The high court could uphold the entire law, strike down its central requirement that most Americans buy health insurance by 2014 or pay a penalty, let stand or quash a major expansion of Medicaid, — or punt a final decision on all these issues into 2015.
The court will consider four matters.
1. Is the mandate penalty a tax? On Monday, the court considered whether the penalty imposed on people who don't buy insurance is a tax. A 19th-century law prohibits legal challenges to a tax before it takes effect. If the justices decide the penalty is a tax, they could throw out challenges to the health law until a taxpayer actually pays a penalty for failing to buy insurance, which could be at least three years.
2. Does the U.S. Constitution empower Congress to enact the mandate? On Tuesday, the court turned to the central issue of whether Congress overstepped its authority in requiring people to buy insurance, — as 26 states have asserted. AARP filed a friend-of-the-court brief supporting the constitutional power of Congress to enact the requirement.
3. Does the fate of the entire law hang in the balance? On Wednesday, the court considered whether other sections of the law fall if any part of it is invalidated. The Obama administration argued that if the court strikes down one provision of the law, it should let most of the law stand. AARP signed onto a friend-of-the-court brief supporting the administration's position.
4. Can the federal government force the states to expand access to Medicaid? Also on Wednesday, the justices took up a feature of the law intended to expand access to Medicaid, the health care program for low-income people that pays for most nursing home care. Opponents contend that the expansion is "coercive" to the states, which share costs with the federal government. But Jane Perkins, the legal director of the National Health Law Program in Carrboro, N.C., argues that the expansion “fits neatly within the Medicaid framework that Congress established back in 1965.” AARP signed onto a friend-of-the-court brief supporting the Medicaid expansion.
Also of interest: America's Health Care Reform through history.