaps in a nod to her seniority. Only Justice Clarence Thomas, as is his custom, stayed out of the fray.

Verrilli also faced pointed questioning over the administration's differing explanations for whether the penalty is a tax.

"General Verrilli, today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax," Justice Samuel Alito said.

Verrilli said Monday's argument dealt with the meaning of the word in the context of the 19th century law, the Anti-Injunction Act. Tuesday's session will explore Congress' power to impose the insurance requirement and penalty. In that setting, he said, Congress has the authority under the Constitution "to lay and collect taxes," including the penalty for not having insurance.

Still, he had trouble keeping his terms straight. Answering a question from Kagan, Verrilli said, "If they pay the tax, then they are in compliance with the law."

Justice Stephen Breyer jumped in: "Why do you keep saying tax?" Breyer reminded Verrilli he should be saying penalty.

"Right. That's right," Verrilli said.

The administration officials involved with the defense and implementation of the health care law, Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius, were in the courtroom Monday. Republican Sen. Jeff Sessions of Alabama and Florida Attorney General Pam Bondi also were in the crowd that filled the courtroom's 400 seats.

Outside the court building, about 100 supporters of the law walked in a circle holding signs that read, "Protect my healthcare," and chanting, "Care for you, care for me, care for every family." A half-dozen opponents shouted, "We love the Constitution!"

Republican presidential candidate Rick Santorum was there, too, declaring anew that GOP front-runner Mitt Romney has no standing to challenge Obama on the law since Massachusetts passed a somewhat similar version when Romney was governor. Santorum said, "If you really want Obamacare repealed there's only one person who can make that happen."

Said Romney, on CNN, "If I'm elected president I will repeal Obamacare. And I will stop it in its tracks on Day One. I believe it's unconstitutional. I believe the court will find it unconstitutional."

A four-person student band from Howard University was part of the group favoring the law, playing New Orleans-style jazz tunes.

People hoping for a glimpse of the action had waited in line all weekend for the relatively few seats open to the public. The justices allotted the case six hours of argument time, the most since the mid-1960s.

The justices also will take up whether the rest of the law can remain in place if the insurance mandate falls and, separately, whether Congress lacked the power to expand the Medicaid program to cover 15 million low-income people who currently earn too much to qualify.

If upheld, the law will force dramatic changes in the way insurance companies do business, including forbidding them from denying coverage due to pre-existing medical conditions and limiting how much they can charge older people.

The law envisions that insurers will be able to accommodate older and sicker people without facing financial ruin because of its most disputed element, the requirement that Americans have insurance or pay a penalty.

By 2019, about 95 percent of the country will have health insurance if the law is allowed to take full effect, the Congressional Budget Office estimates.

Polls have consistently shown the public is at best ambivalent about the benefits of the health care law, and that a majority of Americans believe the insurance requirement is unconstitutional.


Associated Press writers Pete Yost, Jesse Holland and Jessica Gresko contributed to this report.

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  • by P. Footlocke on Apr 1, 2012 at 08:38 AM
    Once Obamacare is struck down let's really provoke change. The problem is the uninsured showing up at hospitals, receiving care and not paying. Another biggie is the cost to keep those on Medicare alive in their last 90 days of life. And let's not forget the big consumers - children with disabilitites sucking up Medicaid dollars. To really make a change in healthcare - and true reform - would be to allow hospitals to refuse treatment of anyone without a means to pay. Had a heart attack? Easy, you must have an insurance card on your person in order to receive treatment by EMS and be taken to a hospital. Those without any type of coverage will have to come to the hospital with cash and pay on a day to day basis. (That's the way it's done in some 3rd world countries.) Then let's put caps on both Medicare and Medicaid to not exceed one million dollars in a lifetime. This will lower costs and make people really think before they have children. Can they afford a sick child? Do they lose their coverage if they have a disabled child and choose to stay home and care for this child? And all of those older folks that want "everything done" no matter cost to taxpayers can be provided comfort only in their last days- let's approach healthcare reasonably!
  • by Anonymous on Mar 27, 2012 at 10:35 AM
    if a state can force you to buy car insurance then why can you not be forced to buy health insurance. Which is more important your health or your car?
    • reply
      by GV on Mar 27, 2012 at 11:12 AM in reply to
      Well to start with,the state does not force anyone to but auto insurance.Do you think that the thousands of people in Florida that rely on public transportaion have to but auto insurance?Could you see the uproar if someone tried to pass a law that said everyone must buy insurance.So why do you puppets keep using that anallogy when it is just not true?And on top of that,it's not the state the is mandating that everyone have health insurance.Are you a troll or just ignorant?
    • reply
      by Anonymous on Mar 27, 2012 at 12:44 PM in reply to
      Name 1 State that forces every citizen(even children) to have auto insurance?
      • reply
        by p. footlocke on Apr 1, 2012 at 07:48 AM in reply to
        Good point. But every child riding in a car is riding in a car with insurance...
    • reply
      by Anonymous on Mar 27, 2012 at 06:44 PM in reply to
      What GV said. Plus, state governments can do many things that the federal government cannot. The federal government is much more limited in what powers it has, than the states, who have much broader powers, their own constitutions, etc.
  • by Will Location: Tallahassee on Mar 27, 2012 at 09:08 AM
    Some who submit comments on this subject must be content with ignorance. Just do a search on "health care reform bill details" and you will find a very informative, short article, "Health Care Reform Bill Summary: A Look At What's in the Bill" by Capitol Hill Producers Jill Jackson and John Nolen of CBS News.
  • by Mother of Children Location: Florida on Mar 27, 2012 at 06:26 AM
    All Americans should have the right to basic healthcare when sick or injured. As I am Christian, I am offended by those who suggest the sick without health insurance should die. The poor and uninsured already use hospitals ER to supply healthcare when sick and we pay an extremely higher rate to compensate this lack of independant coverage for the unisured. The point of healthcare reform is to control these cost while providing care to sick Americans. Private healthcare providers do not want reform because it is more profitable for them to have no reforms. It is time that some one, anyone stood up for the healthcare needs of the American people. The big fuss is over how to spend the hugh amounts of entitlement dollars Medicare and Medicaid. The fact is that we could save more money by providing more cost effective care and enforcement of laws that address vendor and service provider fraud. By the way vendor and service provider fraud accounts for ten times the amount of client fraud. No one tells the public this but think about our governor's pass reputation. But republicans who screamed foul when the Clintons purposed employer paid health insurance mandate in the 90's and offered a personal mandate. These same party supporters of personal mandate are now on the steps of the Supreme Court screaming foul over personal mandate. Go figure who will benefit from healthcare reform the most? One answer is American citizens who will be able to go to the doctor when they are sick. The other answer is insurance companies and political campaign contributors. The most important question is which side do you think the court is on in majority? You the human citizens or corporation humans?
    • reply
      by Father of Children on Mar 27, 2012 at 09:56 AM in reply to Mother of Children
      Obamacare is a joke. It will not do what is advertised by the administration. The only people that will benefit from it are those not paying income tax. Those that pay income tax will foot most of the bill. Those that are fortunate enough to sell their home will pay a tax based on the sale price to support Obamacare. Those that receive a stock dividend will pay an additional tax to help fund Obamacare. Those who have a medicare Advantage Plan will see the turmoil caused by a $500,000,000,000 reduction in funding. Good thing that just corporation will suffer. It's great to be king.
    • reply
      by What??? on Mar 27, 2012 at 10:12 AM in reply to Mother of Children
      Everyone in America does have a right to healthcare and that is why we have excellent Doctors and hospitals when we or our family members are sick. The question is a mandate by the Government to require us to purchase health insurance. Of course not one person has said sick people should die and that is a ridiculous inflammatory statement. We already have medicare for your children if you or their father cannot afford to pay for their healthcare when they are sick.
      • reply
        by p.footlocke on Apr 1, 2012 at 07:44 AM in reply to What???
        "We already have medicare for your children if you or their father cannot afford to pay for their healthcare when they are sick." Medicare for children? Now who doesn't have their facts straight???
    • reply
      by Anonymous on Mar 27, 2012 at 12:49 PM in reply to Mother of Children
      Americans have the right to bear arms, but that doesn't mean the Government has the authority to force every American to purchase a gun.
    • reply
      by Anonymous on Mar 27, 2012 at 07:05 PM in reply to Mother of Children
      If you think the government is the least bit concerned about your health, my health, anybody's health,(other than their own), you are fooling yourself. This is just a power grab.
    • reply
      by Anonymous on Mar 27, 2012 at 07:41 PM in reply to Mother of Children
      Yes, but this law isn't requiring the citizen to buy "health care", it is requiring them to buy "health care insurance". And this is requiring everyone to pay for "health care insurance" whether they need it (or want it) or not. This is exactly the same thing as saying that everyone will eventually need an attorney at some point in their life (even if it is for your will). So let's make a law that every citizen has to have a lawyer on retainer from the time they are 18, and if they don't have a lawyer on retainer, we will penalize them with a tax. The only way to fight that tax is to sue with a lawyer, therefore, we just proved that you needed a lawyer in the first place.
  • by Georgia Boy Location: Cairo on Mar 27, 2012 at 04:40 AM
    Tom, how did prayer in schools get into an article on healthcare? And by the way, the Supreme Court has already decided prayer in schools is a legal right of free speech as long as they are not instituted by a government employee. In other words, a Christian has as much right to pray wherever they want as you do to not listen. And you not wanting to hear prayer doesn't trump that right any more than my not wanting to hear Obama bleat like a Billy goat trumps his right to do so.
  • by this is crooked too on Mar 26, 2012 at 07:29 PM
    One of the justices had a job lobbying for the bill before it passed, she needs to recuse herself immediately. Obummer is trying to stack the deck with that Sotomyer woman on the bench.
  • by What??? on Mar 26, 2012 at 07:22 PM
    Who will monitor people who don't pay the penalty with their tax return and what will be the recourse? JAIL? If 47% of people don't even pay Federal taxes then how will they pay the tax penalty. What about people that don't work and have no income to pay the tax penalty? This is CRAZY!
    • reply
      by GV on Mar 27, 2012 at 05:27 AM in reply to What???
      Um,it pretty simple.The answer is one of the main problems with this law.Do YOU work and pay taxes?Well so do I.That's who will be paying for those people's"free"healthcare.
  • by Tom Location: Tallahassee on Mar 26, 2012 at 07:10 PM
    No matter how many attempts are made to sneak prayer into public schools and no matter how many different ways it is disguised by calling it something else, the result will be the same. It ain't gonna happen. There are many christians in this country, but it is not a christian nation and never will be. Please don't pray in our schools and we won't think in your churches.
    • reply
      by Veritas on Mar 27, 2012 at 09:57 AM in reply to Tom
      Do you think anyplace?
    • reply
      by Anonymous on Mar 27, 2012 at 12:51 PM in reply to Tom
      Prayer isn't just a Christian thing. When school prayer is allowed it isn't allowed ONLY for the Christians. Do you think anywhere?
      • reply
        by p. footlocke on Apr 1, 2012 at 07:50 AM in reply to
        Children can pray in schools. It just isn't led by the teacher.
    • reply
      by Anonymous on Mar 27, 2012 at 06:46 PM in reply to Tom
      I will pray that from now on, you will actually read the story before commenting.
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