"The courts weighed the same statutes, the same arguments and the same cases," says Jane Perkins, legal director of the National Health Law Program, a public interest law firm based in Washington. Despite the similarities, the 6th Circuit Court of Appeals based in Cincinnati upheld the health care overhaul, and the 11th Circuit based in Atlanta struck down its central provision, the individual mandate requiring virtually everyone to have insurance by 2014.
The Supreme Court surely will have the last word — but when?
Many court watchers hope the court will resolve the issues in the term that begins Oct. 3 and will rule when the term ends next June.
"But there remains at least a decent chance that the court does not grant [review to] any of the cases until after January 2012, which would likely mean … a decision in the spring of 2013," Bradley W. Joondeph, a law professor at Santa Clara University, writes in his blog about health care reform litigation.
As attention shifts to timing at the Supreme Court, one question is whether the court wants to be seen as a factor in the 2012 elections. A ruling next summer could obliterate President Obama's signature legislative achievement just before he runs for reelection. A decision that comes after the 2012 presidential election could work to the advantage of the health care law's supporters and Obama.
In the meantime, the Affordable Care Act remains in effect, although Republicans in Congress want to repeal it and many states are balking at implementation. Members of at least 45 state legislatures have proposed bills to limit, change or oppose selected state or federal actions, according to the National Conference of State Legislatures.
People who are 50-plus have much at stake in the judicial and political wrangling, especially those without insurance who are not yet eligible for Medicare. In 2014, under the law, insurance companies can no longer deny coverage for people who have prior or current medical conditions, and the law provides subsidies to help low- and middle-income families buy insurance.
For those in Medicare the law has several key provisions.
It guarantees basic benefits for everyone in Medicare. It gradually closes the Medicare Part D "doughnut hole," the gap in coverage of prescription drugs, starting this year with a 50 percent discount on brand-name drugs. Now, Medicare also provides free annual wellness visits and preventive screening tests, such as mammograms and colonoscopies. The law also aims to help older people with disabilities stay in their own homes and out of nursing homes through a new Community First Choice Option that starts Oct. 1.