Medicare

In 2010 Congress enacted the Patient Protection and Affordable Care Act containing hundreds of provisions across ten titles. The Act requires most Americans to maintain minimum essential health insurance coverage beginning in 2014 or else make a shared responsibility payment calculated as a percentage of household income subject to a floor and ceiling. The Act also expands Medicaid by requiring participating states to cover adults with incomes up to 133 percent of the federal poverty level while increasing federal funding but threatening loss of all Medicaid funds for noncompliance. On the day the President signed the Act Florida and twelve other states filed suit in the United States District Court for the Northern District of Florida challenging the individual mandate provisions under Article I. The original plaintiffs were later joined by eighteen additional states several individuals and the National Federation of Independent Business. The District Court held that the individual mandate exceeded congressional power and could not be severed from the remainder of the Act so it struck down the entire statute. The Court of Appeals for the Eleventh Circuit affirmed that the individual mandate exceeded congressional power but held the provision severable from the rest of the Act while unanimously upholding the Medicaid expansion. Other courts of appeals reached conflicting results on the mandate with the Sixth Circuit and the D.C. Circuit upholding it under the commerce power and the Fourth Circuit applying the Anti-Injunction Act to bar review. The Supreme Court granted certiorari to review the Eleventh Circuit judgment on both the individual mandate and the Medicaid expansion and appointed amici curiae to address severability and the Anti-Injunction Act. The penalty for noncompliance with the individual mandate first becomes enforceable in 2014. The present suit seeks to restrain its future collection. The Act describes the payment as a penalty rather than a tax. It directs that the payment be assessed and collected in the same manner as taxes but bars the IRS from using criminal prosecutions or levies to enforce it.

The Patient Protection and Affordable Care Act was enacted in 2010 after earlier state-level attempts at insurance market reforms in the 1990s produced adverse selection and rising premiums. The Act combined guaranteed-issue and community-rating requirements with an individual coverage mandate and refundable tax credits for households earning between 100 and 400 percent of the federal poverty line. It directed each State to establish an American Health Benefit Exchange but provided that the Secretary of Health and Human Services would establish and operate such an Exchange if a State did not. Sixteen States and the District of Columbia created their own Exchanges; the remaining thirty-four States, including Virginia, have Federal Exchanges operated by HHS. The IRS promulgated a regulation in 2012 interpreting the tax-credit provisions to apply to insurance purchased on any Exchange, whether established by a State or by the Federal Government. Petitioners, four Virginia residents who did not wish to purchase health insurance, filed suit in the Eastern District of Virginia challenging that regulation. The district court dismissed the complaint, concluding that the statute unambiguously made credits available on Federal Exchanges. The Fourth Circuit affirmed, treating the statute as ambiguous and deferring to the IRS interpretation under Chevron. On the same day the Fourth Circuit ruled, the D.C. Circuit reached the opposite conclusion in a separate case and vacated the IRS rule. The Supreme Court granted certiorari to resolve the conflict.

Stephen C. Wiesenfeld and Paula Polatschek married on November 15, 1970. Paula worked as a teacher both before and after the marriage, with maximum social security contributions deducted from her salary each year. Her earnings substantially exceeded Stephen's and constituted the couple's principal source of support, as shown by her 1970 earnings of $9,808 against his $3,100, her 1971 earnings of $10,686 against his $2,188, and her 1972 earnings of $6,836.35 before her death. On June 5, 1972, Paula died in childbirth, leaving Stephen with sole responsibility for their infant son, Jason Paul. Stephen applied at the Social Security office in New Brunswick, New Jersey, for survivors' benefits for himself and his son. His son received benefits under 42 U.S.C. § 402(d) (1970 ed. and Supp. III), initially at $206.90 per month until September 1972 and then at $248.30 per month. Stephen was told he was ineligible for benefits on his own behalf because such benefits were available only to women. Stephen filed suit in February 1973 in the District of New Jersey on behalf of himself and all similarly situated widowers, seeking a declaration that the statute was unconstitutional to the extent it treated men and women differently, an injunction against denial of benefits on the basis of sex, and payment of past benefits from June 1972. Cross-motions for summary judgment were filed. A three-judge court determined it had jurisdiction and granted summary judgment in Stephen's favor, issuing an order providing the requested relief. The Supreme Court noted probable jurisdiction.