That provision is the extension of Medicaid to cover a greater number of the poor. Twenty-six states say the expansion amounts to an unconstitutional coercion of state governments, which provide part of Medicaid’s funding.
The decision on this issue is probably the most important the Supreme Court will be making on the Affordable Care Act,” said Ronald Pollack, executive director of Families USA, a consumer advocacy group that backs the law, referring to the statute by a common shorthand.
“Probably the most important achievement of the law is that it is going to reduce the number of people who don’t have health insurance by tens of millions. . . . About half of these people will gain their coverage through the Medicaid expansion. So the review of this provision goes right to the heart of the major accomplishment of the Affordable Care Act,” Pollack said.
Specifically, the law vastly broadens the minimum eligibility requirements for Medicaid, which provides health insurance to the poor and disabled with a combination of federal and state dollars.
Under the old rules, in exchange for federal grants that covered 50 to 80 percent of their Medicaid costs, states had to offer coverage to all children in families with annual incomes below the federal poverty level — $22,350 for a family of four — as well as to selected children with higher incomes and some adults with lower ones.
Under the health-care law, beginning in 2014, states will be required to cover all residents with incomes up to 133 percent of the poverty level, including childless adults, adding an estimated 17 million uninsured Americans to Medicaid’s rolls.
Initially, the federal government will foot the entire bill for covering the newly eligible. Its share will gradually drop to 90 percent by 2020 and beyond.
The 26 Republican state attorneys general and governors who filed the challenge to Medicaid expansion contend that these changes unconstitutionally force them to increase their spending on the program.
The Supreme Court on Monday announced it will hear five-and-a-half hours of oral arguments on the health care overhaul's constitutionality in March, reviving the health reform debate just months before the 2012 elections.
Given the implications of the case, the court should consider providing live audio and video coverage of the proceedings, Republican Sen. Chuck Grassley of Iowa wrote in a letter to Chief Justice John Roberts on Tuesday.
"The constitutional questions presented in the case are momentous," Grassley wrote. "The public has a right to witness the legal arguments likely to be presented in the case."
House Democratic Leader Nancy Pelosi on Wednesday said she backed Grassley's request.
"When the Affordable Care Act is placed before the highest court in our country, all Americans will have a stake in the debate; therefore, all Americans should have access to it," Pelosi said in a statement. "Openness and transparency are essential to the success of our democracy, and in this historic debate, we must ensure the ability of our citizens to take part."
Brian Lamb, the CEO of C-SPAN, also sent a letter to Roberts on Tuesday with the same request, noting that the five-and-a-half hours of arguments scheduled for the case indicates its significance -- and makes the case for cameras more compelling.
"Interested citizens would be understandably challenged to adequately follow audio-only coverage of an event of this length," he wrote.
Grassley first introduced legislation that would allow cameras in the courtroom in 1999. Since then, the Supreme Court has been releasing audio after the fact of the oral arguments made in compelling cases. The first audio the Supreme Court ever released on an expedited schedule was for Bush v. Gore in 2000, the case that effectively resolved the presidential election.
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