Florida v. HHS MaryBeth Musumeci Senior Health Policy Analyst - - PowerPoint PPT Presentation

Health Care Reform at the U.S. Supreme Court: Florida v. HHS

MaryBeth Musumeci Senior Health Policy Analyst Kaiser Commission on Medicaid and the Uninsured Policy and Political Implications of the Supreme Court Case

• n the Affordable Care Act

Washington, DC March 14, 2012

FIGURE 1

Parties

NFIB and Individual Plaintiffs 26 States, led by Florida vs. U.S. Departments of Health & Human Services, Treasury and Labor and

FIGURE 2

Key Dates

March, 2010: ACA enacted and Fl. v. HHS filed January, 2011:

• Fl. district

court decision August, 2011: 11th Circuit decision November, 2011: Supreme Court accepts case January, 2012: Supreme Court briefing begins March, 2012: Supreme Court oral arguments Supreme Court decision expected by June, 2012

FIGURE 3

The Road to the Supreme Court

At least 26 cases filed in federal district courts:

2 struck down mandate, 24 have not

Decisions from 7 federal appeals courts:

1 struck down mandate, 6 did not

• Fl. v. HHS accepted by

the Supreme Court

FIGURE 4

States’ Positions in FL. v. HHS

WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL States both challenging and supporting the ACA (2 states) States challenging the ACA (25 states) States not taking a position in the litigation (12 states) States supporting the ACA (11 states)

Note: VA filed its own challenge separately and is not a party in the case accepted by the Supreme Court

FIGURE 5

Issues

1.Do courts have jurisdiction to decide the constitutionality of the ACA’s individual mandate provision now? 2.If so, is the ACA’s individual mandate provision constitutional? 3.If unconstitutional, is the individual mandate provision severable? 4.Is the ACA’s Medicaid expansion constitutional?

FIGURE 6

Issue 1: Anti-Injunction Act (AIA)

• If the Court decides that the ACA’s financial

penalty is considered a “tax” under the AIA, this challenge to the mandate is dismissed, and courts cannot hear cases about the whether the mandate is constitutional until April, 2015.

• If the Court decides that the AIA does not apply,

the Court will decide whether the mandate is constitutional now.

FIGURE 7

Issue 2: Constitutionality of the Mandate

• Possible Bases for Constitutionality:
• Commerce Clause
• Necessary and Proper Clause
• Tax Clause
• If the Court decides the mandate is

constitutional, it will take effect in 2014, unless Congress acts to repeal or postpone it.

FIGURE 8

Issue 3: Mandate is Struck Down – Is it Severable?

• If the Court decides the mandate is not severable

from the rest of the law, it invalidates the entire ACA.

• If the Court decides the mandate is severable, the

Court could

• strike just the mandate, or
• the Court could also strike the guaranteed

issue and community rating provisions.

FIGURE 9

Issue 4: Medicaid Expansion Upheld

If the Court decides the Medicaid expansion is constitutional, it takes effect in 2014, unless Congress acts to postpone or repeal it.

FIGURE 10

Issue 4: Medicaid Expansion Struck Down

• If the Court decides the Medicaid expansion is not

severable, it invalidates the entire ACA.

• If the Court decides the Medicaid expansion is

severable, the Court could:

• strike just the Medicaid expansion, or
• strike the Medicaid expansion and other

provisions of the ACA.

FIGURE 11

What’s At Stake for Health Care Reform in the Supreme Court?

• Individual Mandate
• Medicaid Eligibility Expansion
• Entire ACA, including:

– Health insurance market reforms – Health insurance exchanges – Employer responsibility provisions – Tax subsidies for premiums and cost-sharing – Medicare benefits expansion, payment reductions – Delivery system reforms (ACOs, etc.) – Public Health and Prevention Fund – Health care workforce expansions – Transparency and program integrity provisions