Health Reform and the Constitutionality of the Individual Mandate

Abstract

The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to health care for virtually all legal U.S. residents. A vital but controversial provision of the ACA requires individuals to maintain health insurance coverage or face a tax penalty—the individual mandate. We examine the constitutionality of the individual mandate by analyzing relevant court decisions. A critical issue has been defining the “activities” Congress is authorized to regulate. Some judges determined that the mandate was constitutional because the decision to go without health insurance, that is, to self-insure, is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating “inactivity,” that is, compelling people to purchase insurance when they otherwise would not. The U.S. Supreme Court is set to review the issues and the final ruling will shape the effectiveness of health reform.

Keywords

health reform Affordable Care Act Constitution individual mandate Commerce Clause nursing

Get full access to this article

View all access options for this article.

References

Baldwin v. Sebelius, 3:10-cv-01033 (CA9 2011).

Barnett

R. E.

(2010). Commandeering the people: Why the individual health insurance mandate is unconstitutional. NYU Journal of Law & Liberty, 5, 581-637.

Complaint, State of Florida v. U.S. Department of Health and Human Services, 780 F. Supp. 2d 1256 (N.D. Fla. 2011).

Cordray

M. M.

Cordray

(2004). Philosophy of certiorari: the jurisprudential considerations in Supreme Court case selection. Washington University Law Quarterly, 82, 389-452.

Gibbons v. Ogden, 22 U.S. 1 (1824).

Gonzales v. Raich, 545 U.S. 1 (2005).

Hall

M. A.

(2011). Commerce Clause challenges to health care reform. University of Pennsylvania Law Review, 159, 1825-1872.

Heart of Atlanta Motel v. United States, 379 U.S. 241 (1964).

Huhn

(2011). Constitutionality of the Patient Protection and Affordable Care Act under the Commerce Clause and the Necessary and Proper Clause. Journal of Legal Medicine, 32(2), 139-165.

10.

Jost

T. S.

(2011). Can Congress regulate “inactivity” (and make Americans buy health insurance)? New England Journal of Medicine, 364, e17.

11.

Liberty University v. Geithner, 753 F. Supp. 2d 611 (W.D. Va. 2010).

12.

Liberty University v. Geithner, WL 3962915 (CA4 2011).

13.

McCulloch v. Maryland, 17 U.S. 316 (1819).

14.

Mead v. Holder, 766 F. Supp. 2d 16 (DC 2011).

15.

New Jersey Physicians v. Obama, 2:10-cv-01489 (CA3 2011).

16.

Oberlander

(2011). Under siege—The individual mandate for health insurance and its alternatives. New England Journal of Medicine, 364, 1085-1087.

17.

Pauly

M. V.

Danzon

Feldstein

Hoff

(1991). A plan for “responsible national health insurance.” Health Affairs, 10(1), 5-25.

18.

Perez v. United States, 402 U.S. 146 (1971).

19.

Printz v. United States, 521 U.S. 898 (1997).

20.

Purpura v. Sebelius, 3:10-cv-04814 (CA3 2011).

21.

Rosenbaum

(2010). A “broader regulatory scheme”—The constitutionality of health care reform. New England Journal of Medicine, 363, 1881-1883.

22.

Seven-Sky v. Holder, 1:10-cv-00950 (CADC 2011).

23.

Smith

P. J.

(2011). Federalism, Lochner, and the individual mandate. Boston University Law Review, 91, 1723-1747.

24.

State of Florida v. U.S. Department of Health and Human Services, 780 F. Supp. 2d 1256 (N.D. Fla. 2011a).

25.

State of Florida v. U.S. Department of Health and Human Services, 648 F. 3d 1235 (CA11 2011b).

26.

Thomas More Law Center v. Obama, 720 F. Supp. 2d 822 (E.D. Mich. 2010).

27.

United States v. Comstock, 551 U.S. 274 (2010).

28.

United States v. Lopez, 514 U.S. 549 (1995).

29.

United States v. Morrison, 529 U.S. 598 (2000).

30.

Virginia v. Sebelius, 728 F. Supp. 2d 768 (E.D. Va. 2010).

31.

Virginia v. Sebelius, 656 F. 3d 253 (CA4 2011).

32.

Wickard v. Filburn, 317 U.S. 111 (1942).