By Lisa Esposito
HealthDay Reporter
MONDAY, March 26 (HealthDay News) -- The U.S. Supreme Court on Monday began its review of the constitutionality of the controversial and massive health-reform initiative known as the Affordable Care Act. And the justices gave every indication that a little-known 19th century tax law wouldn't keep them from hearing the case.
The Affordable Care Act -- the most ambitious government health-care initiative since the Medicare and Medicaid programs of the 1960s, and the legislative landmark of President Barack Obama's presidency -- is the first federal effort to rein in health-care costs. It aims to extend insurance coverage to more than 30 million Americans through an expansion of Medicaid and a provision that people buy health insurance starting in 2014 or face a penalty.
The nine justices began the unprecedented three days of legal arguments with a 90-minute discussion of whether the high court has the right to hear the case at this time. At issue: whether the court can consider tax challenges before they take effect. Some, including a federal appeals court in Richmond, Va., have contended that the provision in the health-reform law that people pay a penalty if they don't have insurance is, in reality, a tax.
But the justices' questions Monday morning suggested that they did not think the insurance penalty was tantamount to a tax. An obscure 1867 law prohibits legal challenges to a tax until it has been collected. The penalty for not having health insurance wouldn't take effect until 2014, with payment due in 2015, the Washington Post reported.
Although the insurance penalty is "being collected in the same manner of a tax doesn't automatically mean it's a tax," said Justice Stephen Breyer, the Post reported.
Justice Antonin Scalia seemed to agree. The courts should not be deprived of jurisdiction in cases unless the reasoning is very clear, he said, adding, "I find it hard to think this is clear, whatever else it is," the newspaper reported.
Attorneys for both the Obama administration and challengers to the law were united on one issue Monday -- the Supreme Court could hear the case now, The New York Times reported.
The key sticking point in the constitutional challenge is whether Congress exceeded its authority with the 2010 health-care law's so-called "individual mandate," which requires almost all adult Americans to maintain health insurance or risk a financial penalty.
The individual mandate -- scheduled to take effect in January 2014 -- is the pivotal piece of the law.
"The requirement that people purchase insurance is the key to having health insurance be there for everyone when they need it," said John Rother, president of the National Coalition on Health Care, which works to achieve reform of the U.S. health-care system.
Opponents call the mandate a stunning government intrusion into the private lives of Americans and argue that Congress has no right to tell an individual to buy a certain product.
Grace-Marie Turner, president of the Galen Institute, a conservative public policy group, and a critic of the new law, was heartened that the High Court agreed to hear challenges to the legislation.
"This case is before the Supreme Court in record time. Two years from the law being enacted to the case being heard is really remarkable," Turner said. "And you have 26 states -- the majority of states -- challenging the law."
The Supreme Court will also hear arguments this week on whether the law is unconstitutional for requiring states to either comply with an expansion of Medicaid to cover more lower-income people without health insurance, or lose federal matching funding. At issue is the concept of "federalism," the division of powers between the federal and state governments.
Finally, the court will address "severability" -- that is, whether the individual mandate can be struck down while leaving the rest of the law intact.
"There are 50 million people in this country who don't have health insurance. The Affordable Care Act will probably extend coverage to an estimated 30 to 32 million of those people," said Renee Landers, a professor at Suffolk University Law School in Boston.
In a recent New England Journal of Medicine commentary, Landers described arguments for and against severability.
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