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Health Care Arguments Center On Taxes


Well, if the arguments inside the courtroom today were not as exciting as what was going on outside the court, they were, of course, important. In fact, today's arguments will determine whether the case even gets to proceed.

We're joined now by NPR health policy correspondent Julie Rovner to explain more about what happened today and what will happen over the next two days. Julie, welcome back.

JULIE ROVNER, BYLINE: Nice to be here.

BLOCK: And today's argument had as much to do with taxes as it did with health care. Explain that, please.

ROVNER: Well, it turns out that an 1867 law called the Anti-Injunction Act prevents people from suing to block a federal tax until after that tax has been collected. In fact, because the health insurance requirement doesn't start until 2014, no one would pay the penalty until they pay their taxes in 2015. So, no suit could go forward until then.

So, really, the question at hand is whether the penalty in this health law for not having health insurance is a tax or not. And if it is - and one of the appeals courts that heard this case said it was - then no lawsuit could go forward yet, couldn't go forward until 2015.

Interestingly, no one on either side of the case actually wants to wait that long. So, both sides argued that the penalty is not a tax. Because of that, the court actually had to appoint an independent lawyer to argue that fourth circuit court of appeals finding that it is a tax and therefore the case must be put off.

BLOCK: Was there any indication today, Julie, from the justices' questions that they agree that the penalty is, in fact, a tax and that the whole case should be put off, kicked down the road a stretch?

ROVNER: Well, from talking to people more expert than I am at reading the justices, apparently not. This was one case where opponents and proponents of the law watched an argument and seemed to see the same thing. Here, for example, is Florida Attorney General Pam Bondi. She's one of the people who's suing to have the entire law overturned.

PAM BONDI: I think they made it very clear that they had extreme concerns, the justices, that this is not a tax. And that's what we wanted. The case will go forward and we are excited to argue the mandate tomorrow.

ROVNER: I might add here parenthetically that even if the justices did or do believe this is a tax, they wouldn't say so today and stop the proceedings. They won't tell us that until they deliver their full opinion, which is expected in late June. But those on the other side of the case who want the law preserved also said they think the justices will overlook the tax versus penalty argument. This is Ron Pollack, head of the consumer group Families USA, who, by the way, is also a member of the Supreme Court bar.

RON POLLACK: I think the justices, you know, on the liberal and conservative side, they want to move forward. And my guess is that they're going to find, even though there was a good thoughtful argument about why the Anti-Injunction Act applies, they probably will move forward and hear the merits of the case.

BLOCK: So that was the argument today, Julie. What about tomorrow?

ROVNER: Well, tomorrow we get to the heart of the dispute and that's whether Congress is within its constitutional authority in deciding to impose the part of the law called the individual mandate. And that's the part of the law that requires, starting in 2014, that most Americans either have health insurance or else pay this penalty that was the subject of today's discussion. And, of course, that's what's most in contention. Now, those who oppose the law say if the government can force you to purchase health insurance, they can force you to buy a car or join a gym or eat broccoli or basically do anything.

The government and supporters of the law say that health care is unique, that it's something everyone will use eventually, and that if you don't have health insurance, unless you're independently wealthy, you'll basically end up making everyone else pay for it. And because the health care system is clearly something that crosses state lines, Congress has the power to regulate it under the clause of the Constitution that lets it regulate interstate commerce.

BLOCK: So the individual mandate, Julie, at the heart of the argument is tomorrow. And then the last day, Wednesday, what happens then?

ROVNER: That's right. Wednesday, there are two more questions the court will consider in the morning. It will look at whether if it decides the mandate is not constitutional, will it have to strike down the entire law or just the mandate or the mandate and some other pieces of the law that are considered inextricably linked.

In practice, that could be some of the very popular provisions like the requirement that insurance companies sell to people with preexisting conditions. Those companies say unless they have healthy people to spread the risk over, which they'll get if everybody has to have insurance, then they won't be able to afford to sell to sick people.

And then, finally, Wednesday afternoon, the court will take up the question of whether the law's expansion of the Medicaid program for the poor is an unconstitutional intrusion of state's rights. States say even though the federal government's paying most of the cost to expand Medicaid to low-income adults without children, about 16 million extra people, the states could lose all the rest of their Medicaid money if they don't agree to that expansion.

BLOCK: And again, Julie, a decision expected late June, you said?

ROVNER: Late June, should be probably the last thing we'll hear from the court before their recess.

BLOCK: OK. NPR's health policy correspondent Julie Rovner, thanks so much.

ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.

As special correspondent and guest host of NPR's news programs, Melissa Block brings her signature combination of warmth and incisive reporting. Her work over the decades has earned her journalism's highest honors, and has made her one of NPR's most familiar and beloved voices.