Today, the Unites States Supreme Court heard the first arguments to determine the constitutionality of the Patient Protection and Affordable Care ACA (ACA) -- commonly, if pejoratively known as Obamacare. The Court addressed only one issue today: Does a prior federal law, the Anti-Injunction Act, prevent the Court from deciding the case at this time.

The ACA’s individual mandate provision, which takes effect in 2014, requires that those who violate the mandate must pay a fine, starting in 2015. If the Court determines that those fines are equal to taxes, the Anti-Injunction Act might apply. This act would bar the Court from hearing the case until the first penalty, or tax, was paid by someone refusing to purchase the coverage. 

Today’s hearing was basically a technical statutory interpretation to determine whether the Court has jurisdiction to decide the case.  From my reading of the transcript, it’s likely that the Court will decide the case -- nothing raised during the hearing suggested that the Court would postpone the decision. 

The technical legal issues argued today are not likely to affect the issues of greatest concern to the public; the argument only tangentially raised the mandate.  Even when discussing the mandate, I don’t think the questions provided any particular insight into how the Court views its constitutionality. 

But in considering if the Justices signaled their views on whether the individual mandate penalties could be considered a tax, an exchange between Justice Alito and the Solicitor General (the government’s chief legal authority) was illuminating. Justice Alito asked the following question: “Has the Court ever held that something that is a tax for purposes of the taxing power under the Constitution is not a tax under the Anti-Injunction Act?”  The answer was a firm, “No.” 

Later in the argument, Chief Justice Roberts stated that, “…the idea that the mandate is something separate from whether you want to call it a penalty or tax just doesn't seem to make much sense.”  After attorney Gregory Katsas responded that the “…statute was very deliberately written to separate mandate from penalty in several different ways,” Chief Justice Roberts said, “Why would you have a requirement that is completely toothless? You know, buy insurance or else.  Or else what?  Or else nothing.”

I doubt that any firm conclusions can be drawn from these exchanges.  But several similar exchanges suggest that the Justices are grappling with some of the deficiencies in how the legislation was drafted.  For example, one exchange indicated concern for opening the courts to the proverbial floodgates of litigation over individual challenges to the mandate, the exemptions to the mandate, and the related penalties.

On Tuesday, the Court will address the constitutionality of the ACA’s individual mandate, far and away the ACA’s most controversial aspect. Not much that occurred today gave us much insight into the Justices’ inclinations on that issue.

Supreme Court oral arguments serve several important functions.  It’s an opportunity for the Justices to explore the broader constitutional and policy implications of the case being decided.  Especially in controversial cases, such as whether the ACA is constitutional, the Court uses the oral argument to press the attorneys on how the ruling will influence future constitutional decisions.  Will overturning the ACA lead to a large number of new cases challenging other aspects of the modern administrative/welfare state?  Will upholding the act give Congress unbridled authority to tell Americans how to behave?

It's also important not to over-analyze what takes place during the hearings.  Just because a Justice asks a probing or thought-provoking question doesn't mean he or she is leaning one way or the other.  The Justice may simply be trying to clarify the nature of the argument or its implications.  A Justice may also use questions to frame arguments for other Justices that the attorneys miss or do not clearly articulate. 

And there’s an intangible factor to consider as well.  More than any other venue, the Supreme Court is very concerned with its legitimacy as an institution and is wary of getting too far ahead of the public.  That’s a significant reason why the Justices will want to understand the policy implications of how the Court might rule in the ACA litigation.

As with many constitutional challenges, the legal issues the Court is hearing this week are easy enough to state, but very difficult to resolve.  The provisions of the Constitution are broad statements that can easily be interpreted in different ways.  Since the general outlines of each side’s arguments have been stated in their legal briefs and in the arguments in the lower courts, there are several questions to consider regarding the oral arguments. 

• Did we learn anything that helps us understand the issues in a new way? 
• Did the oral arguments reveal new legal or policy implications? 
• Did the hearings reveal clear weaknesses in one side or the other?
• Were there any revealing questions or answers that offer new insight into how the case might be resolved? 
• Were there any unanticipated arguments or even unexpected concessions that might change the Court’s thinking? 
• Did the arguments focus on whether the ACA is desirable policy or strictly on Congress’s power to exercise its policy judgments?
• Did the arguments live up to the hype?

For all of the abstract constitutional arguments we’re likely to see Tuesday and the technical arguments that dominated today’s hearings, it is important to keep in mind that how the Court rules has significant implications for Medicare beneficiaries.  Even though the individual mandate does not directly affect Medicare recipients, the act contains numerous provisions that are beneficial to them that would be lost if the act is overturned. 

For instance, the act requires that Medicare recipients receive preventive care at no cost, and Medicare beneficiaries have saved money through closing the so-called donut hole.  Most importantly, the ACA puts in place potential long-term strategies that could reduce health care costs and help sustain Medicare without reducing the benefits patients receive.

In short, everyone has a stake in how the Court rules. 

Peter Jacobson is president of the Public Health Law Association, professor of health law and policy and director for the Center for Law, Ethics, and Health at University of Michigan’s School of Public Health. He received his law degree from the University of Pittsburgh School of Law in 1970, and a Masters in Public Health from UCLA in 1988. Before coming to the University of Michigan, he was Senior Behavioral Scientist at RAND from 1988 to 1996. His current research interests focus on the relationship between law and health care delivery and policy, law and public health systems, and health care safety net services.