Health care

“These findings suggest that many states may need to take action in 2013 to ensure that consumers receive the full benefits promised under the Affordable  Care Act,” the report concludes. “Because states are expected to be the primary enforcers, most will need to implement the new protections so they are reflected in state law or—at a minimum—give the insurance department the authority to enforce and write new rules on the 2014 market reforms.”

If a state does not have authority to enforce the Affordable Care Act, that doesn’t mean it becomes null and void: Rather, the enforcement authorities then fall to the federal government.

“It’s a question of both capacity and complexity, whether they have an appreciation for the nuances of each state market,” lead study author Katie Keith, also at Georgetown, says.

The 2012 Supreme Court ruling

The Supreme Court’s 2012 ruling was a major victory for the White House less than five months before the November 2012 elections as President Obama was making his push for a second term. The rulling has helped redefine the power of the national government and is affecting the health-care choices of millions of Americans.

Chief Justice John G. Roberts Jr. sided with the majority in voting to uphold the law, Obama’s signature domestic initiative.

Passage of the legislation by the Democratic-controlled Congress in 2010 capped decades of efforts to implement a national program of health care. The legislation is expected to eventually extend health-care coverage to more than 30 million Americans who currently lack it.

Here’s an excerpt from the section of the ruling on the mandate:

Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.

The Court heard oral arguments on the case for three days — March 26-28, 2012.

Day 1: Supreme Court begins review | Full audio transcript | Audio excerpts

Day 2: Court weighs individual mandate | Quotes from each justice | Audio excerpts

Day 3: Court weighs severability; Medicaid expansion | Audio excerpts

The court began the first day of it’s review by examining a statute that keeps courts from hearing tax challenges before they go into effect. But the justices’ questions indicated skepticism that the penalties prescribed for those who do not buy health insurance by 2014 amount to taxes under the 1867 law forbidding tax challenges.

On Day 2, in an intense interrogation of the government’s lawyer, Solicitor General Donald B. Verrilli Jr., the justices posed repeated and largely unanswered questions about the limits of federal power. At the end of two hours, the court seemed split on the same question that has divided political leaders and the country: whether the Constitution gives Congress the power to compel Americans to either purchase health insurance or pay a penalty.

On the final day of review, the court addressed two key questions: If the insurance requirement is ruled unconstitutional, should the rest of the health-care law stand? And is the law’s expansion of Medicaid to cover a greater share of the poor constitutional?

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