High Court showdown on health reform just one week away

Next week, two years after passage of a sweeping overhaul of the nation's health care system, Supreme Court will hear arguments as to whether that overhaul should be allowed to proceed, should be struck down, or even whether it's premature to be discussing the issue.

Beginning Monday, March 26, the Court will spend a highly unusual six hours over three days listening to and questioning attorneys for the parties on several aspects of the health law.

Here at Health Reform Talk, we'll monitor all of next week's arguments closely and will offer our analysis of the highlights. We'll also spend this week giving you all the background you'll need to follow what's going on at next week's historic sessions.

So, how did we get here?


2010 enactment. On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (P.L. 111-148). Coupled with its companion legislation (the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), enacted on March 30, 2010), the Affordable Care Act contains significant expansions of access and coverage for almost all Americans. Chief among its provisions is a requirement that, beginning in 2014, most Americans purchase minimum qualifying coverage (the "individual mandate"). State-based Health Insurance Exchanges will provide a forum where individuals and small businesses can choose from competing private insurers offering qualifying coverage. Large employers must also offer minimum essential coverage or face a penalty.

In addition, the ACA expanded Medicaid eligibility and made significant changes to Medicare. (For more on the ACA, including the full text of the law and additional information on health reform and other recent developments in employee benefits, just click here.

Circuit Court decisions. The ACA was controversial from the start, and litigation quickly began in the district courts. Several federal appellate courts ultimately ruled on the law, with three courts upholding the law for various reasons, and one striking it down:

• In June 2011, the Sixth Circuit upheld the individual mandate.
• In August 2011, the Eleventh Circuit struck down the individual mandate, but held that the remainder of the law could remain in effect.
• In September 2011, the Fourth Circuit ruled that the Anti-Injunction Act bars challenges to the law until 2014, when the individual mandate is scheduled to go into effect.
• In November 2011, the Court of Appeals for the D.C. Circuit also upheld the mandate.

After much speculation about how and when the Supreme Court would reconcile the conflicting opinions from the circuit courts, the Court elected to review the Eleventh Circuit's ruling striking down the mandate.