Mr. Affordable Care Act Goes [Back] To Washington

The most eagle-eyed tourists visiting Washington D.C. for the 100th annual Cherry Blossom Festival might have noticed a line forming at One First Street. Starting on Friday of last week, court watchers and assorted activists took their place in line (or, alternatively, paid someone else to stand in line for them) for the opportunity to see oral arguments in the cases filed against the Affordable Care Act. They lined up early for a good reason; this case is effectively the Super Bowl of constitutional litigation, as the Supreme Court recognized when it allotted a nearly unprecedented six hours to oral arguments over three days.

The Affordable Care Act is a comprehensive piece of legislation aimed primarily at decreasing the rate at which U.S. spending on healthcare increases. It includes a host of regulatory schemes and pilot programs, including provisions implementing the concept of care delivery by ' Accountable Care Organizations,' banning healthcare insurers from excluding people because of preexisting conditions, banning the practice of rescission of health insurance by insurers except in cases of fraud, expanding Medicaid participation eligibility, creating health insurance 'exchanges' at the state level, and authorizing the Secretary of Health and Human Services to developed bundled payment plans to alter the dynamics of the current fee-for-service model of payment for healthcare by third-party insurers. However, the most controversial provision by far (with the possible exception of a completely fictitious provision establishing 'death panels') is the so-called 'individual mandate,' which requires all adults, with certain exceptions, to carry a minimum level of health insurance or pay a penalty come tax time every year.

The Supreme Court agreed to hear arguments on four issues from two cases from the 11th Circuit Court of Appeals challenging the Affordable Care Act, specifically National Federation of Independent Business v. Sebelius and Florida v. Department of Health and Human Services. The first case, filed by the National Federation of Independent Business and two individual plaintiffs who cannot be bothered to carry health insurance and want everyone to know it, argues that the individual mandate is an unconstitutional exercise of federal power to regulate interstate commerce. The other case, filed by the Attorney General of Florida and joined by the Attorneys General of twenty five other states, also argues that the individual...