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U.S. healthcare reform to the Supreme Court: What you need to know

Arguments in March. A decision by June. Those are the first two things you need to know about the decision Monday by the U.S. Supreme Court to hear arguments over President Obama’s healthcare reform law. Of all the different challenges to “Obamacare,” the Supreme Court chose to review the only decision that stated Congress went […]

Arguments in March. A decision by June.

Those are the first two things you need to know about the decision Monday by the U.S. Supreme Court to hear arguments over President Obama’s healthcare reform law. Of all the different challenges to “Obamacare,” the Supreme Court chose to review the only decision that stated Congress went beyond its  power “to regulate commerce” and “to lay and collect taxes.” That was the decision made in August by a three-member panel in the United States Court of Appeals for the 11th Circuit.

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It is a decision that will occur in the heart of the next presidential campaign and will be made in a powder-keg environment (politically). There are a handful of factors everyone should know about the pending decision. Here are the key factors that matter for the Supreme Court’s decision.

It could be totally anticlimactic. There’s a very good chance that the court’s ruling in healthcare reform would happen in the middle of the presidential election. But the first step in the Supreme Court hearing will be to review the Anti-Injunction Act, which, in the words of Politico, “could prohibit a ruling on the individual mandate until the mandate goes into effect in 2014.”In short: the Supreme Court could punt.

It will be a Supreme Court Marathon. The justices will allow for five-and-a-half hours of oral arguments, which is the longest in recent memory. Two hours will focus on whether the law’s requirement to buy insurance is constitutional. Another hour and a half will examine what others part of the law would be unconstitutional if the Supreme Court overturns the law on insurance purchases. The discussion for the Anti-Injunction Act will take about an hour, as will the Medicaid expansion section.

Brush up on your Commerce Clause. The ruling the Supreme Court will review focuses intently on the Commerce Clause, stating specifically: “what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”

Here’s one of the best summaries of the pros and cons of the Commerce Clause when it comes to healthcare reform.

Everything comes down to Kennedy. For months Supreme Court handicappers have focused on the mind of Justice Anthony Kennedy, who they expect to be the swing vote in a close decision. Why is his opinion on the law such a coin flip?

The question of the individual mandate’s constitutionality is closely tied to two competing values that Kennedy believes in deeply: a judicial duty to enforce limits on the federal government, and acceptance of a practical post-New Deal conception of the federal power to regulate a national economy. His record contains repeated defenses of both commitments, and when confronted with cases that pit them against each other, he often tries to have it both ways. With the mandate, though, Kennedy will have to choose.

Observers think Kennedy leans toward supporting Obama’s healthcare reform legislation. As long as he believes the law is connected to the powers of the federal government to powers to tax and to regulate commerce; that reform is closely tied to the issues in the national economy; and that even with the law there are “meaningful, judicially enforceable limits” in place. This third part has always been the toughest for healthcare reform proponents, according to The New Republic.

They cannot simply ridicule mandate opponents’ contention that the law would open the door to legislation requiring people to eat their broccoli. They must provide realistic examples to demonstrate that principled limits on federal power to regulate commerce among the several states remain meaningful and are not merely words on parchment. Were Kennedy to vote to strike the mandate, it would most likely be because its defenders could not present a principled, enforceable stopping point to federal power under the Commerce Clause.

Keep an eye on the conservatives. The Wall Street Journal points out most conservative Supreme Court justices, such as Chief Justice John Roberts and Justice Samuel Alito, haven’t ruled on federal commerce power since joining the Supreme Court.

Also, notes the Journal: “Justice Antonin Scalia also is likely to be a key focus of attention. The conservative justice joined two rulings in 1995 and 2000 that placed limits on Congress’ commerce power. But Justice Scalia also embraced a broader view of that power in 2005, saying Congress had the authority to prohibit seriously ill Californians from growing marijuana for their personal medical use, even though a state law allowed it.”

Public opinion is shifting. Public opinion will matter — particularly when it comes to backlash on the ruling and its impact on who will be the next president of the United States. Here’s an interesting tidbit: an increasing number of people are backing the requirement that everyone have health insurance.

Chris Seper runs and contributes regularly to the site. He is the vice president of healthcare for Breaking Media, MedCity's corporate owners. Reach him at [email protected].

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