"Can you create commerce in order to regulate it?" he asked.
Chief Justice John G. Roberts Jr. and Justice Samuel A. Alito, both considered conservatives, compared forcing Americans to buy health insurance to compelling them to purchase commodities such as cellphones or burial services, respectively.
Budget office sees savings; opponents skeptical
Here's how the health-reform law is designed to provide health insurance to uninsured Americans:
- Individual mandate. It requires most adults to purchase health insurance or pay a penalty. By 2016, the phased-in penalty will reach either $695 or 2.5 percent of yearly taxable income, whichever is greater. People with incomes below tax-filing thresholds will be exempt from the provision. Up to 16 million people are projected to join the rolls of the insured under the mandate.
- Medicaid expansion. This would increase eligibility to all people under age 65 with annual incomes up to 133 percent of the federal poverty level -- about $14,850 for a single adult and $30,650 for a family of four in 2012. Non-disabled adults under 65 without dependent children were previously ineligible. Another 16 million people are estimated to gain insurance under the expansion.
- State-run insurance exchanges. They will be created to help small businesses and individuals purchase insurance through a more organized and competitive market.
In February 2011, the Congressional Budget Office estimated that savings from the Affordable Care Act would cut the federal deficit by $210 billion during the next decade.
But opponents say that the cost-cutting provisions probably won't work.
Devon Herrick, a health economist at the free-market National Center for Policy Analysis, said the law sets up a "slippery slope" that will increase costs, not lower them.
"If Congress and company have the legal authority to decide the minimum coverage you must have, all manner of lobbyists and special interests and providers for specific diseases will descend on Washington and state capitals, as they always have, to make sure that their respective services are covered by that mandate," Herrick said.
The law's supporters argue that without the requirement that people have insurance coverage while they're healthy, there won't be enough money to pay for the nation's health insurance needs.
"If people don't feel like paying, then get sick and go to the emergency room or the hospital, those people's costs will be added on to our insurance bills as they are today, which makes it much more expensive," said John Rother, president of the National Coalition on Health Care, which works to achieve reform of the U.S. health-care system.
The Affordable Care Act has been controversial since it was passed by Congress and signed by Obama in March 2010. Poll after poll has found that Americans don't like the individual mandate. But a recent Harris Interactive/HealthDay poll revealed that people are starting to warm up to certain key provisions of the law -- such as the ban on insurance companies turning away applicants with preexisting health problems.
Some popular provisions -- including allowing children to stay on their parents' health plans until age 26 -- are already in place.
Other provisions meant to help older Americans began in 2011, with changes to continue through 2020.
The Supreme Court ruling is expected in June. The court could go one of several ways:
- It could rule the individual mandate is unconstitutional and the entire law invalid.
- It could rule the mandate is constitutional and the entire law can stand.
- It could reach a middle ground: that the individual mandate is unconstitutional but the rest of the law can stand.
- It could decline to rule on the case and the health reforms would proceed.
The American Bar Association website links to briefs filed with the U.S. Supreme Court case on the Affordable Care Act.