The Supreme Court has turned down the first preliminary challenge to President Barack Obama's healthcare overhaul.

The decision Monday to reject an appeal from a former Republican state lawmaker in California was no surprise because a federal appeals court has yet to consider the case. The high court almost never reviews cases before the issues have been aired in lower courts.

Of more significance is the sign that all the justices took part in rejecting the appeal. New Justice Elena Kagan refused to say during her confirmation hearings whether she would take part in the court's deliberations over the healthcare law. Kagan was Obama's solicitor general before joining the court.

The court has noted Kagan's absence in more than two dozen other cases, suggesting that she voted on the healthcare appeal.

Kagan has stepped aside from cases in which she was involved as a Justice Department official before joining the court.

Justice Clarence Thomas also apparently voted on the case. Some critics have called on Thomas to step aside from the healthcare cases because his wife, Virginia Thomas, has been an outspoken opponent of the law in her role as founder of the conservative advocacy group Liberty Central.