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The U.S. Supreme Court enters the third and final day of opening arguments on the various challenges to the health care reform law.  Yesterday, the court heard arguments concerning the individual insurance mandate, Monday on the topic of whether or not a challenge can be raised against a tax that has not yet been imposed and today on the Medicaid expansion and whether the federal government overstepped its authority by requiring states to expand Medicaid programs nationwide.  Finally, this afternoon the court will hear arguments on whether or not certain pieces of the law can be struck while leaving other intact - also known as “severability.”

At this juncture, it appears as if there are deep divisions between justices, in particular among the key “swing-vote” justices, those that generally tip the scale in favor or against an issue.  With 9 justices, 5 are required to agree.  The court is expected to rule on these issues in June.

For more information, IHA has developed a “Policy Brief” on the issues providing an in-depth view of the cases before the court.


The U.S. Supreme Court is set to hear opening arguments on a case challenging the constitutionality of the Affordable Care Act, or “Health Care Reform” law passed in 2010. The law is being challenged on a variety of grounds by 26 states.

The court’s decision, not expected until this summer, will have a major impact on the future of reform efforts. The court has a variety of options concerning this issue: 1) they can uphold the law in full; 2) rule that certain sections of the law are unconstitutional, while leaving some parts intact, 3) rule the entire law unconstitutional, effectively repealing it or 4) defer ruling based on an argument that a court can’t rule on a challenge to a tax that has not yet been assessed. Though a highly technical argument, which the court will hear first, it could punt this issue 3-4 years down the road.

The oral arguments will be as follows:

March 26 – 90 minutes on whether the Anti-Injunction Act (AIA) disallows the court from taking up the challenge against the individual mandate. The AIA prevents a court from striking down a tax before the tax is enacted. Even though the Affordable Care Act is current law, many of the provisions to not go into effect until 2014. Should the court rule in favor of the AIA, it would punt the court’s consideration of this issue into the future.

March 27 – 2 hours on the individual insurance mandate and whether the federal government has the constitutional authority to mandate a consumer’s purchase of health insurance.  The federal government will argue that the mandate is constitutional because it falls within the authority of Congress to regulate interstate commerce.  Meanwhile, the plaintiffs will argue that the law represents near limitless power of the federal government and that Congress cannot require an individual to enter into commerce under the interstate commerce clause of the Constitution.

March 28 – 1 hour on the constitutionality of the ACA’s Medicaid expansion. The plaintiff will argue that the federal government is overstepping its bounds by requiring states to expand their Medicaid programs.

Following the discussion the court will hear 90 minutes of argument concerning the ability for the individual mandate, should it be found to be unconstitutional, to be removed from the law, while leaving the rest of the law intact.

All of these possible rulings would set up a variety of challenges for hospitals, but perhaps most troubling is the scenario whereby the court strikes sections of the bill that would be beneficial to hospitals while leaving the existing Medicare cuts to hospitals also found in the bill. This “swiss-chesse” approach would punch holes in the law that could keep hospitals on the line for the $155 billion in Medicare cuts but hospitals would not benefit from the insurance mandate, should it be struck down, that would result in more insured patients.

Check the IHA Policy Blog for updates on this issue and for additional information and insight on the case.

Featuring hospital and health care headlines from the media and the Web.

Iowa News

Mental Health Funding Plan ‘Only a Starting Point’
An Iowa House committee approved a funding plan for the redesign of Iowa’s patchwork mental health delivery system, but even its sponsor called it only “a starting point.” (

The Transplant Process: Why You Should Help
113,000 people are in need of an organ. Over 600 of those live right here, in the state of Iowa.  (KCAU-TV)

Health Plus: Dietitian interns get real world experience
Many of us take what we eat seriously, but for aspiring dietitians, nutrition is a career commitment. In Health Plus, how one eastern Iowa hospital is helping them connect with real patients.  (

Iowa mental health reform up in air
Lawmakers are struggling with how to transform Iowa’s 99-county system for providing mental health services into a more uniform, statewide network. Meanwhile, the underfunded system leaves thousands waiting for services. (Omaha World-Herald)

National News

Rockefeller convenes hearing on prescription drugs
Medical experts testified Thursday before a congressional subcommittee looking into how the Medicare and Medicaid systems can help prevent and treat prescription drug abuse.  (Wall Street Journal)

House Votes to Kill a Medicare Cost Panel
In a rebuff to President Obama, the Republican-controlled House passed a bill on Thursday to abolish a Medicare cost control board created by the new health care law.  (New York Times)

How The Health Law Could Survive Without A Mandate
The Supreme Court will hear oral arguments next week on, among other things, whether the 2010 health law can require most Americans to have health insurance starting in 2014.  (NPR)

White House marks healthcare anniversary with caution, defiance
The second birthday of President Obama’s landmark legislative achievement, coming just three days before the Supreme Court begins oral arguments on its constitutionality, falls amid serious questions over whether it will have a third. (The Hill, Healthwatch Blog)


Featuring hospital and health care headlines from the media and the Web.

Iowa News

UIHC officials present updates to Regents
University of Iowa Hospitals and Clinics officials said they’re experiencing a slight budget lag at the state Board of Regents meeting Wednesday afternoon. (The Daily Iowan)

Classes to help diffuse a crisis
Every second counts in a medical emergency. To survive a heart attack or stroke, or a grievous injury, timely intervention by a trained individual is crucial. (Clinton Herald)

3 Finley Nurses Selected for 100 Great Iowa Nurses Celebration
The Finley Hospital announced that Julie Bartmann, Yolanda (Londi) Brauer, RN and, Sarah Ryan, RN were selected from a pool of over 500 applicants to be recognized at the “100 Great Iowa Nurse Celebration,” on Sunday, May 6, 2012, at Grand Ballroom at the Veterans Memorial Auditorium in Des Moines, IA.
(The Finley Hospital News Release)

National News

Ohio to begin Partnership for Patients program on Friday
The Ohio Hospital Association (OHA) will host Ohio hospitals, nursing homes, home health agencies and federal healthcare officials on Friday, March 23, in Columbus to begin the implementation of the Partnership for Patients program, a national public-private collaboration to improve the quality, safety and affordability of health care for all Americans. 
 (Healthcare Finance News)

Most states making healthcare reform headway
Forty-nine states and Washington, D.C., already have taken action supporting the Patient Protection and Affordable Care Act’s (PPACA) implementation, such as passing legislation, issuing regulations or other guidance, or actively reviewing insurer filings, according to an issue brief from Commonwealth Fund. (CMIO)

IPAB Repeal Bill, with Malpractice Rider, Heads to Full House
The repeal of the Independent Payment Advisory Board will get a full House hearing on Wednesday after the House Committee on Rules voted late Tuesday afternoon to pass HR 5 (the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011). (HealthLeaders Media)

Nurse shortage to reemerge
Although the nursing shortage has temporarily ended, healthcare providers need to utilize existing nurses as efficiently as possible, as the shortage will reemerge as the U.S. economy improves, according to a study published yesterday in the New England Journal of Medicine. (Fierce Healthcare)

Featuring hospital and health care headlines from the media and the Web.

Iowa News

Bids to be sought for old hospital demolition
The Van Diest Medical Center Board of Trustees Tuesday night approved a measure to seek bids for the demolition of the former Hamilton Hospital building.  (The Daily Freeman- Journal)

Supervisors hold off on support for Keokuk hospital
Lee County supervisors have said they are as concerned about the operation of the Keokuk Area Hospital as anyone else, but they decided to table a letter of support during their meeting Tuesday at the Lee County Sheriff’s Office. (The Daily Gate City)

National News

The New Jersey Experience: Do Insurance Reforms Unravel Without An Individual Mandate?
On Monday, when the Supreme Court hears arguments about whether the Affordable Care Act is constitutional, the justices will also contemplate a policy issue: Is it possible to reform the private insurance market, making affordable coverage available to all, without an individual mandate? (Kasier Health News)

Diagnostic Medical-Test Patents Limited by U.S. High Court
The U.S. Supreme Court put new limits on the availability of patents for diagnostic medical tests, ruling in favor of the Mayo Clinic in a case that will shape the growing field of personalized health care. (Bloomberg News)

Supreme Court rules that states can’t be sued for denying workers medical leave
The Supreme Court divided along ideological lines Tuesday in ruling that states may not be sued by their employees for illegally denying them medical leave. (The Washington Post)
Two (Very Different) Miami Hospitals Prepare For Health Law’s Medicaid Expansion
The health law’s expansion of Medicaid will cover some 16 million more Americans in the government program for the poor – if that part of the law survives the legal challenge it faces in the Supreme Court beginning next week.  (Kaiser Health News/NPR)


10,000 additional employees join Emanuel’s wellness plan
Ten thousand more employees at five city agencies have signed on to Mayor Rahm Emanuel’s plan to raise monthly health insurance premiums by $50 for employees who fail to participate in a “wellness program” to manage chronic health problems. (Chicago Sun-Times)