For Health Care, Will One Part's End Be The End-All?

Mar 28, 2012
Originally published on March 29, 2012 9:11 am



This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block. The Supreme Court's historic proceedings on health care have come to a close. On the last of three days, the justices heard arguments on two issues: the expansion of Medicaid and something called severability – that's legalese for whether the rest of the health care overhaul will survive if the individual mandate is struck down. And that's where we begin our coverage. NPR's Nina Totenberg was in the courtroom. As she reports, there were signals from key justices suggesting the court may be prepared to strike down not just the mandate but the entire law.

NINA TOTENBERG, BYLINE: Keep in mind that this morning's entire argument is premised on this supposition. Suppose, asks the court, we do strike down the individual mandate, what other parts of the law, if any, should be allowed to stand? The government contends that most of the law can remain intact but not the two most popular parts: the provision barring discrimination based on previous medical conditions and the provision making insurance rates more uniform. The challengers, represented by lawyer Paul Clement, told the justices today that the whole bill should fall. Justice Ruth Bader Ginsburg noted that the 2,700 page statute contains myriad provisions that are unquestionably OK and have not been challenged.

So why should we say it's a choice between a wrecking operation, which is what you are requesting, or a salvage job? And the more conservative approach would be salvage rather than throwing out everything.

Several justices pointed out that the court generally tries to keep as much of a law intact as possible, on the theory that, as Justice Kagan put it, half a loaf is better than no loaf at all. But lawyer Clement argued that without the mandate and the two provisions that make insurance rates uniform and non-discriminatory, the law would be a hollowed-out shell. Justice Kennedy, a swing vote, pressed Clement for a principle to use as a guide.

PAUL CLEMENT: I don't understand...

JUSTICE ANTHONY KENNEDY: And that objective test is what?

CLEMENT: That it's whether the statute can operate in the manner that Congress intended. And, I mean, I...

JUSTICE SONIA SOTOMAYOR: No statute can do that because once we chop off a piece of it, by definition, it's not the statute Congress passed. So it has to be something more than that.

TOTENBERG: That last was Justice Sotomayor. Shouldn't it be up to Congress to fix the bill, she asked, and not the court? Chief Justice Roberts noted that deals are made for votes all the time in major bills like this so that it would be nearly impossible for the court to unwind what the intent of Congress was. And when Mr. Clement seemed to flounder for a moment, Justice Scalia moved in to help, suggesting that Congress can't do anything anyway.

CLEMENT: The question is...

JUSTICE ANTONIN SCALIA: There is such a thing as legislative inertia, isn't there?

CLEMENT: Well, that's exactly what I was going to say, Justice Scalia...

TOTENBERG: Justice Breyer, holding up a thick copy of the law pointed to its many provisions that have nothing to do with the individual mandate: provisions to encourage doctors to move to underserved areas, provisions on drug pricing, even a provision on breastfeeding. They could stand on their own, he said. Clement replied: Those are only peripheral provisions, and the court should strike down the whole bill. Justice Alito asked what the challenger's fallback position is. The answer was still: Strike down the whole law.

Making a contrary argument was Edwin Kneedler, the deputy solicitor general, who said that the mandate only implicates two other provisions of the overall law: the provision that guarantees insurance without regard to medical conditions and the provision grouping insurance rates based only on age. Justice Scalia said that the mandate plus these two provisions are the heart of the law. And if the court cuts out the heart, the whole thing should die.

SCALIA: There is no way that this court's decision is not going to distort the congressional process. Whether we strike it all down or leave some of it in place, the congressional process will never be the same.

TOTENBERG: Better, he said, to force Congress to reconsider the issue in toto. Lawyer Kneedler urged the court to follow the conservative course of judicial restraint, leaving Congress to fix the law if the mandate is struck down. But Justice Kennedy countered that the effect would be the opposite of restraint.

KENNEDY: We would be exercising the judicial power to impose a risk on insurance companies that Congress had never intended. By reason of this court, we would have a new regime that the Congress did not provide for, did not consider. That, it seems to me, can be argued at least to be a more extreme exercise of judicial power than to strike ­ than striking the whole.

TOTENBERG: Lawyer Kneedler pointed to the many provisions of the law that have already gone into effect as evidence that Congress intended pieces to remain intact even if the mandate and the two connected provisions were struck down. He noted, for instance, that two and a half million more young people under the age of 26 have been added to insurance rolls. Justice Scalia:

SCALIA: That's going to bankrupt the insurance companies, if not the states, unless this minimum coverage provision comes into effect.

TOTENBERG: By the end of the argument, it seemed pretty clear that if there are five votes to strike down the individual mandate, there likely are five votes to strike down the entire Obama health care overhaul. Until today, that seemed a remote possibility - no lower court had reached that conclusion. But the current Supreme Court seems on the verge of proving itself to be dramatically more conservative than any court since the 1930s when it comes to matters that pit its power against the power of Congress to regulate economic matters. Nina Totenberg, NPR News, Washington. Transcript provided by NPR, Copyright National Public Radio.