An RWJF Scholar Shares Lessons Learned - Inside and Outside the Courtroom - When the U.S. Supreme Court Considered Health Reform

Apr 2, 2012, 12:00 PM, Posted by


In my view, the Patient Protection and Affordable Care Act (PPACA) is the single most important piece of health care legislation since the Social Security Act in 1964. Many others disagree. But few would argue that it’s also the most controversial. Since the law passed in March 2010, there has been an onslaught of legal battles to determine its constitutionality, especially the individual mandate and Medicaid expansion. These legal battles cumulated at the Supreme Court last week. The Court has given this case unprecedented time and attention, dedicating six hours of oral arguments over a three-day time frame.

Given the historic nature of the Supreme Court hearings and my own personal and professional interests in not only the case but also the implementation of the law, I found myself sitting in line at 7 pm the night before the first day of hearings, prepared to sleep on the sidewalk to secure a seat inside. I anticipated being kept company all night by other policy “nerds” or political strategists. However, I quickly discovered that, with few exceptions, the people in line had little interest in the case, but rather in the money they would earn holding a spot in line for those willing to pay.

Line holding is a booming business in Washington, D.C. and there are several companies that will provide these services to busy professionals for a fee of $35 to $50 an hour. Although there is no official oversight to the line, there were many owners and managers of line companies who were intent on maintaining its integrity. They kept detailed schematics of everyone’s place.

The actual line holders were much different than the sharp, aggressive businessmen managing the line. Most are homeless, rounded up from various shelters and paid as little as $5/hour to stay in place. They are not provided with food, water or blankets, and are generally not permitted to leave the line.

I found it challenging to sleep that night. I do not know if it was the excitement of the oral arguments, my direct view of the Capitol from my folded lawn chair, or the cold strangeness of being outside, but I found myself awake until dawn. To pass the hours, I spoke to several of the men and women surrounding me and I listened closely to their conversations and behaviors. Everyone I encountered was courteous and kind, both to each other and to me, offering to watch my belongings when I went to the bathroom or got up to stretch.

Some had been homeless for many years, some were employed and using this as an opportunity to earn extra money, all were African American. There were none, including a pregnant woman, who had health insurance or access to care. When we talked, they often asked insightful questions about the PPACA, including why my colleague and I, as nurses who had insurance, would care so much about the people who didn’t. They were interested in learning why this case was so important and how the law might impact them and their families.

I observed people walking by who made derisive comments about the line sitters, including: “These are exactly the kind of people I don’t want to pay for.” As the morning came, I watched as the media seeking opinions about the case systematically ignored the line sitters, as if they could have nothing to contribute to the discussion.

My long night of sitting paid off and I was honored to get a ticket, and with it the opportunity to go into the Supreme Court. The proceedings inside demonstrated the gravity of the issue being considered. It was truly a once in a lifetime experience, and the Supreme Court lives up to its grandeur and dignity. However, sitting in line was one of the most profound experiences of my life. It drove home the reason I work so hard for equal access to health care and why that fight is so important.

The line sitters I met that night are from a different world than mine, but nonetheless deserving of care and consideration. As providers and policy makers, we must keep them on our minds as we move forward in the journey, no matter what the Supreme Court decides.

The RWJF Nursing and Health Policy Collaborative at the University of New Mexico is helping prepare a new generation of diverse, PhD-prepared nurses to meet the nation’s health policy challenges.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.