Two years ago Friday, President Obama signed what has been called the most significant legislative achievement of his administration, the Patient Protection and Affordable Care Act.
The president's signature was barely dry before opponents began challenging the law in federal courts across the country. The Supreme Court agreed to take up the case after the lower courts divided on a key provision.
So, for three days next week, the court will hear six hours of arguments against the law brought by 26 states, as well as a small-business group and four individuals.
Central to the issues before the court is the individual mandate, which requires almost every individual to buy health insurance by 2014 or pay a penalty. The justices will also consider whether the rest of the law can stand if the individual mandate is found to be unconstitutional, and whether the challenge to the mandate should even be heard now because it doesn't take effect until 2014. The court will also address the provision of the law that expands Medicaid coverage.
The government says that health care law was passed in part because in 2009, 50 million individuals lacked health insurance. Costs of the uninsured were spiraling out of control and were being shifted to other market players such as those who are insured, doctors and insurance companies. In addition, Individuals with pre-existing conditions were being denied coverage.
1. What does the law do?
The government says it reforms health care coverage by, in part, expanding Medicaid, enacting tax measures to prod employer-sponsored insurance, creating health insurance exchanges and enacting market reforms.
Beginning in 2014, the act will bar insurers from denying coverage to any person because of a pre-existing medical condition and from charging higher premiums because of a person's medical condition. A key part of the law is the minimum coverage provision, also known as the individual mandate, that requires most individuals to buy health insurance by 2014 or pay a penalty.
The government argues that Congress was well within its authority to pass the individual mandate under the Commerce Clause and the Necessary and Proper Clause of the Constitution.
"The minimum coverage provision is within Congress' power to enact not only because it is a necessary component of a broader scheme of interstate economic regulation," Solicitor General Donald B. Verrilli Jr. said, "but also because, within that scheme, the provision itself regulates economic conduct with a substantial effect on interstate commerce, namely the way in which individuals finance their participation in the health care market."
The government says the law is not about forcing someone to buy a product, but about financing payment for something that almost every individual will need sometime in his life.
As a secondary argument, the government says the mandate is justified under the taxing power. "It is fully integrated into the tax system, will raise substantial revenue and triggers only tax consequences for non-compliance," the government argues.
But opponents of the law say that Congress cannot force someone into a market place and require him or her to buy a product.