Understanding the Supreme Court’s Healthcare Reform Case


PACS, healthcare reform, supreme court Just about everyone in the healthcare world knows that the Supreme Court will take up the controversial Patient Protection and Affordable Care Act (PPACA) sometime in March 2012, with a decision scheduled for June.

The issues at stake, however, are less well-known. Here is a very brief summary of the Supreme Court documents that show what the justices have to wrestle with (in no particular order):

  • The individuals mandate. PPACA states that, as of 2014, individuals who have not purchased health insurance will be subject to a fine. The big question is, “Does Congress have the authority to do this?” Those who say “yes” appeal to the Constitution’s commerce clause, which grants Congress the power “to regulate interstate commerce.” Those who say “no” assert that allowing the government to penalize citizens for commercial inaction is tantamount to tyranny.
  • The severability of the individual mandate. Suppose that the Court finds the individual mandate unconstitutional. Does that mean the rest of PPACA is unconstitutional as well? Is the individual mandate “severable” from the rest of the law, in other words? At least one district judge has said that it is not, and one appeals court has said that it is.
  • The Anti-Injunction Act. This one’s tricky. There is precedent for limiting the Court to ruling on cases involving penalties only after someone has been fined. If the Court rules that this precedent applies to PPACA, then no one will be able to challenge the individual mandate’s constitutionality until after 2014.
  • Medicaid expansion. PPACA mandates that states expand Medicaid to cover more people. The practical problem is that the states themselves have to fund part of this expansion. The legal problem: does Congress have the authority to make such a huge demand of the states?

The Court has slotted 5 ½ hours of oral argument time for these issues – a modern record.

Will healthcare reform hinge on the Supreme Court’s decision? In some ways yes, in some ways no. Many of the not-yet-implemented reforms of PPACA are already taking place in the private healthcare world, especially the move away from a fee-for-service reimbursement model. The healthcare market – and not government policy – is dictating reform on many fronts, in other words. But many changes that will affect healthcare pricing and delivery – especially the state-run “exchanges” and penalties for some employers that don’t provide adequate coverage – are almost certainly dependent on the continuation of PPACA.

Needless to say, June should be an interesting month.  Stay tuned to see how this plays out and what affect it will have on PACS, CVIS and other medical imaging functions.


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