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Supreme Court Hearings On Health Care Reform Begin With Tax Rule Debate

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Members of the U.S. Supreme Court waded Monday into the constitutional challenge to President Barack Obama's controversial health care overhaul.

The hearing, which lasted just under 90 minutes, was the first of three days' worth of proceedings to determine whether justices will hear the case regarding the Patient Protection and Affordable Care Act.

Passed by Congress in 2010, the legislation aims to provide health insurance to more than 30 million uninsured Americans.

While protesters outside the Supreme Court focused on the heart of the issue before the judges, whether it is constitutional to require citizens to get health care or be penalized, inside the court arguments focused on whether the mandate should be considered a tax.

If a 19th-century law in called into play, it would bar the court from hearing challenges to the law until it goes into effect in 2014, when the penalties would be first implemented.

"That it's being applied or if it's being collected in the same manner as a tax doesn't automatically make it a tax," said Supreme Court Justice Stephen Breyer.

Much of the justices' questions echoed Justice Breyer's comment, giving many the impression, including the attorneys general representing the 26 states challenging the law, that the court will be prepared to deal with the constitutionality issue this year, rather than putting it off until April 2015.

"It looks like we will be able to clear that hurdle without much of a challenge so we will be able to get to the heart of the matter, which involves the individual mandate," said Texas Attorney General Greg Abbott, a Republican.

Those in support of the health care overhaul would also prefer for the case to be resolved this year.

"It's like turning an aircraft carrier. If we're going to do it we need to know ahead of time, we need years of notice," said Dr. Cameron Page, a Beth Israel physician. "At my hospital if we're going to make changes based on this law we need years ahead of time. I want to know in the next few months if this law is going to stand or fall."

Some say the justices' questions, specifically Samuel Alito's, do not bode well for the Obama administration.

"Today you're arguing that the penalty is not a tax. Tomorrow you're going to be back and arguing that the penalty is a tax," said Alito.

"What they're going to argue tomorrow is that they can, under the commerce clause, do this as taxing power, yet Monday they clearly argued it was not a tax," said Florida Attorney General Pam Bondi, a Republican.

All eyes are watching the outcome, which as presidential candidate Rick Santorum said outside the Supreme Court on Monday, will have far-reaching political implications.

"This is the most important issue in this election. It's one that encapsulates all the issues that are at stake," Santorum said.

On Tuesday, the court will hear arguments over the individual mandate, which requires Americans to buy or get health insurance through their jobs starting in 2014 or face a penalty.

On Wednesday, lawyers will debate whether the rest of the law can take effect even if the mandate is declared unconstitutional.

The court will also hear arguments over whether the law goes too far in making states expand Medicaid by threatening to cut off federal aid if they do not comply.

A decision is expected in late June.

There is no television coverage in the court, but audio recordings of the arguments are being posted each day online at ClientIP:, UserAgent: CCBot/2.0 ( Profile: TWCSAMLSP