Health Care Act Upheld

The Sixth Circuit Court of Appeals ruled in Thomas More Law Center v. Obama that the government can require a minimum amount of insurance for Americans. It is the first ruling by a federal appeals court on the constitutionality of the individual mandate for insurance coverage. The lead plaintiff, based in Ann Arbor, MI, argued that the “Patient Protection and Affordable Care Act” was unconstitutional and that Congress overstepped its powers when it imposed a penalty for failing to comply with the mandate. The individual plaintiffs contended that if they do not purchase health insurance and are forced to pay a tax, it would go into the general fund where it could be used to fund abortions. They object to being forced to contribute to the funding of abortions.

The District Court for the Eastern District of Michigan at 720 F. Supp. 2d 882 (2010) dismissed the claim that the minimum coverage provision is unconstitutional. The 2-1 ruling by the Circuit Court, written by Judge Boyce F. Martin, appointed by former President Jimmy Carter, and joined by Judge James L. Graham, appointed by former President Ronald Reagan, affirmed the lower court saying “Congress had a rational basis for concluding that the minimum coverage provision is essential to the Affordable Care Act’s larger reforms to the national markets in health care delivery and health insurance.” The ruling went on to say:

No matter how you slice the relevant market — as obtaining health care, as paying for health care, as insuring for health care — all of these activities affect interstate commerce, in a substantial way. Start with obtaining medical care. Few people escape the need to obtain health care at some point in their lives, and most need it regularly… Congress could reasonably conclude that the decisions and actions of the self-insured substantially affect interstate Congress.

In choosing how to regulate this group, Congress also did not exceed its power. The basic policy idea, for better or worse (and courts must assume better), is to compel individuals with the requisit income to pay now rather than later for health care…Call this mandate what you will — an affront to individual autonomy or an imperative of national health care — it meets the requirement of regulating activities that substantially affect interstate commerce…

Does the Commerce Clause contain an action/inaction dichotomy that limits congressional power? No — for several reasons. First, the relevant text of the Constitution does not contain such a limitation. To the extent “regulate,” “commerce,” “necessary” and “proper” might be words of confinement, the Court has not treated them that way, as long as the objects of federal legislation are economic and substantially affect commerce. All three methods of paying for medical care (private insurance, public insurance and self-insurance) meet this modest requirement. And if Congress may prescribe rules for some of these methods of payments, as plaintiffs seem to agree, it is difficult to see why these words prohibit it from doing the same for all three….

Second, the promise offered by the action/inaction dichotomy — of establishing a principled and categorical limit on the commerce power — seems unlikely to deliver in practice. Level of generality is destiny in interpretive disputes, and it remains unclear at what level plaintiffs mean to pitch their action/inaction line of constitutional authority or indeed whether a workable level exists.

An appeal of the ruling to the full circuit court to review the case is likely as is review before the US Supreme Court.

The BLS Library has in its collection Patient Protection and Affordable Care Act by CCH (Call #KF6276.6201 .A2 2010b) which has the full text of the Act. Earlier this year, Brooklyn Law School debate “Is ‘Obamacare’ Unconstitutional?”
featured Professor Nelson Tebbe, an expert in constitutional law, and Ilya Shapiro, Senior Fellow in Constitutional Studies at the Cato Institute and Editor-in-Chief of the Cato Supreme Court Review.