Obama health care law at Supreme Court: mega case for the history books

Insurance 'necessity'

Government lawyers say that medical insurance is a necessity of American life, so it is acceptable for the government to require everyone to buy it.

"This is classic economic regulation of economic conduct," Verrilli wrote in his brief. "Congress has wide latitude when deciding how best to achieve its constitutional objectives," he said.

The Constitution entrusts such policy choices to the democratically accountable branches of government, and the courts should respect those choices, the solicitor general said.

Mr. Clement counters that the mandate represents an unprecedented and unbounded power grab by the federal government. "If Congress really had this remarkable authority, it would not have waited 220 years to exercise it," he said.

Specifically at issue in the case is whether Congress acted within its constitutional authority when it passed the ACA.

Under the Constitution, the federal government is limited to regulating only certain areas dealing with national issues.

From the 1940s to the '90s, the Supreme Court embraced a broad interpretation of Congress's Commerce Clause authority, allowing the government to dramatically extend its reach into areas that were once the exclusive domain of the states. But in the 1990s, the court began to enforce tighter limits on Congress's power to legislate under the clause.

What makes the ACA case hard to predict is that these decisions did not uniformly restrict the commerce power, and most were decided by a sharply divided court.

It is with that backdrop that the ACA arrives at the high court. Supporters emphasize prior legal precedents embracing a broad reading of the authority to regulate commerce. Opponents point to the few examples where the Supreme Court has pushed back against congressional attempts to expand its commerce power.

Both sides have precedents to cite, but it's not clear whether the court is prepared to endorse the expansive commerce power advocated by the administration. It is equally unclear whether a majority of justices will embrace the more restrictive approach favored by the challenging states.

Other issues to be decided

In addition to the individual mandate issue, the high court has agreed to decide whether lawsuits challenging the ACA should be dismissed under the Anti-Injunction Act, which bars courts from hearing lawsuits challenging a federal tax.

The court has also agreed to decide whether the ACA's significant expansion of Medicaid at the state level amounts to unconstitutional commandeering of states to carry out the work of the federal government without the states' assent.

The final issue the court is expected to examine is whether the entire ACA, which has measures not linked to the individual mandate, or just a portion of it would need to be struck down should the high court decide that the individual mandate was unconstitutional.

The health-care appeal involves three cases: National Federation of Independent Business v. Sebelius (11-393), Department of Health and Human Services v. Florida (11-398), and Florida v. Department of Health and Human Services (11-400).

Decisions are expected by late June.

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