Dozens had lined up outside the Supreme Court Sunday afternoon to hear the health care oral arguments that begin Monday morning. (Sarah Kliff | Washington Post)

One reason these oral arguments will last so long has to do with the variety of the topics that the justices will address. The Court won’t consider the Affordable Care Act as one single issue, but rather has broken the case into four separate issues. Here’s a Wonkblog guide to what those issues are, how and when each side will argue their case, and why it matters. One quick programming note: While the Supreme Court’s arguments will not be broadcast live, C-Span has said it will make them available within a few hours of their conclusion each day here.

Anti-Injunction Act

What it is: This is the question that decides where any of the other questions even matter. Under a law passed in 1867, the Anti-Injunction Act, a tax cannot be challenged until someone has actually had to pay it. Health reform’s penalties don’t start until 2015. The Court opens its oral arguments with a debate over whether it can even issue a ruling on the Affordable Care Act since its penalties for not carrying insurance have not come into effect yet.

What the two sides will argue: One weird quirk of this provision is that neither the defendants or plaintiffs think it applies: Both sides contend that the Court should be able to rule right now . So the justices appointed an outside lawyer, Robert Long, to argue on their behalf. Long will likely look to the Fourth Circuit Court of Appeals for precedent. It ruled, in September, that the Anti-Injunction Act prevented it from issuing a ruling on the health law.

When it happens: Monday, March 26, 10-11:30 a.m.

Why it matters: The Anti-Injunction Act gives the Supreme Court an opportunity to put off its decision for at least three years, potentially diffusing their role in a presidential election year. This could be a mixed-bag for health care supporters: On the one hand, it gives the law three more years to be implemented. On the other, it would still leave the law’s fate uncertain, and likely extend the national debate around the Affordable Care Act.

The individual mandate

What it is: The most-contested part of the health reform law, the Affordable Care Act’s individual mandate requires nearly all Americans to carry health insurance or pay a financial penalty. The legal question centers on whether such a regulation is permissible under the Commerce Clause, which allows the federal government to regulate interstate activity.

What the two sides will argue: Health reform opponents contend that the decision not to do something — namely, not buy health insurance — is economic inactivity, rather than activity, and therefore not a behavior the federal government can regulate. Health reform supporters argue that the decision to not purchase health insurance has an economic effect. An individual without coverage, for example, may not have the money to pay for an emergency room visit, sticking hospitals or taxpayers with the bill.

When it happens: Tuesday, March 27, 10 a.m. - 12 p.m.

Why it matters: With no penalty for not purchasing health insurance, but a requirement for insurers to accept anyone still standing, many expect the costs of insurance would skyrocket. Congress could, theoretically, replace the individual mandate with another policy that doesn’t run afoul of the activity-inactivity distinction -- Medicare Part D, for instance, solves a similar problem by forcing seniors who wait to buy coverage to pay higher premiums -- but it is unlikely that congressional Republicans would permit such a fix, at least in the near term.


What it is: A related question is whether the Supreme Court can strike down the individual mandate without striking down the entire health-care law -- in legal parlance, whether the individual mandate is “severable.”

What the two sides will argue: The Department of Justice says that if the court strikes down the mandate, it should also repeal the health reform law’s guaranteed issue provision, which requires insurers to accept all customers regardless of their health-care status. The argument there is that the mandate is so integral to making insurance work - by getting the healthy people to sign up - that, without it, insurance markets could no longer accept all applicants. Opponents of the law go even further. They contend that because of how the law was written - without a clause that specifically noted that individual provisions could be severable - that the whole thing should fall with the mandate.

The Eleventh Circuit Court of Appeals came to an opposition conclusion: It overturned the mandate, but allowed the rest of the law to stand.

When it happens: Wednesday, March 28, 10 - 11:30 a.m.

Why it matters: If the Court finds the individual mandate unconstitutional, then severability will become a key issue in determining how much of the law falls with it. It could decide that just the mandate falls, leaving the insurance industry facing a disastrous future. Or it could rule that the mandated purchase of health insurance is so critical to the health reform law that if it goes down, it takes other key parts of the Affordable Care Act with it.

Medicaid Expansion

What it is: The health reform law expands Medicaid to cover everyone under 133 percent of the federal poverty line (about $14,000 for an individual) in 2014. Medicaid is run as a state-federal partnership and, right now, states are only required to cover specific demographics, groups like low-income, pregnant women and the blind or disabled.

What the two sides will argue: The states contend that this provision is too onerous: They’ll be responsible for footing part of the Medicaid expansion’s bill, and say they can’t afford the costs. The federal government, for its part, has centered its argument on the fact that states voluntarily participate in Medicaid. If they don’t like the new expansion, they could pull out of the program.

When it happens: Wednesday, March 28, 1-2 p.m.

Why it matters: Since states’ participation in Medicaid is voluntary, Supreme Court watchers widely expect the justices to find this part of the law constitutional. There is worry though, that if they were to strike down this part of the law, it could set sweeping new precedent for how state-federal partnership programs function.


- The Supreme Court and the business of waiting in line.

- Health reform at 2: Why the business of health care will never be the same.

- What happens if the individual mandate falls, in one chart.