1 year later, healthcare battle looms

WASHINGTON (RNN) – Three-hundred Dexter Avenue. That's the address of the U.S. Supreme Court, which will ultimately decide the fate of one of the most controversial laws ever enacted - the Affordable Care Act.

The act, which turns 1 on March 23, has become one of the most divisive policies enacted on Capitol Hill, and paved the way for newly elected Republican legislators to waltz into Congress during the 2010 midterm elections.

Try as they might to repeal so-called "Obamacare" – as the House did when it voted for repeal on Jan. 19 of this year – the act was purely symbolic.

That's because a Democratic-controlled Senate and presidential veto stand in their way.

As the fate of the law hangs in limbo (and in the midst of ongoing economic troubles, two wars, and other social changes), the 2012 presidential election is likely to shape up to be more divisive than ever.

The Supreme Court, however, could ease the mounting tension sooner rather than later if it makes an uncharacteristic decision to hear an expedited appeal made by a state's attorney general not much more than 100 miles away from Washington, in the Commonwealth of Virginia.

Turning to judicial remedies

Currently, the battle is spread out among America's lower courts, where the legislation has twice been ruled unconstitutional.

In the most recent lawsuit, filed by 26 states, Florida District Judge Roger Vinson dismissed key portions of the legislation, the most important of which requires individuals to purchase health insurance or face government sanctions and fines. Vinson ruled that Congress had overstepped its bounds.

"I must reluctantly conclude that Congress exceeds the bounds of its authority in passing the Act with the individual mandate," Vinson ruled in January. "That is not to say, of course, that Congress is without power to address the problems and inequities in our health care system."

An appeal has been filed.

Similarly, a Virginia judge, U.S. District Court Judge Henry E. Hudson, ruled in December that the Minimal Essential Coverage provision is unconstitutional because it forces an individual to purchase health insurance or face a penalty.

The battle in Virginia

The federal government has filed an appeal in that case, as well.  An expedited hearing on the case will be heard May 10 by the U.S. Court of Appeals for the Fourth Circuit in Richmond, VA.

"We won the initial round in federal court back in December," said Brian Gottstein, director of communication for the Virginia Attorney General's office.

The state of Virginia views the entire law as unconstitutional.

To speed the case along, the Attorney General's office is trying a unique tactic: It has asked the U.S. Supreme Court to "hear the case on expedited review," Gottstein said.

The move would allow the lawsuit to pass over the fourth circuit and go directly to the Supreme Court. But having such a motion granted is rare, Gottstein said, as historically only one or two cases per decade receive such treatment.

"We don't know when we'd hear from them," he said. "That's totally up to the Supreme Court."

The move, however, could be good for both sides of the debate, perhaps shaving more than a year's time off a final resolution.

"Obviously, we feel it's important for this to be expedited because states are already spending money," said Melissa Nitti, a public affairs officer for the U.S. Department of Health and Human Services.

A matter of politics?

The Department of Justice, which is run by the Obama administration, doesn't see it that way, however.

"In fact, last week they responded to our request to the Supreme Court," Gottstein said, saying the department favored the normal appeal track.

One thing Gottstein made clear is that the Virginia case is not a matter of politics. Gottstein said his office is acting strictly from a legal perspective, arguing that the individual insurance mandate in the law is unconstitutional.

"And that's the contentious part for us," Gottstein said.

Gottstein said that the mandate doesn't line up with the intent of the commerce clause in the U.S. Constitution.

Forcing Americans to buy insurance could be the start of a slippery slope, he says.

"They could make you buy anything," he said. "This is a virtually unlimited power they could be granted."

The economic picture

For Virginia, there are also concerns about the cost of implementing the sweeping legislation. Gottstein said the governor has projected a $2 billion price tag by 2022.

And that's just the cost to the state. It does not include the cost to the individual or to business owners, he said.

A press release issued by the Department of Health and Human Services paints a different economic picture.

"And since the president signed the Affordable Care Act into law last March, the economy has grown at an average annual rate of 2.7 percent, created nearly 1.4 million private sector jobs and moving forward, will help create anywhere from 250,000 to 400,000 jobs each year," the release said.

Nitti noted that the demand for primary care services is likely to increase in the coming years as the baby boomers continue to age. Thus, she said, the White House has made the recruitment and retention of primary care professionals a main concern.

"If we are going to meet the needs of the newly insured Americans, we need to invest in our healthcare workforce," Nitti said in an email. "Primary care clinicians are the key to creating better coordinated care and better health outcomes for all Americans."

Nitti said that both the enacted healthcare legislation and federal investments in the healthcare workforce "are training new primary care providers, providing incentives like loan repayments and scholarships to encourage primary care providers to practice in underserved areas and investing in the construction and expansion of our nation's community health centers."

Nitti said the Obama Administration is also investing in innovations in training programs, faculty development and recruiting diverse and well-prepared students to help shape the development of the next generation of primary care workers.

A study authored by the Urban Institute, a nonpartisan economic and social policy research group, concludes that the Affordable Care Act will not have a negative effect on the economy.

"The ACA is unlikely to have major aggregate effects on the U.S. economy and on employment, primarily because the changes in spending and taxes are very small relative to the size of the economy," the study concludes. "Moreover, most of the effects offset each other."

Not a clear victor

Gottstein said the law is also in contention with the Virginia Healthcare Act, which says that individuals can't be forced to buy health insurance. The state attorney general is thus obligated to defend the law against the federal government. If it's found unconstitutional, it won't be enforced.

As for the odds of that outcome, the ball could be on either side of the court. But Gottstein remains hopeful it's his net that receives the final slam dunk.

"We definitely think we've got a shot," he said.

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