As the Supreme Court analyzes the issues, the nation anxiously awaits their final decision on the healthcare law. It seems like just yesterday the nine Justices heard oral arguments, but in actuality, it was late March. To prepare for the final decision expected by the end of the month, it's helpful to review the arguments and refresh our healthcare law memories.

What is this case about and who are the "sides"?

Termed "Obamacare," the Patient Protection and Affordable Care Act is at the center of the case; Passed in 2010, it is hailed as the shining achievement of the Obama Administration. Specifically, the Court heard arguments relating to the mandate provisions in PPACA that apply to individuals and to state Medicare and Medicaid providers.

Solicitor General Donald Verrilli, Jr., Deputy Solicitor General Edwin Kneedler, and court-appointed attorneys H. Bartow Farr III and Robert Long argued in favor of the government. The government argued in support of the law. Those opposing the law included the State of Florida and the National Federation of Independent Businesses. They maintained that it is unconstitutional for a number of reasons, set forth below. 

What are the issues?

There are four issues before the Court. First, the Court must determine whether the challengers of the law have standing to bring suit. Although it's a substantive issue, most assume that the Court determined that there is standing, since they decided to hear the case.

Second, the Court must determine whether it is a violation of the Constitution to require individuals to purchase health insurance or face an excise tax (the so-called "individual mandate" provision). Third, the Court must determine whether it is Constitutional for the federal government to order the states to increase Medicaid funds in order to continue to receive matching federal grants.

Finally, if the Court finds any of the provisions unconstitutional, whether the law can stand absent those provisions.

Where can I hear and read the transcript?

A transcript and audio recording will be posted on the Supreme Court's website.  

What are the possible holdings?

The Court has five broad holding options. First, they may uphold the entire law, ending the legal fight (absent appeal) and allowing the administration to push forward with implementing the provisions of the law. Oppositely, the Court may strike down the entire law, thereby killing the entitlement and allowing previously implemented provisions of the law to roll back. 

It is possible to strike certain provisions and uphold others, and holding options three and four could look like mod podge of both constitutional and unconstitutional provisions. Theoretically, the Court may strike down the individual insurance requirement, but allow the Medicaid expansion and employee insurance coverage provisions to take effect. Similarly, the Court may strike the Medicaid expansion and uphold the individual requirement. This holding would severely limit the law's impact, but would effectively bring everyone making up to 138% of the federal poverty level eligible for Medicaid. Striking portions, particularly the mandate, will make the residual laws difficult to implement and especially difficult for states to finance.

Although it highly unlikely, the Court may determine that the challengers to the law brought the case before the Supreme Court prematurely and rule that there is no standing to bring suit; basically the Court will not rule on the substantive portions of the law. Both the challengers to the law and the administration urged the Court during oral arguments to decide on the merits of case, as opposed to putting off the decision until the law is implemented and there is a true plaintiff to bring suit.

What is happening in the court of public opinion?

Earlier this month, a number of news sources polled the public, asking whether striking down the healthcare law completely or in part is favorable. In a June 5th Fox News poll, only 40% favor the new law, while 49% oppose it; 30% would prefer the Supreme Court to uphold the law, while 21% favor the Court striking down the individual mandate and 38% want the entire law thrown out by the Court.

Similarly, in a New York Times/CBS poll in early June, the polling results revealed that just 34% of Americans support PPACA (18% strongly), while 48% disapprove (36% strongly). Only 24% want to keep the entire law, while 27% want the individual mandate gone and 41% want the entire law struck down. 

When can I expect a decision?

Most predict that the Supreme Court will release the decision either Monday, June 18, 2012, or Monday, June 25, 2012; it is likely that the latter date will be the winner. State Budget Solutions will continue to analyze the impacts of the decisions on the state budgets, so keep checking in!