The U.S. Supreme Court is hearing arguments this week on the constitutionality of the Patient Protection and Affordable Care Act1 (ACA), the contentious, complex and costly overhaul of the nation’s health care system that was enacted in 2010 and that is to be phased in over several years. It is an indication of just how much is at stake in this case that the Court has scheduled six hours of oral arguments over three days, from March 26-28. In an effort to provide some background, this column will briefly summarize the challenges to the law, and the major pro and con arguments that have been advanced thus far.

Law

Two of the most controversial parts of the ACA are the mandate that certain individuals carry at least a minimum amount of health insurance or pay a penalty, and the requirement that states expand their Medicaid programs. Numerous lawsuits have been filed challenging the constitutionality of the ACA. The Supreme Court has chosen to review a lawsuit brought by 26 states, by the National Federation of Independent Businesses, and by certain individuals alleging that the ACA’s imposition of the individual mandate exceeds Congress’ constitutional powers. The lawsuit also alleges that the law’s mandatory expansion of Medicaid violates the Tenth Amendment by forcing the states to expand the benefits they provide under their Medicaid programs.2

Standing

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