Patient Protection and Affordable Care Act

  • January 6, 2012

    by Jeremy Leaming

    The Obama administration’s signature domestic achievement, the Patient Protection and Affordable Care Act, which requires many people to purchase health care coverage in 2014, is a reasonable and constitutional means to provide millions of uninsured with health care coverage, the Department of Justice argues in a brief lodged today with the Supreme Court.

    The brief “arguments track the Obama administration’s arguments before lower courts,” Brian Beutler reports for TPM, which also provides access to the 130-page document.

    As Beutler notes, the DOJ explains why the law’s so-called individual mandate is a constitutional means to help millions of Americans afford health insurance. The law bars insurance companies from denying coverage or charging more to people who have pre-existing medical conditions. For that provision of the law to work, however, the law must require individuals who can afford health insurance to obtain minimum coverage or pay a penalty via their annual income tax returns.

    The DOJ’s brief argues that the law is a permissible regulation under its constitutional authority to regulate commerce and its taxing power.

    The federal government already regulates the health care market – Medicare and Medicaid are examples. However, millions of people, because of a lack of additional regulation have been unable to afford health care insurance or been denied it because of preexisting conditions.

    The DOJ argues that the law’s so-called individual mandate will bridge the gap.

    “The uninsured shift tens of billions of dollars of costs for the uncompensated care they receive to other market participants annually,” the brief states. “That cost-shifting drives up insurance premiums, which, in turn, makes insurance unaffordable to even more people.”

  • November 14, 2011

    by Jeremy Leaming

    As expected the Supreme Court announced this morning that it will review a legal challenge to President Obama’s landmark health care reform law, the Patient Protection and Affordable Care Act.

    The high court, as noted by SCOTUSblog and The New York Times, set aside five and half hours of oral argument in the case involving the U.S. Court of Appeals for the 11th Circuit opinion invalidating an integral provision of the health care reform law. In August, the 11th Circuit ruled 2-1 that the minimum coverage provision, which requires some individuals to carry health care insurance starting in 2014 or pay a penalty, is unconstitutional. In late September, the Department of Justice asked the Supreme Court to review the 11th Circuit opinion.

    White House Communications Director Dan Pfeiffer, said in a statement released earlier today, “We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree.”

    Georgetown University law school professor Randy Barnett, an opponent of the Affordable Care Act, told The New York Times, “It is high time for the high court to strike down this unconstitutional, unworkable and unpopular law.”  

    ACS President Caroline Fredrickson said:

    The Supreme Court has agreed to provide a welcome resolution to the ongoing debate over the constitutionality of the Affordable Care Act. Long-standing precedent shows that Congress can regulate commerce in the national interest. If Congress can’t regulate an industry with such a huge impact on the U.S. economy, is there any limit on a judge’s ability to undermine federal stewardship of equally pressing issues?

    Time and again the high court has reaffirmed the established power of lawmakers to address national problems with national solutions. We eagerly await a clear and categorical statement by the Court affirming the Act’s constitutionality and ensuring that the Constitution is not a straightjacket on the legislative branch. Only a radical or cramped reading of Congress's constitutional power to regulate commerce could lead the Court to find the law unconstitutional.

    Just last week, the U.S. Court of Appeals for the District of Columbia Circuit ruled in favor of the law’s minimum coverage provision. Judge Laurence H. Silberman, a Reagan appointee, concluded, in part, “The right to be free from federal regulation is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems, no matter how local – or seemingly passive – their individual origins.” In an article for Slate, Simon Lazarus, author of ACS Issues Briefs on the health care law, and public policy counsel for the National Senior Citizens Law Center, explains why Silberman’s opinion could carry considerable influence for the high court’s conservative justices.

  • October 18, 2011
    Guest Post

    By Reuben Guttman and Oderah Nwaeze. Reuben Guttman is a Director at the firm of Grant & Eisenhofer and heads the firm's False Claims Act litigation group. He is a Senior Fellow and Adjunct Professor at the Emory Law School Center of Advocacy and Dispute Resolution. Oderah Nwaeze is member of the Grant & Eisenhofer False Claims Act Litigation Group, and a 2011 graduate of Emory Law School.


    Buried in President Obama’s healthcare reform law, the Patient Protection and Affordable Care Act (PPACA), is a measure called the Physician Payments Sunshine Provision or the “Disclosure Law.” This law requires the public disclosure of payments made to doctors by pharmaceutical and medical device manufacturers.  Since even small gifts can compromise a doctor’s objectivity, a patient should know whether his physician has received money and/or gifts from drug or device companies.  Recent civil prosecutions of the pharmaceutical and medical device industries under the False Claims Act (FCA), resulting in pharmaceutical giants paying millions of dollars to resolve allegations that they paid kickbacks in order to induce the writing of prescriptions, demonstrates that the transparency required by this law is long overdue.

    The FCA allows private citizens with knowledge of a fraud on the government to bring suit in the name of the government. Whistleblower cases brought under the FCA against some of the world's largest pharmaceutical companies have surfaced allegations and information raising real concerns that illegal marketing schemes including off label marketing -- or marketing a drug for purposes outside its indication -- and kickbacks in form of payments made to doctors under the guise of research studies -- have caused billions of dollars of prescriptions to be written for drugs that are not needed or that may actually cause injury or illness with additional costs for treatment further burdening our nation's health care system. Within the last five years alone, Pfizer, AstraZeneca, Boston Scientific, Eli Lilly, and Biovail paid a combined total of $4.3 billion to settle claims of unlawful marketing.  Although Pfizer's share was a record $2.3 billion, the company posted revenues of more than $171 billion for the drugs that were illegally marketed. To a large degree, these settlements -- even with the huge monetary sanctions -- only serve to highlight problems rather than fully address them.