By Kirsten Adshead | Wisconsin Reporter
MADISON — When the U.S. Supreme Court rules on the Patient Protection and Affordable Care Act, likely Thursday, its decision could affect far more than how the United States handles health care, experts said Monday.
Indeed, key principles that have guided American domestic policy for years fundamentally could be altered by the Court’s ruling.
Federalism. Limited government. Religious freedom.
“I think that we’re having a discussion now of the relative capacity or ability of the government to deal with 21st-century problems,” said Robert Kraig, executive director of liberal-leaning Citizen Action of Wisconsin, which advocates for providing health care for more Americans.
Alabama Attorney General Luther Strange last week railed against the federal law, arguing that there should be more exemptions for religious organizations that provide health insurance for their employees but don’t want to be forced to pay for things, such as the morning-after pill, to which they morally object.
“This fight is not about the right to have access to contraception,” Strange said during a panel on the topic organized by the conservative Heritage Foundation. “This fight is about the federal government’s decision to make religious objectors pay for it. That’s one of the reasons that people of all faiths, all faiths, are deeply concerned about this issue and are joining together to oppose this mandate.”
The full implications, of course, won’t be understood until the Supreme Court rules on the health care reform package,possibly by Thursday.
At 2,200 pages, the law is massive, and far-reaching.
Some of its most controversial provisions, however, involve the government requiring that non-exempted individuals purchase health insurance and requiring states to expand their Medicaid coverage in exchange for continuing to receive any Medicaid funding.
Most provisions in the law aren’t being challenged.
But the Supreme Court has the ability to uphold the entire law, dismiss the entire law or dismiss parts of it.
University of Wisconsin-Madison assistant law professor Andrew Coan said the court’s ruling may have limited impact beyond the health care law or may have far-reaching implications, depending on the ruling itself.
In Coan’s opinion:
- If the court simply tosses out the individual mandate, “the broader implications may be relatively narrow.” The goals of the individual mandate, including ensuring that as many people as possible are contributing to the insurance pool, easily could be addressed by other means, including providing tax credits for purchasing health insurance, he said.
- A ruling by the court to either uphold or dismiss the law in its entirety may have limited impact beyond the approval or dismissal of the health care law itself – although, Coan said, the significance of that alone should not be ignored.
The justices may accept the argument that, if they dismiss part of the law, they should dismiss all of it, in favor of letting Congress start fresh with the subject. Or they may simply uphold the law.
“If it does uphold the constitutionality of the act, I don’t expect it to announce any new principles,” Coan said. “If anything, I expect it to slightly narrow the scope of federal power,” while arguing that the health care law falls within that scope.
- The broadest implications from the court’s ruling could stem from “the sleeper issue” – Medicaid expansion.
Congress has, for decades, been allowed to use federal funding as the stick that convinces states to implement programs – such as requiring states to raise the drinking age to 21 if they want to receive transportation money.
Lawyers opposing the Medicaid expansion, however, said that it oversteps Congress’ conditional spending powers because it’s overly coercive — states need the Medicaid funding that they’re getting so they aren’t actually able to reject the Medicaid expansion.
The court hasn’t sided against Congress’ conditional spending powers since 1936, according to Cohen.
For the court to strike down the Medicaid expansion now, he said, “I think would shock most people … . But the Court was a lot more sympathetic to this argument at oral arguments than I think a lot of people expected it to be.”