Supreme Court Background

***This page contains background, pre-decisional information on the Affordable Care Act cases decided by the Supreme Court in June 2012. For updated information and resources about the decision, visit our main Supreme Court page.***


In March 2012, the U.S. Supreme Court heard three days of oral arguments on the constitutionality of several provisions of the Affordable Care Act, the historic health reform law enacted in March 2010. The key provisions challenged by both private interests and a number of states included the minimum coverage provision ("individual mandate") that will require most Americans to obtain health insurance or pay a small penalty, and the requirement that states cover more uninsured individuals by expanding eligibility for their Medicaid programs. The challenges to the minimum coverage provision were brought by Florida and 25 other states and by the National Federation of Businesses and two private citizens who do not currently have health insurance. The challenge filed by Florida and the other states also addressed the Medicaid expansion.

APHA joined briefs in support of ACA provisions
Early in 2012, APHA joined other public health organizations in signing on to two friend-of-the-court briefs supporting the ACA, submitted as the U.S. Supreme Court prepared to hear arguments from opponents and supporters in considering the law’s constitutionality.

Three days of hearings

Day 1: Monday, March 26, 2012
On the first day of the hearings, arguments focused on a preliminary question--whether the court could even make a judgment on the law, when the provisions in question haven't taken effect yet. The question was whether the 19th century Anti-Injunction Act barred court action at this time. Both the states and the federal government argued that the court should make its decisions now; the court had to bring in an outside lawyer to argue that the ruling must be delayed. Kaiser Health News created this
guide to the day's arguments, which includes links to audio and transcripts of day one proceedings. The Washington Post and Politico were among the many news outlets that also provided coverage.

Day 2: Tuesday, March 27
On the second day of the hearings, the court heard arguments on the minimum coverage provision ("individual mandate"), which would require most Americans to obtain health insurance or pay a penalty starting in 2014.
A guide to the day's arguments, which includes links to audio and transcripts, was again provided by Kaiser Health News. Articles by The New York Times and CNN were just two of many more analyses of the arguments and the justices' questions. This short paper, recently issued by the Robert Wood Johnson Foundation and the Urban Institute and linked from Health Reform GPS, provides more information about the minimum coverage provision.

Day 3: Wednesday, March 28
On the final day of the hearings, the court focused on the Medicaid expansion, and also considered the issue of severability, or whether the rest of the law can stand even if other provisions are struck down. Kaiser Health News again provided
a guide to the day's arguments, along with links to audio and transcripts.

Also on Wednesday, APHA's Executive Director Georges Benjamin wrote a powerful piece for Public Health Newswire about the importance of this week's hearings.

After the hearings

June 15 update: Pre-decisional analysis commissioned by APHA
In advance of the Supreme Court's decision, APHA commissioned 
this analysis by the National Health Law Program and the Network for Public Health Law. It succinctly summarized the major legal issues at stake, the arguments on both sides, and the implications of potential rulings.

June 28 update: Supreme Court uphold the Affordable Care Act!
Visit our main 
Supreme Court Decision page for an overview of the ruling and its impacts, and for updated resources.

Additional pre-decisional resources
(See our main Supreme Court Decision page for updated resources.)

APHA resources

Other resources

APHA statements and media mentions