By Adam Liptak

On March 26, the Supreme Court began three days of hearings on challenges to the constitutionality of the Affordable Care Act, the health care reform bill pushed by President Obama and passed by Congress in March 2010 over bitter Republican opposition.

It is one of the most significant cases heard by the court in decades, with implications for the presidential race as well as the future of health care coverage. The decision, due in late June, is also likely to be a major factor in shaping the legacy of Chief Justice John G. Roberts Jr., as well as Mr. Obama, whose signature domestic initiative is on the line.

Day Three

On the third day of health care arguments, the justices shifted their attention to a question with enormous practical implications: If they strike down a key provision of the sprawling law, what other provisions would have to fall along with it?

Justice Antonin Scalia said the whole law would have to go. “My approach would be to say that if you take the heart out of this statute,” he said, “the statute’s gone.”

Other justices considered a variety of possible approaches.

The issue took on practical urgency after some of the questioning the day before had suggested that the law’s core provision, often called the individual mandate, may be in peril. It requires most Americans to obtain insurance or pay a penalty.

Last year, the United States Court of Appeals for the 11th Circuit, in Atlanta, ruled that the mandate was unconstitutional, but it said the balance of the law survived.

The Obama administration argued for a middle ground: that if the mandate falls, two politically popular provisions must die with it — those that prohibit insurers from declining coverage or charging higher premiums because of pre-existing medical conditions.

The challengers to the law argued that the entire act must fall along with the what one lawyer called “its heart.’’ The court appointed an outside lawyer, H. Bartow Farr III, to argue the 11th Circuit’s position, that the mandate could fall alone.

The court separated the day’s arguments into two sessions. After the morning session, which focused on the effect of overturning the mandate, the afternoon’s hearing dealt with the law’s expansion of Medicaid, part of its attempt to reduce the number of Americans without health insurance.

In the second argument, the court’s more conservative justices expressed concern that the law’s Medicaid expansion was unduly coercive to states. The law would give states additional money to expand Medicaid – which covers largely lower-income households – and also add new rules about that coverage.

Justice Anthony M. Kennedy, often the swing vote on the court, wondered whether Medicaid created accountability problems because the federal government set the rules but the states operated it.

The court’s more liberal justices expressed surprise that the expanded program, financed largely with federal money, was at all questionable on constitutional grounds. Read more…