The US Supreme Court is expected to hand down its judgment in the high profile, heavily debated case of Florida v Department of Health and Human Services before its 2012 term draws to a close at the end of June.

The Patient Protection and Affordable Care Act passed through Congress and was signed into law by President Obama in March 2010. The Act is being challenged by attorney generals representing 26 states, the National Federation of Individual Business, and various other organisations and individuals, who are seeking a declaration from the US Supreme Court that the Act is unconstitutional. Oral arguments were heard over three days in March and the upcoming decision will have important ramifications for the future of healthcare in the US.

The key issues that the US Supreme Court will be ruling on are:

•Whether to strike down the “individual mandate” provision in the Act that obliges individuals to purchase health insurance. While this was implemented to make insurance widely affordable by spreading the cost, those who oppose the Act state that this provision is unconstitutional in that Congress is obliging people to purchase a product from a private company.

• Whether to strike down the expansion of Medicaid under the Act; the argument against this is that it places undue burden on individual states to pay for the expansion of a health care program for the poor.

• If both the individual mandate and the expansion of Medicaid are struck down, whether these provisions can be severed from the rest of the Act, some provisions of which have already come into effect. The Obama administration argued that the Act can only exist in its entirety and if the provisions are severed the Supreme Court justices would be conducting an exercise of guessing what Congress meant when it passed the law.

If the Act stands, Americans will be obliged to purchase health insurance from 2014. If the entire Act is struck down, the whole health care law may be dismantled – according to a recent poll by CBS News/New York Times, only approximately a quarter of Americans want to see the whole Act upheld.

Even if the Act is struck down, the US’ largest health insurer, UnitedHealth Group Inc. has today announced that it will continue the coverage protections included in the Act regardless of the US Supreme Court’s decision, for example, the provision of coverage for those under the age of 26 on their parents’ plan.

The US Supreme Courts’ decision will have both judicial and political ramifications for the US: if the Act is struck down, it will constitute a high-profile display of judicial activism that may affect public support of and confidence in the US Supreme Court (President Obama said in April that it would be wrong for an “unelected” Supreme Court to strike down legislation passed by an elected Congress). Either way the decision goes, the upcoming US presidential elections in November are likely to be played out in part over what healthcare Americans want.

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