Justices appear open to saving parts of health law

WASHINGTON (AP) — Arguments in the U.S. Supreme Court failed to yield clear hints how the justices would rule on the question of whether President Barack Obama's health care overhaul would be left standing if the high court were to strike down the linchpin provision that all Americans must have health insurance.

The last of three days of extended hearings on the two-year-old health care law spent much time dealing with hypothetical arguments by both supporters and opponents: Does the whole law collapse if the so-called individual mandate — the requirement that all Americans acquire health insurance — is ruled to be an unconstitutional government intrusion in the rights of citizens?

The Wednesday afternoon session dealt with the law's expansion of Medicaid, the shared state-federal government program that provides health care for low-income and disabled Americans. The expansion of the Medicaid program was designed to give insurance coverage to 15 million more people.

When the court rules in June, the decision will have a major impact on the lives of virtually all Americans and will reanimate, regardless of the outcome, the political fight over how to deal with the country's high medical costs. Health care consumes 17 percent of the nation's economy.

When the Obama law squeaked through Congress, Democrats still controlled the House of Representatives. Every Republican member of Congress in both the House and the Senate voted against the law, and all the Republican candidates for the nomination to challenge Obama in November have vowed to work for the law's repeal -- assuming the conservative-dominated Supreme Court does not first strike it down.

Before the health care law was passed, 50 million Americans did not have insurance. That was largely because those people could not afford to buy coverage or were denied it because of their health history. The plan, signed into law by Obama two years ago, was estimated to bring 30 million of the uninsured under the health care umbrella — half that number through the Medicaid expansion.

Before Obama's overhaul, the United States was the only major developed country without a national health care program.

Wednesday's court arguments showed several of the justices receptive to leaving portions of the sweeping plan in place, even if they were to strike down the mandate.

That provision is key to the law because it would protect the profits of the private insurance companies, which would remain central to providing coverage. The mandate would force younger people, who often forgo buying insurance, into the market. Those new premiums would help make up for the law's requirement that insurance companies stop denying insurance to people with health problems — so-called pre-existing conditions. The law would also limit the cost of insurance as people grow older and require more health care.

The court is hearing the constitutional challenge to the overhaul law after 26 states and a private business group filed suit to have it stricken as a government intrusion into citizens' rights.

Democratic-appointed liberal Justices Sonia Sotomayor, Elena Kagan and Ruth Bader Ginsburg — and even Republican-appointed conservative Chief Justice John Roberts and Justice Antonin Scalia — seemed open to the idea that the law contains provisions that can be saved even if the mandate to buy health insurance is struck down.

The justices seemed skeptical Wednesday of the position taken by Paul Clement, a lawyer for the 26 states that oppose the law.

"The rest of the law cannot stand" if the mandate is struck down, Clement told the justices.

"What's wrong with leaving this in the hands of those who should be fixing this?" asked Sotomayor, referring to Congress.

Scalia suggested many members of Congress might not have voted for the bill without the central provisions, and he said the court should not go through each page to sort out what stays and what goes.

"What happened to the Eighth Amendment?" Scalia asked, referring to the Constitution's ban on cruel and unusual punishment. "You really expect us to go through 2,700 pages?"

The court's decision on the health care overhaul, regardless of how it turns out, likely will intensify the ideological differences splitting the country.

The Obama administration argues that the only other provisions the court should kill if the insurance mandate is stricken are ones that require insurers to cover people regardless of existing medical problems and limit how much they can charge in premiums based on a person's age or health.

Conservative justices on the nine-member court on Tuesday pointedly questioned the law's core requirement that all Americans must buy insurance coverage or face a penalty.

The high court justices are appointed for life terms by the president in office when vacancies occur. It is made up of four Democratic-appointed, reliably liberal judges and four Republican-appointed conservatives. Justice Anthony Kennedy, while chosen by conservative Republican President Ronald Reagan, has voted with either camp depending on the issue.

While he sharply challenged the mandate, Kennedy also conceded that the absence of the requirement affects "the rates of insurance and the costs of providing medical care in a way that is not true in other industries."