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How Will the Supreme Court Rule on PPACA?

by Bill Coffin

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Nearly 300 members of the Nashville Health Care Council and Leadership Health Care heard from a diverse panel yesterday about the future potential implications of the U.S. Supreme Court’s pending decision on the constitutionality of the Patient Protection and Affordable Care Act.

“The highly anticipated Supreme Court decision on health reform is much more than a legal opinion, it’s a defining event in the health care marketplace,” said panel moderator Dick Cowart, chairman, Health Law & Public Policy Department, Baker, Donelson, Bearman, Caldwell & Berkowitz. “These historic proceedings have the potential to change the way health care companies do business.”

The Court will hear arguments on the Affordable Care Act from March 26-28, just over two years after the bill’s passage into law. The Act made sweeping changes to the nation’s health care system, including individual and employer insurance provisions, payer requirements around preexisting conditions, age thresholds and preventative care, along with Medicaid expansion.

The panel, Supreme Decision: The High Court on the Affordable Care Act, discussed views on how the Court’s decision could impact health care providers, payers and consumers. Participants included Lyle Denniston, journalist and dean emeritus of the U.S. Supreme Court Press Corps; Paul Heldman, senior health policy analyst, Potomac Research Group;Tony Hullender, senior vice president and general counsel, BlueCross BlueShield of Tennessee; and Tevi Troy, senior fellow, Hudson Institute, and former Deputy Secretary, U.S. Department of Health and Human Services.


The Court has established an unprecedented six hours for the oral arguments. During the March proceedings, the Court will evaluate four issues relating to the law, including: 1) the “individual mandate,” or requirement that every American citizen purchase health insurance; 2) “severability,” whether the overall health care law can stand even if the individual mandate provision doesn’t; 3) the law’s new Medicaid requirements for states and 4) the Anti-Injunction Act, whether it’s appropriate for courts to currently hear challenges to the law given that its mandates do not take effect until 2014.

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“The Court is taking this matter very seriously, as it should, given the scope of the law and the kinds of changes it represents, not only to the health care system but also to matters as grand as the separation of powers and the very structure of our constitutional republic,” said Troy.

According to Denniston, the case is multi-layered and historically significant. “The Court could have only focused on the constitutionality of the individual mandate,” he said. “But the Court has chosen broader deliberations around severability and the implications of the law’s expansion of Medicaid.”

The health insurance industry, a sector integral to health reform’s impact, is poised for implementation regardless of the outcome. “The individual health insurance mandates are a key part of health care reform’s goal to control the cost of care,” said Hullender. “With this in mind, our industry understands the need for their inclusion in the original law.”

Heldman said he leans toward the view that the law’s requirement that individuals buy insurance will be upheld. “It’s our thinking that the Supreme Court will leave much of the health reform law standing, even if it finds unconstitutional the requirement that individuals buy coverage. But, in my opinion, removing the individual mandate could destabilize the insurance market and negatively impact providers who might be exposed to increased bad debt.”

The panel discussion comes on the eve of the Leadership Health Care’s 10-Year Anniversary Delegation to Washington, D.C. The annual trip will feature industry perspectives on key components of health care reform, discussions on federal reimbursements and budget issues, and expert views on the likely outcomes and industry impact of both the March Supreme Court hearing on reform and the November elections.

“Today’s discussion was an exceptional opportunity to hear from experts and key stakeholders on this highly anticipated decision,” said Council President Caroline Young. “The outcome will have an unprecedented impact on the future of the Affordable Care Act, the national landscape of the health care industry and Nashville as a health care capital.”