Monthly Archives: March 2012

Supreme Court Weighs Health Reform Law: Poor, African Americans to be Most Impacted by Decision

(Photo/courtesy Supreme Court Collection)

 By Talib I. Karim
Contributing Health Writer

This week, the U.S. Supreme Court convened hearings to settle the question once and for all of whether the historic health reform law, the Patient Protection and Affordable Care Act, dubbed “Obamacare” by Republicans is constitutional. Supreme Court experts suggest that this case is the most significant before the Court in more than 50 years – rivaling Brown v. Board of Education – a landmark case that led to the end of legalized segregation.

Given the magnitude of the case, the Supreme Court had set aside six hours of arguments over a three day period which began on Monday, March 26 through Wednesday – more time given to any case since 1966. The justices have also postponed half of their normal monthly case load to clear way for the Court to issue a decision by as early as July. 

The case will have a significant impact on the upcoming election in November. If the Court strikes down the Affordable Care Act, it could be considered a win by Republicans who seek to unseat President Obama and take over both houses of Congress. However, if the Court allows the law to stand in whole, or in part, the president could declare his signature legislative achievement to date, a victory.

A recent report by Brown University Professor Michael Tesler makes the point what many, including former President Jimmy Carter, have long stated: much of the opposition to Obama’s initiatives like health reform has less to do with policy than with race. While Obama himself has attempted to set aside the racial dimensions of debates over health care and even the tragic killing of Trayvon Martin, Tesler’s study is clear.

“African-Americans were about 20 points more supportive of the Barack Obama [health] plan (with 80% support) than they were of the Bill Clinton plan,” said Tesler in an interview for a National Public Radio (NPR) program hosted by Michel Martin.  Yet, the divide is not simply an issue between African Americans and European Americans, Democrats and Republicans, suggests Tesler.  Instead, Tesler argues that health and other policies of President Obama are likely to be supported by people of all race who have liberal attitudes about race.

Four Separate Hearings

The reason behind the unprecedented three-day, 6 hours of oral arguments before the Supreme Court is rooted in the four separate issues being considered. Each issue is considered so unique, that the Supreme Court has afforded separate hearings for each. On Day One, lawyers were asked to debate whether the Supreme Court has the power to decide on the merits of the Affordable Care Act’s penalty for failure to get health insurance – considered a tax by some – since the fines and other sanctions don’t kick in until 2015. If the Court rules that the penalty for not getting health insurance is a tax then it could punt and put off the issue for three more years, after the presidential elections.

On Day Two, the Court requested arguments on whether the health law’s individual mandate itself is constitutional under the Commerce Clause, which allows the federal government to regulate interstate activity.

The final day of arguments focused on two questions, the first: whether the health reform law can stand even if the Court declares the individual mandate unconstitutional; the second whether the Affordable Care Act’s expansion of Medicaid to cover everyone under 133 percent of the federal poverty line [individuals with yearly earnings of about $14,000] by 2014 is too onerous.  The federal government argues that Medicaid is a voluntary grant program, thus states can opt-out if they object to the expanded coverage.

People of Color, Poor Caught in Middle

While health reform was being debated by lawyers before the Supreme Court, the nation’s top African-American physicians – members of the National Medical Association (NMA) – along with state legislators from across the country lobbied federal officials to ensure people of color are able to get their fair share of benefits.

NMA President, Dr. Cedric Bright, said people of color may likely feel the brunt of any decision. On the one hand, if the law stays intact, out of those unable or unwilling to get health insurance as mandated, Bright acknowledges that African Americans in particular may be those disproportionately required to pay the-lack-of-insurance fine [at least $695 per year by 2016]. Bright argues, that even this modest sum is a lot for “… folk with only a few dollars a month left over in their pockets.”  Bright said, “I believe an ounce of prevention is much better than a pound of cure.” He also said that the mandate is a small cost for benefits provided by health reform: billions to build community health centers, funding to address ethnic health disparities, and increased minority participation in clinical trials.

Another historic dimension of this case is the record number of legal filings [at least 170, including more than 120 “friend-of-the-court” or amicus briefs]. These briefs, or written legal arguments, are known to have great weight on the Court’s decisions, so much so that often justices quote directly from these submissions in writing their own decisions.

One such brief was filed by a coalition led by the NAACP Legal Defense Fund under the lead signature of John Payton, who was the group’s president until he died suddenly the week before the Supreme Court hearing.  In their brief, the legendary civil rights lawyer Payton and his colleagues write, “[U]ninsured persons experience significant hardship that has a profound cumulative impact on our nation….These burdens are disproportionately borne by racial and ethnic minorities, lower-income persons…For many individuals, being uninsured is not a choice, but rather is a consequence that is imposed on them due to circumstances largely beyond their control.

For the nation, and the tens of millions who benefit from the health reform law, eyes are likely to stay glued on the Supreme Court until its ruling this summer.


The writer is a lawyer focused on health, business, and family law in the District of Columbia.  To contact the writer, email him at