Perspective:

Later this month, the US Supreme Court will examine the constitutionality of the Affordable Care Act (ACA). The Supreme Court will address four questions: First, the Court will determine whether the Tax Anti-Injunction Act (AIA), which dates back to the 1800s, precludes review of the ACA until after 2014. Second, if the Court determines that review is appropriate, it will next consider whether Congress has the authority to require most US citizens to purchase health insurance or pay a penalty. Third, if the Supreme Court rules the mandate unconstitutional, it will determine whether the rest of the ACA must also be overturned or whether the mandate is “severable” from the rest of the law; and finally, the Court will consider whether the ACA’s Medicaid expansion is constitutional and whether states can be required to comply with it in order to remain eligible for federal Medicaid funds. Whichever way the Supreme Court rules, the implications for health care in the United States will be profound.