By Lisa Esposito
WEDNESDAY, March 28 (HealthDay News) -- On the last of three days of legal arguments over the nation's 2010 controversial law that overhauled health care, Supreme Court justices debated Wednesday whether a key provision of the legislation could be ruled unconstitutional without invalidating the entire law.
The discussions focused once again on the same pivotal piece of the law that occupied most of Tuesday's debate -- whether the federal government can require adult Americans to purchase health insurance or face a penalty for not doing so. As many as five of the nine justices expressed varying degrees of doubt Tuesday about the constitutionality of that requirement -- often referred to as the individual mandate.
"My approach would be to say that if you take the heart out of this statute, the statute's gone," Justice Antonin Scalia, one of the court's leading conservatives, said Wednesday, The New York Times reported.
Some of the other justices weren't prepared to go that far Wednesday, the Times reported, but they seemed to agree that striking down the individual mandate would basically gut the law.
If the mandate were ruled unconstitutional, Justice Ruth Bader Ginsburg, a liberal jurist, said the court would be left with a choice between "a wrecking operation" and "a salvage job," the newspaper said.
Opponents of the law -- including 26 states that contested the constitutionality of the legislation, resulting in the Supreme Court review -- contend that Congress exceeded its authority with the individual mandate.
The law's supporters argue that without the requirement that people have insurance coverage while they're healthy, there won't be enough money in the risk pool to pay to take care of them when the need for health care eventually -- and inevitably -- arises.
The individual mandate -- scheduled to take effect in January 2014 -- is arguably the key component of the law.
Critics of the law have said that provisions of the legislation are too intertwined for the law to stand without the individual mandate. The Obama administration has said the law can still work without the mandate, but provisions such as prohibiting insurance companies from denying coverage to people with preexisting conditions would be greatly compromised without the mandate.
The Patient Protection and Affordable Care Act is the most ambitious government health-care initiative since the Medicare and Medicaid programs of the 1960s. It's also the legislative cornerstone of President Barack Obama's presidency, and 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 the provision that people buy health insurance starting in 2014 or face a penalty.
Medicaid expansion also scrutinized
The Supreme Court justices also spent part of Wednesday considering a challenge by the 26 states to the Affordable Care Act's expansion of Medicaid, the government-run insurance program for low-income Americans. An estimated 15 million Americans would gain insurance coverage under the expansion of Medicaid.
The court's liberal justices gave every indication they were prepared to uphold the Medicaid expansion, with Justices Sonia Sotomayor, Elena Kagan, Ruth Bader Ginsburg and Stephen Breyer expressing strong disagreement with the states' contention that the expansion of the joint state-federal program was a coercive maneuver that violated the Constitution, the Associated Press reported.
"Why is a big gift from the federal government a matter of coercion?" Kagan asked. The law calls for the federal government to fund 90 percent of the expansion for 10 years.
But the court's more conservative justices suggested that Medicaid expansion was coercive to states, the Times reported.
On Tuesday, the court's four conservative justices appeared opposed to the mandate requiring most adults to have insurance or pay a penalty, with several questioning whether the mandate falls under the federal government's constitutional powers. Four liberal justices seemed to come out in its favor.
Justice Anthony M. Kennedy, considered a swing vote, also seemed critical of the mandate. He suggested that the health-care law assigns the federal government regulatory powers over interstate commerce that exceed those previously supported by the court, the Washington Post reported.